Electronic Health Records

Q&A: EHRs, meaningful use bring efficiency, quality to Kaiser

Kaiser Permanente is the largest healthcare provider in California, and has never shied away from the front lines of EHR adoption and technological innovation.  As one of the major early adopters focused on improving the delivery of coordinated care, Kaiser’s emphasis on efficiency has been held up as a national model.  EHRintelligence spoke to Dr. Richard M. Dell, a Kaiser practitioner and member of the American Academy of Orthopedic Surgeons, to get his perspective on how EHRs and meaningful use have affected his specialty practice within the Kaiser system.

How much feedback have you received from CMS about your progress and the future direction of meaningful use?  How helpful has it been?

Kaiser actively prepared for meaningful use, and we proactively reach out to the government and tell them what things are important.  I think Kaiser and AAOS and others are really coming to realize that you have to sit down with CMS and others and say, “Look, we understand what you’re trying to do with meaningful use.  You’re trying to get us to use the EHR, and you’re trying to improve patient care.  How can we do this best with you?”  So it’s not an adversarial relationship, it’s something that’s patient-focused, and we all want to see the same thing.  We want better care for our patients, in a cost-effective manner, in a systematic manner.  And I think we’re moving closer and closer each and every day to the realization that we have to work together.

I get the sense that CMS is actively working to be better at communicating with us, too.  Because that’s what we have been missing.  Everyone wants to know the same thing: am I effectively managing my patients in a cost-effective way?  Am I constantly improving what I’m doing?  Am I doing the right thing?  Did I get the good outcomes?  Am I systematically closing all the care gaps in my patient population?  Am I doing something that’s different than the standard of care around me, and is that better or worse?

So you really need that feedback, and I get it every day that I practice medicine, just like everyone in medicine should be.  Because there will always be some minor variation in the way we practice medicine, and that’s probably a good thing.  You don’t want to have every single person doing exactly the same thing: minor variation is good, but major variation is bad.

Many specialists have had difficulty with the EHR Incentive Program and have complained about the guidelines being unclear.  Has that been your experience?

I think as specialists, we are being heard by the folks in Medicare.  We want to have quality measures and other factors in meaningful use that capture what we do, and make us want to adopt the EHR.  We have our needs, including really good communication between our clinic and our hospital, communication with other physicians so that we seamlessly move the chart, the x-rays, the labs, the pharmacy information, because that will help patient care, help our offices run more efficiently, and also just improve the quality of my life as a physician.  I’d rather be taking care of patients than looking for a piece of data that’s already been done.  So I think it would improve care and make my life better if we can knock down these barriers between one area and another.

The EHR Incentive Program took a 2% hit under sequestration earlier in March.  How do you think this is going to affect your practice and EHR adoption in general?

I’m not sure how sequester is going to affect the program.  I think there’s a tremendous amount of waste in the system currently, and I think the 2% is probably a starting point for Medicare to lower the costs.  I honestly do think it had to be done.  Medicare can’t just keep going forward and paying more and more and more.  There had to be something that proves to clinicians that they’re taking it seriously.  I don’t think that will be enough to actually decrease the quality of care.

I mean, if you look at the Affordable Care Act, the first word is about cost.  And if you look at the triple aim that’s built on, cost is in there, too.  We’ve run up the bill for healthcare delivery to a tremendous, unsustainable level, and with the huge number of people that are going to be coming into the system with the ACA, and the huge number of people coming into the Medicare population who will drastically increase the costs, we have to address that.  There’s no going back to the old ways.  If you don’t embrace the change, you’re going to be trampled by it.  Kaiser has embraced it.  We know these things are coming.

If anything, [sequestration] is probably going to improve cutting costs, and maybe get rid of a lot of unnecessary fat.  And I hate to say this, but even in the Kaiser system, I see some fat.  Not much – I think we’re leaner than most health plans, but there are still places to save money and do things more innovatively and at a lower cost.  Orthopedic surgeons as a whole are a pretty smart group of guys, and I think we’ll be fine.  We’ll rise to the occasion. I’m a very optimistic person, and I think we’re going to innovate our way out of the problems.

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