Spring, Progress vs. Perfection in EHR Meaningful Use Adoption

As the crocuses, daffodils, and hyacinths begin to bloom here in the Northeast, I like to think about what has contributed to the growth of these beautiful plants. We have had a very mild winter here in New England, including some record-breaking warm weather. Perhaps it was the plant fertilizer I used last fall, giving these flowers the nutrients needed for the early bloom. Regardless, these blossoms will need the (much-needed) April showers to help them flourish with spectacular spring colors of tulip gold, azalea red, and purple magenta for a true Mayflower.

Last week, I visited my primary care physician, a small practice with three doctors and two physician assistants typical for my state of Connecticut. I had a case of poison ivy that I received during my zealous early gardening. I wound up with poison ivy due to a gardening technicality. I remembered to wear my gloves, but they weren’t long enough.

During my visit, I went through the typical check-in procedure with the medical assistant, and then, one of the physicians entered the room. Something was different: this time she had a laptop with her. I thought to myself… WOW — some progress after my many discussions with them.

After she took a look and confirmed I had poison ivy, we discussed my practice’s journey to adopt an electronic health record and meaningfully implement the technology into the practice. She told me she preferred the free EHR system the practice used, since it allowed her to free text her notes into my electronic chart, and it is quicker.

This physician also uses another larger commercial EHR system in a large group practice she covers for on weekends. She does not like this other EHR system as much because it makes her click through many, many “useless” screens, resulting in more work to document patient visits.

I asked her if the free system allowed her to ePrescribe my prescription to my local pharmacy (a large pharmacy chain here in the Northeast). She said yes, and I suggested we try it for my visit.

I left the practice and drove to the pharmacy 10 minutes away. I pulled up to the drive-in window to be advised the script had not yet been filled. I waited another 15 minutes (good thing Starbucks is next door), and my prescription was ready. The pharmacy had received the prescription, but had not filled it due to staffing; the second pharmacist did not begin until 9 a.m. that morning.

This scenario reminded me of what I learned in school: it takes people and process to make technologies work efficiently. The electronic prescribing process took the same amount of time, from my perspective, as the old paper process.

My patient experience also reminded me that while health IT and EHR technologies are not perfect, we have made some progress. Three years ago, my practice could not find my chart, then in the basement of the practice. Now, at least, they had my electronic chart to reference for my visit and note of my drug allergies.

This gardening experience followed my trip in February to Las Vegas for HIMSS12. I heard the keynote presentation of Farzad Mostashari, MD, ScM, National Coordinator for Health Information Technology within the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. He updated the audience on the status of the Meaningful Use program:

  • 46,000 EHRs have “gone live” since the start of the program
  • $920 million in Medicare EHR Incentive Program payments paid from May – November 2011
  • $916 million in Medicaid EHR Incentive Program payments paid from January – November 2011
  • 39 states have Medicaid EHR incentive programs, and 23 states are making Medicaid EHR payments

ONC has asked us all to continue working with physician practices and eligible hospitals on achieving Meaningful Use of electronic heal records. ONC also has set a goal to have an additional 100,000 eligible providers using electronic health records by the end of 2012.

I have concluded that gardening is not perfect, and yes, you may get some poison ivy along the way; still, the time, effort, and energy you put into it will bring some beauty into your life and that of others.

The time and effort to help our providers is worth a safer and efficient healthcare system… Hence, I ask all of you to join me and bring the water to our garden and make it prosper.


One response to "Spring, Progress vs. Perfection in EHR Meaningful Use Adoption"
  • April 21, 2012
    Arvind Cavale

    Dear Mary,

    This is the first time I have heard somebody from the “IT world” actually agree, albeit subtly, that “meaningful use” cannot be standardized, like CMS would make us believe. So, congrats on taking the first step.

    A couple of take home messages from your experience at the PCP’s office and Pharmacy, that you should further explore…

    First, why does your doctor like the free EHR as compared to the expensive one at another practice?

    Second, why do you think your pharmacy was not ready with your script even when the Rx was sent electronically?

    I would love to read your answers.

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