HIMSS: EHRs make post-Katrina success story of small diabetes clinic
ORLANDO, Fla.—EHRs can make it possible to impact population health for diabetic patients and provide patient specific counseling for this condition, according to K.C. Arnold, ANP, an adult and acute care nurse practitioner at The Diabetes Center, who made the Feb. 22 presentation on the topic at the 2011 annual Healthcare Information and Management Systems Society (HIMSS) conference.
The Diabetes Center, a nurse practitioner-owned and -led practice in Ocean Springs, Miss., has sought to establish benchmarks for optimal diabetes care through EHR and medical device integration. Its owner, Arnold, the first nurse practitioner HIMSS Davis award winner, lost her job of eight years at an endocrinologist clinic several days after Hurricane Katrina hit on Aug. 29, 2005. She officially was laid off on Oct. 10, 2005. Within days, she had decided to take a loan against her home to open her own diabetes clinic.
However, due to the storm, many problems arose. There were no phone lines for four weeks, but she was able to link from a physician’s server to her own to gain internet access. Despite the geographic adversities, their personal server was up and running by Oct. 31, 2005, when Arnold uploaded the software. On Nov. 1, 2005, she opened a clinic with one nurse employee—three weeks after losing her job.
Determined to go “paperless or bust,” Arnold knew she had to more comprehensively learn the billing process within an EHR, as she had only used the scheduling and the charting system at her former practice. She also noted that for non-patient-related inter-office communications, the employees most often used AOL instant messaging service.
“Helping patients with diabetes was the driving force behind all my determination to get this accomplished,” Arnold said. “Plus, due to the post-storm healthcare upheaval, I had a pretty good niche.”
EHRs have made it possible to impact population heath (treating patients 13 years and older) and provide patient-specific counseling, according to Arnold. Some of the tools the technology provides are:
The Diabetes Center was one of the first outpatient clinics in Mississippi to access the local HIE. “This access has been tremendously helpful in finding out information on additional care received by new patients or existing patients,” Arnold explained.
Arnold credits the expanded use of the EHR and integrated billing system to drive practice efficiencies. As a result, the practice:
“Realize the importance of leveraging technology to facilitate care coordination through medical device integration and patient portal access,” she advised the audience.
For device integration, the staff is downloading blood glucose meter device data when the patient presents to the receptionist. The data are uploaded in PDF format directly into the EHR, so provider can review information with the patient during the exam. Additionally, the clinic is starting to track patients with continuous monitoring systems, with the patient having the ability to download sensor data at home or in the physician’s office.
Arnold said that she has seen a return on investment for her EHR with a virtual server. With the $25,000 initial capital from her home loan, she paid $7,575.75 for the EHR software (licenses for providers, users and enterprise), $3,967.56 for the hardware (local servers for EHR, images, etc.) and $ 5,589.67 for EHR user devices (PCs, tablets, laptops, scanners, upgrades to existing PCs, etc.). For the current interfaces (labs, PM system, devices, hospitals, etc.), she pays $600, as well as yearly EHR and EHR-related software maintenance/support fees of $1,599 and yearly formulary fees of $240.75. To keep up with training and technical support, Arnold reported paying more than $5,000 annually.
However, she sees a return on investment through a growing practice. Also, Arnold mentioned not having the additional costs incurred annually for prescription pads, transcription or maintaining a physical patient chart. Also, she requires fewer employees to manage records.
To the audience, she suggested that practitioners visit other medical practices using EHR technologies for best practices, and encouraged her fellow care givers to share their health IT experiences.
The Diabetes Center, a nurse practitioner-owned and -led practice in Ocean Springs, Miss., has sought to establish benchmarks for optimal diabetes care through EHR and medical device integration. Its owner, Arnold, the first nurse practitioner HIMSS Davis award winner, lost her job of eight years at an endocrinologist clinic several days after Hurricane Katrina hit on Aug. 29, 2005. She officially was laid off on Oct. 10, 2005. Within days, she had decided to take a loan against her home to open her own diabetes clinic.
However, due to the storm, many problems arose. There were no phone lines for four weeks, but she was able to link from a physician’s server to her own to gain internet access. Despite the geographic adversities, their personal server was up and running by Oct. 31, 2005, when Arnold uploaded the software. On Nov. 1, 2005, she opened a clinic with one nurse employee—three weeks after losing her job.
Determined to go “paperless or bust,” Arnold knew she had to more comprehensively learn the billing process within an EHR, as she had only used the scheduling and the charting system at her former practice. She also noted that for non-patient-related inter-office communications, the employees most often used AOL instant messaging service.
“Helping patients with diabetes was the driving force behind all my determination to get this accomplished,” Arnold said. “Plus, due to the post-storm healthcare upheaval, I had a pretty good niche.”
EHRs have made it possible to impact population heath (treating patients 13 years and older) and provide patient-specific counseling, according to Arnold. Some of the tools the technology provides are:
- Built-in teaching tools, including Krames guidelines;
- Storing individualized insulin regimens in Word documents within the record;
- Printed copies of these regimens and health summaries for the patients, with nonmedical terms, stating activity and medication goals for the patient;
- Tracking labs with flow sheets;
- Better tracking and flowing of labs with HL7 interface; and
- Mississippi health information exchange (MSHIE) access for labs and visits.
The Diabetes Center was one of the first outpatient clinics in Mississippi to access the local HIE. “This access has been tremendously helpful in finding out information on additional care received by new patients or existing patients,” Arnold explained.
Arnold credits the expanded use of the EHR and integrated billing system to drive practice efficiencies. As a result, the practice:
- Has grown from one employee to five employees in five years.
- Does not use paper charts, except in the rare case of one-page summary for emergencies.
- Utilizes taskman messages for patient phone communications.
“Realize the importance of leveraging technology to facilitate care coordination through medical device integration and patient portal access,” she advised the audience.
For device integration, the staff is downloading blood glucose meter device data when the patient presents to the receptionist. The data are uploaded in PDF format directly into the EHR, so provider can review information with the patient during the exam. Additionally, the clinic is starting to track patients with continuous monitoring systems, with the patient having the ability to download sensor data at home or in the physician’s office.
Arnold said that she has seen a return on investment for her EHR with a virtual server. With the $25,000 initial capital from her home loan, she paid $7,575.75 for the EHR software (licenses for providers, users and enterprise), $3,967.56 for the hardware (local servers for EHR, images, etc.) and $ 5,589.67 for EHR user devices (PCs, tablets, laptops, scanners, upgrades to existing PCs, etc.). For the current interfaces (labs, PM system, devices, hospitals, etc.), she pays $600, as well as yearly EHR and EHR-related software maintenance/support fees of $1,599 and yearly formulary fees of $240.75. To keep up with training and technical support, Arnold reported paying more than $5,000 annually.
However, she sees a return on investment through a growing practice. Also, Arnold mentioned not having the additional costs incurred annually for prescription pads, transcription or maintaining a physical patient chart. Also, she requires fewer employees to manage records.
To the audience, she suggested that practitioners visit other medical practices using EHR technologies for best practices, and encouraged her fellow care givers to share their health IT experiences.