Portal/EHR Interoperability: One Practice's Struggle
After going live with its patient portal in March, the 12-physician Carolina Family Practice & Sports Medicine (CFP&SM) has had measured success linking up 2,800 patients via the portal. Compared to its 40,000 patient population, the number of patients who have used the Intuit Health (Cary, Calif.) portal is rather small; however, the practice has done little advertising since CFP&SM can only reasonably handle 300 to 500 new patients a month, according to Aaron West, CFP&SM operations manager.
“We want to stay out front in medicine and be innovative and dynamic in the way we provide service and care to our patients in our community,” says Josh Bloom, M.D., a physician at CFP&SM.
CFP&SM, which has two locations in Cary and Raleigh, N.C., practices family medicine, with 35 to 40 percent of their practice dedicated to sports medicine. Currently, patients can schedule and cancel their appointments, ask staff questions, and fill out online health history questionnaires on the CFP&SM portal. The next phase of the portal will be communicating lab results and offering patient education. In the future, West sees the portal as an avenue for e-visits and a way to allow patients to fill out a subjective history to save time during office visits.
PORTAL/EHR INTEROPERABILITY CHALLENGES
CFP&SM was an early adopter of electronic health records (EHRs), when the practice began with Practice Partner seven years ago, before it was acquired by San Francisco-based McKesson in 2007. West admits to making some mistakes in implementation along the way because his team couldn't foresee what the future held for healthcare technology. CFP&SM still deals with a good deal of paper, which include faxes, which are scanned as images into the EHR; patient referrals; and some paper billing.
The main challenge that CFP&SM faces is patient portal/EHR interoperability. The physicians now have to cut and paste information from the Intuit portal into the McKesson EHR. “I think there's a lot of movement to bridge that gap, but we have a ways to go,” West says.
West also notes that efficiencies haven't been realized because of the disconnect between the portal and EHR, and only once these disparate systems are linked, can efficiencies be measured like reduction in waiting time, as well as time saved with refills, scheduling, and billing. “The reality of our situation is pretty frustrating with the difficulty in getting these various components of an EHR to talk to each other,” says Bloom. “It's tremendously expensive, and it's been cumbersome. We love the Intuit product and yet we can quite get the portal to connect easily.” Bloom adds that with low-margin specialties like family practice, efficiencies are even more important to recognize. “We've looked at other EMRs, and every one of them is imperfect,” he says.
DIFFICULTIES WITH DATA MINING
Another area that Bloom and his colleagues have difficulty with is mining data through their EHR. They currently do manual chart review using billing and diagnosis codes. Of the practice's 12 providers, eight have been recognized by the National Committee for Quality Assurance (NCQA) for heart/stroke and five have been recognized for diabetes care. West notes that even generating a list of patients with specific conditions like diabetics and heart/stroke and accurate patient registries is a challenge. “Some of the EMR challenges that were prohibitive for getting recognized for heart/stroke were because we couldn't query our data very well, but I feel like we'll probably get to that by the end of the year,” he says.
West and Bloom are both confident they will reach meaningful use; however, they are waiting for the new release of the McKesson EHR to get them where they need to go. They have started e-prescribing, but still need to electronic order entry and health information exchange (HIE). They are concerned how they will achieve medication reconciliation, as well as provide timely access of health information and lab results to patients. But they see their patient portal as a big step to getting all this done.
Healthcare Informatics 2011 January;28(1):46
