At some patient care organizations, the road to attestation is bumpy with lots of learning experiences along the way. For Core Physicians, attestation was more like a trip down memory lane.That’s not to say the Exeter, N.H.-based multispecialty physician group didn’t have its struggles. It did, like any other groups have had. However thanks to its decision six years prior to implement an EMR, the organization didn’t have to start from scratch like many others have had to when it comes to implementing an EMR. In fact, the organization’s own minimum specifications on how the EMR will be used matched up nearly word-for-word with the government’s meaningful use Stage 1 requirements.As a result of coming prepared, Core Physicians completed its Stage 1 preparations at the end of August, and the group earned a total of $1.2 million from Medicare. Sean O’Neil, the vice president of organizational excellence at Core Physicians, recently spoke with Gabriel Perna, assistant editor at Healthcare Informatics, to discuss the process.
Sean O'NeilTell us about your organization.We’re a multispecialty group on the coast of New Hampshire. We have 36 offices spread out in that territory. We have 145 providers, 115 of whom are physicians; the rest are physician’s assistants, etc. We are affiliated with Exeter Health Resources, which is our parent company, which also owns Exeter Hospital and RVNA (Rockingham County Nurse’s Association).How many patients are in your portfolio?We see about 100,000 patients per year, of whom 60,000 are covered by our primary care doctors.Tell us about your attestation experience.I think what I can take away from our attestation experience was that it was an affirmation of a journey that we started six years ago by going onto electronic medical records. We decided with the patient as the center, that was the right thing to do. Anything that you have to attest to, we had been working on or had done already. Of the different criteria, we had met most of them already, because we started a long time ago thinking this was the right thing to do for our patients. We had already been doing things like e-prescribing, medication reconciliation, outreach, etc.So when the government mandate came down, it sounds like the transformation for your organization was fairly smooth? I’ve heard of organizations struggling with this, even with the NextGen Ambulatory EHR that we use [from the Horsham, Pa.-based NextGen Healthcare], but as I said, it was like a road trip that we had gone on. We were already headed that way. I think the biggest thing for us as far as workflow that we had to change was the document given to the patient when they leave on what happened during their visit, as well as what to follow up with in terms of medication, what they started, what they stopped, etc. The beauty of that was our board of directors said this is something we should be doing two years before the federal government said this is something you should be doing. The hard part was being on the appropriate upgrade track with our vendor, NextGen EMR. And also reporting on if we're doing something or not was a little hard. But overall, it was not a big struggle.How long did the actual attestation process take?We started in June, and by the end of August we were done. I don’t want people to think it was ho-hum. There was a lot of background work, lots of work with upgrades, and lots of IT work had to be done. But this was not like unwrapping it on day one for us and saying we got to get there right now, which I know some people are trying to do — implementing an EMR to get to meaningful use.What were some of the other challenges of attesting early?One of the struggles early on was there was no great interpretation of what the federal government means when they say such and such. You have to work through that process. Also, there was the challenge of finding data within the EMR. These EMRs allow you to place data wherever you want and streamlining that was a big workflow challenge for us. It’s a matter of figuring out where’s the best place to put data in terms of workflow for our physicians.Speaking of physicians, what was the best way for your organization to get them on board?They all attested individually; we did all the legwork for them for the most part. But the biggest part was the physician leadership and the buy-in we got from them. They just pointed out how important this was to patients. Take away the fact that there’s some dollars attached to meaningful use, because I’ll be honest the dollars achieved per meaningful use are a small percentage of what we’ve had to invest in an EMR over the past five to six years. It’s about putting the patient in the center, and when the patient leaves, they have a full record of everything that went on. Physicians are there to take care of patients, so if you can explain to them what this is all about — and that’s what we truly believe — the buy-in is simple.How have they responded to the EMR implementation?I think any EMR implementation at first will be difficult. It does slow the physician down. Everybody likes change; they just don’t like the change. But I think if you ask them now, would you go back to a paper record, they’d say no because they see the benefit of what an EMR can do, how we can mine data, how we can find people who may have otherwise slipped through the cracks as far as their healthcare is concerned.What advice would you give to an organization attesting now or in the future? You have to understand it’s about the meaningful use of an EMR, and not just having an EMR. I think you have to get away from, “Oh we’re on the right version” and figure out what that’s going to happen to the workflow and how workflow will be enhanced. Also, the end user is critical, make sure they are bought in and understand why you’re all doing this. We never talk about dollars associated, it’s just, is this right for the patient, yes or no? There’s nothing in meaningful use that isn’t for the patient. If you keep that in the forefront, you should get by it and it will be a little less painful.How optimistic are you feeling about Stages 2 and 3? Very optimistic; I think our numbers are way above the threshold for Stage 1 right now. Depending on what Stages 2 and 3 look like, I think we will be ready. Because of our leadership, we’re in a good place to go forward.
