HIMSS: Smaller practices just as capable of achieving meaningful use
| Slideshow | What Does the Future of the Ambulatory Practice Look Like in a Post-ARRA Era? |
| A. John Blair, III, MD President, Taconic IPA  |
By way of the American Reinvestment and Recovery Act (ARRA) the government has taken a stance in support of EHR adoption across physician practices.
Looking ahead to the future and envisioning what a practice would look like after EHR implementation in 2015, Blair co-presented an educational session entitled “What Does the Future of the Ambulatory Practice Look Like in a Post-ARRA Era?” along with Karen Bell, MD, senior vice president of health IT at Masspro.
While EHR implementations within a larger physician practice will bring forth different issues than that of a smaller practice, Blair said that both settings will have to learn new software and re-design existing processes. However, he noted that the different healthcare settings will have different levels of administrative and IT support, which will play a significant role in terms of whether or not EHR impementation will be successful.
“If you look at practices of 100 to 200 physicians, those groups may have an IT staff of 10 to 30 people and may have administrative staffing that allows them to almost do the implementation themselves,” noted Blair. “It’s different from a two-physician practice that might have a family member running the office and not even a full-time nurse employed. With this very skeletal infrastructure, these smaller groups have a different set and more extensive needs.
While larger groups may have the required infrastructure and expertise, they need help in refining both, noted Blair.
“When you move from a paper system, you don’t want to digitize your current process. You want to take the opportunity to re-engineer your practice to develop efficiencies, improve and coordinate care delivery, while bringing the patient more to the center of care,” he said.
Once the large healthcare setting refines patient care, then the practice can be digitized with that in mind, said Blair.
Smaller practices on the other hand, said Blair, will require a great deal of help understanding appropriate goals and setting expectations, as well as granular support and instruction at all levels. On an IT, hardware and networking level, making sure their system stays up and running may prove to be a challenge when implementing an EHR system.
“It’s a completely different level of IT service,” explained Blair. “The practice needs to consider about availability, uptime and response time. You have to find a way to really get to the smaller provider and provide different avenues to do the training that meets them where they are.”
Blair stressed that the implementation process should be considered ongoing, citing the need to revisit practices six to eight weeks following implementation, which may not end until several years down the line.
While smaller providers may have more initial obstacles to overcome for EHR implementation compared to larger providers, Blair said that smaller settings will not have any harder a time than their larger counterparts as long as adequate training and support has been administered.
“It can be done if the providers are motivated,” reassured Blair. If there is no leadership in the practice or if they have unrealistic expectations then they will never make it. But any practice can do this, any size.”
In terms of infrastructure, a transformation must occur within the primary care setting, starting with the conventional 15-minute office visit.
One concept that is currently being tested via a nationwide pilot program is self-management support, or coaching roles within the primary care setting. “Some patients that need an hour, and some need 15 minutes,” explained Blair.
As of now, Blair said that registered nurses are being considered for these “care coordinator or case manager” roles. These coaches have several responsibilities, including visiting with the patient before and after a doctor visit. The first visit could consist of medication reconciliation, while during the post-visit, the coach could further explain to the patient anything that went on during their visit with the physician, provide the patient with educational material and/or make sure they understand if or why any medications have been changed.
Blair noted that these roles are important as approximately 50 percent of patients do not understand what happened during their doctor visit.
“I think that [the coaches] will have more of a personal relationship with sicker patients and more of a supervisory role with some of the other patients,” theorized Blair.
In addition, Blair believes that patients must be thought of as a decision maker along with their physician. “[The patient] is part of the team,” he said. “They have to understand what’s going on and the provider’s team has an obligation to ensure that.”
In order for both the technological and infrastructural transformations to be feasible, Blair noted that additional funding and reimbursement is necessary.
“I think if you have the reimbursement reform and the incentives there, and you give the tools to the motivated practice, it’s imminently feasible,” he said. “Now if you don’t change reimbursement and you don’t pay them or give them the tools, than it’s infeasible.”