Dr. Nilesh Patel is a solo family physician at Millgrove Medical Center in Audubon, PA. On the road to EHR Meaningful Use (MU), his practice has been faced with many challenges but found ways to effectively resolve them and utilize the technology to improve patient care.
One of the primary challenges Millgrove Medical encountered was incorporating clinical lab test results into EHR structured data since specimens are sent out to an outside laboratory. To resolve this problem, Dr. Patel and his staff initially scanned all the paper lab results into their EHR then electronically filed them in a “Lab Result” folder. This process was cumbersome and an ineffective use of time since it was not fulfilling the criteria for MU. The data was available in both systems but had to be pulled from one system and manually incorporated into the practice’s electronic health record (EHR). “It was clear that we needed to streamline the process. Our EHR vendor worked with the Quest on an interface. This was a step-by-step process and we can now incorporate the labs directly into the EHR and use the data in a meaningful way,” said Dr. Patel. “The importance of incorporating the data was emphasized. The quality measure is now at a level above the minimum," reported Dr. Patel. "This was a time consuming effort since it involved outside vendors but one which has been worth the effort.”
Another challenge was medication reconciliation, which is an issue for primary care physicians overall since many patients routinely visit specialists and they are constantly changing/ deleting patient’s medications. According to Dr. Patel, “We are requesting changes and reconciling the medications at every visit. It is a time consuming effort but an important one, and with the help of our staff pharmacist, the process is being streamlined.”
Additionally, incorporating patient specific education resources into the practice’s EHR as structured data presented a technical challenge for Millgrove Medical Center. Patient education is an ongoing effort. Patients are constantly being educated in a variety of ways. Dr. Patel shared that on many occasions patient education is a practical effort, i.e. demonstration of an inhaler to COPD patients, demonstration of an insulin delivery device to diabetic patients, pre-printed calorie count sheets, demonstration of home blood pressure monitors, etc. “Often the patients are provided specific education resources in paper form to take home. The latter is particularly challenging since we have a large ethnic minority population (>48 percent) and delivering the information effectively can be time consuming with the added barrier of limited language proficiency,” said Dr. Patel.
The practice offers various patient education resources in different forms, such as dietary sheets in different languages. Dr. Patel reports that educating patients and measuring effective outcomes is attainable, however he feels that delivering this information electronically to the patients would probably not be as effective as verbal delivery and demonstration. “Language and comprehension of electronically delivered material is questionable in the ethnic groups. In the majority of cases this is a practical effort and we envisage it as one being the most challenging to measure and deliver via EHR technology. EHR scores may be low and do not reflect the ongoing effort to educate all groups of patients,” said Dr. Patel. Millgrove Medical has implemented best practices within the office as well as utilizing outside resources, such as Diabetic Education Classes, as a solution to this problem.
As a result of increased efforts around patient education, Millgrove Medical has been very successful in controlling and monitoring blood pressure (>94 percent). The education outreach has played a role in this area because the data is numerical in value it is easily quantified with successful measurable outcomes. According to Dr. Patel, the challenge has been to incorporate all the data effectively since the majority of disease states do not exist in isolation and the EHR does not consider the issue of language barriers and the comprehension levels of the patients. Thus some parameters can be quantified more easily than others with high scoring outcomes while others may be as effective but the efforts are not reflected in a measurable outcome.
Thanks in part to the challenges encountered by Millgrove Medical Center on the road to MU, Dr. Patel shared that the practice has learned many valuable lessons along the way. “The transition to EHR and Meaningful Use is an evolving process. There are many pieces to the puzzle and the process involves putting the pieces together,” said Dr. Patel. He also said that effort is required from the patients since the MU measures place so much emphasis on prevention, wellness and maintaining a healthy lifestyle. “Patient education is paramount. The transition to EHR and Meaningful Use is inevitable, difficult and one which requires education and effort from health care providers and patients,” said Dr. Patel. While the MU goals can be achieved with valuable benefits and rewards, Dr. Patel shared that it is a time consuming process and places many constraints on the physician and the team as a whole. “Our accomplishments thus far can be attributed to the ongoing support and guidance from Peter Mercuri from PA REACH East. Their future support is going to be crucial if we are to continue on the road to successful Meaningful Use.”