As federal officials strive to define "meaningful use" of electronic health records, Sam Lederman, M.D., offers a simple prescription. "Meaningful use means it somehow will improve patient care," says the managing partner of Palm Beach Obstetrics & Gynecology, a two-site group practice in Lake Worth, Fla.
When Lederman talks about meaningful use of EHRs, folks should listen. The practice, with five physicians, a nurse practitioner, a nurse midwife and about 20 staff members, was a winner of the 2008 Nicholas E. Davies Awards of Excellence for achievements in use of information technology, particularly EHRs. The Healthcare Information and Management Systems Society in Chicago administers the awards program.
Used effectively, EHRs improve care in many ways, Lederman says. "You can see patient data much better because you have an updated face sheet always in front of you. That gives you a lot of good information that is buried in the chart. It's a basic history you can use every day."
He also likes embedded decision support that automatically analyzes patient data to search for statistically high risk of specific diseases. The EHR, for instance, can flag a patient being treated for a yeast infection who is at high risk for breast cancer and should have a mammogram scheduled. More Benefits

For three years, Palm Beach OB/GYN has been using an integrated practice management/electronic records system from Carrollton, Ga.-based Greenway Medical Technologies Inc.
The practice took about seven months to complete its migration from paper to electronic documentation because of the need for staff training. Within three months of going all-electronic, however, the return on investment started to show.
"You're not so busy any more," Lederman explains. "If there are a few staff members who resign, you don't really have to replace them. Those were the people running around looking for medical charts."
In addition to saving on labor with less personnel and overtime, the practice is making more money because better coding leads to higher reimbursement. Consequently, the physicians are making more money, with Lederman taking home 10% to 15% more.
But the biggest benefits are intangibles, such as lower stress because of fewer errors and higher morale. "The best benefit is an improved work environment. It's much more satisfying to go to work," Lederman says.
All that said, migrating to EHRs is tough work, and clinics just starting in hopes of qualifying for Medicare/Medicaid incentives by 2011 have some challenging times ahead, Lederman cautions. Getting the job done in two years will be difficult, he adds.

Hard Slog

The benefits of EHRs are the reward for a very difficult transition period, Lederman cautions. He calls adopting EHRs "the hardest thing I've ever done in my professional life."
Setting up the decision support is one of the toughest tasks and requires a physician champion, he adds. "The vendors are good at writing code, but they're not practicing medicine." So the champion has to customize templates and functions. And that requires getting others in the practice to meet for several hours two or three times a month for many months.
Once various EHR functions, such as computerized physician order entry, are up and running, a practice will need to make more tweaks to fix glitches or address workflow issues. Sometimes, for instance, Lederman decides to order an ultrasound but forgets to actually place the order until someone else notices the omission. "You need a lot of people looking out for each other."
Billing problems also can arise. If a clinician orders an ultrasound, the test typically is done in house and the staff bills for it. But some imaging tests, such as mammograms, are referred to other facilities "and you have to make sure you're not billing for it," Lederman says. "Those are the little things that they don't teach you." This piece was originally published at healthdatamanagement.com. For more on group practices, visit healthdatamanagement.com/portals/group_practices.html

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