Electronic Health Records

Adoption & Implementation News

Miami Valley physician discusses EHR adoption

By Patrick Ouellette

- Though Dr. Brian Zimmerman, M.D. at Miami Valley hospital in Ohio, has already achieved Stage 1 Meaningful Use without much of a hitch, he still has a unique outlook on what works and what doesn’t for meaningful use. In this Q&A with EHRIntelligence.com, Zimmerman reviews how EHR adoption went for his hospital, Stage 1 challenges, concerns about Stage 2 Meaningful Use and why Dragon’s voice-recognition software has paved the way for more effective use of EHR at Miami Valley.

Have you attested to meaningful use? How did it go?

We have. You know, it really wasn’t that bad. We’ve been up on EHR since 2006 so we had a lot of lead time. Most physicians [at Miami Valley] were pretty nervous initially to make the jump – we were all paper and traditional transcription documentation. We were nervous about the transition but now we’re doing everything electronic and we surveyed our docs, and I don’t think there’s anyone that would want to go back to the old paper way. So I think [they have] gained an appreciation of the benefits of an EHR.

What were some EHR adoption challenges?

We really didn’t anticipate several things. One was the printers – the volume of printing that would happen from the EHR. So when a patient is discharged, they need to have a summary of care printed out for them. And we had some printers that were fairly high volume, but we didn’t expect all these people firing off large packets of paper to the printers. Interestingly enough, the printer weren’t separating the print jobs. When we were starting attestation, all these documents were interspersed with patients from other rooms – it was a nightmare. It took about 2 weeks to handle the volume of information heading their way.

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A lot of us were really concerned about order entry as well. Because in the past with paper charting, the providers would just scribble out some orders, put them in the rack and they were done. But we were really worried about having to enter the information into the computer. The EHR at our hospital is Epic and I’m sure a lot of the EHRs are the same, but they’ve made the ordering fast for providers. Now there are order sets that with a couple of clicks that I can have a whole panel of orders ordered instantly and those orders, instead of going into the rack like they used to, they go to the departments they were intended to go. So I can be talking to a patient in the room, place their order and have the radiology department come knock on the door before I leave the room. That’s an area where I think EHR has brought significant efficiency to the processes we were used to.

What would you say to those who believe that EHR and meaningful use aren’t worth the money for healthcare providers?

In talking to some other physicians, there are many physicians that feel the cost savings is going to the hospital and the hospital is paying a lot of money to install these systems, but a lot of the money that’s going back in reimbursements is going right to the hospital. And so I think there’s the feeling that a lot of the benefits aren’t going to be realized by them. And I think that a lot of providers feel in some ways that the EHR makes them less efficient, which means less patients and potentially less revenue. That’s a real palpable feeling among providers.

I’m a proponent of EHR and was asked to be one of the physician champions of our Epic deployment and I’ve seen both sides of the coin. I can see some areas that physicians are concerned about but at the same time there are a lot of benefits that come with it, like added efficiencies that I think will help patient care in the long run.

I will be the first to say that providers are concerned about meaningful use and the level of require elements and processes that are asked of providers because the more they ratchet this up, the less efficient the providers are going to become and it’s going to reach a boiling point. We’ve already seen that in the pushback for some of the elements they had. If we continue to push, it’s going to increase frustrations providers are experiencing.

Do you think some of the problems that healthcare providers had with Stage 1 were hashed out in Stage 2?

I don’t think [Stage 2] is going to be that much of a problem, but some of the things that they’re adding or did add are a little bit concerning. One of the biggies that I’ve seen was that in Stage 2, the patients need to be provided a summary of care and one of the requirements was that 5 percent of patients need to be able to access that online for you to be able to achieve that measure.

I think that’s pushing it too far and I know several providers have raised their eyebrows at that one. Because it’s one thing to ask your patients to do things and encourage them to do them, but to tie my success in Stage 2 Meaningful Use to the patients’ ability to do that…I’ve heard someone say that physicians are now becoming like cheerleaders. We have to recruit them and encourage them to do this and make they access the record online so we can achieve meaningful use. It’s crazy.

I think if you push too hard [with Stage 2 Meaningful Use], I think you’re going to end up hurting medical care and doing the opposite of what was intended. Looking at some of the things that they’re adding, one of them is secure messaging. Where are you going to go with that? Are you going to require the providers to answer messaging? I just don’t know. A lot of us are concerned and a lot of us thought this was one of the curious additions to Stage 2. Like having patient copies of the EHR available, if you start requiring patients to do 10-15-20 percent of record retrieval online and tying that to reimbursement, I think that’s going to raise frustration. They’re over-reaching what was intended with patient safety etc…

How do you approach clinical documentation during meaningful use attestation?

We use Dragon natural language processing (NLP) technology. When we first went with EHR, our providers were really worried that most EHR, when you go in to the note or some type of documentation, you have to use some type of point-and-click method to enter in things like the history of present illness or their physical exam. And when our providers saw that, they really did freak out and said that it was going to make them so inefficient. So we wanted to figure out some way to speak into the chart so we could dictate into the EHR. Dragon not only types the words that you say, but does voice commands. And in our estimation, that was one of the biggest thing, because I can take a multi-step process in the EHR and create a voice command out of it so that it automates that whole process.

Another provider and I created about 2,000 commands that work in our EHR and the providers love it. I can say, for instance, sign my chart and Dragon will click the sign button and scroll down a couple windows, it will type a special phrase in another window and click the accept button in a single command. So in our estimation, it’s significantly improved our efficiency in the EHR.

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