Topeka practices transition to electronic health records ; Records: Providers switching to electronic [Topeka Capital Journal (KS)]
(Topeka Capital Journal (KS) Via Acquire Media NewsEdge) Electronic medical records have been held out as a way to improve patient care, but getting to full implementation isn't an easy task, according to some Topeka practices.
Federal officials have discussed electronic medical records as a way to improve care coordination, so doctors can easily access a patient's information anywhere in the country. Implementation has been on a more modest scale so far, however, with most sharing involving affiliated hospitals and clinics.
Michelle Meier, administrator of Kansas Medical Clinic, 2200 S.W. 6th, said the practice is implementing a cloud-based system that is designed to combine patient health records and billing into what they hope will be a seamless system. At the moment, however, they have to focus on adjusting to the new system while providing care, she said.
For example, they keep a handwritten log of biopsies they send off, whether they have gotten results back and if the patient has been notified, Meier said. Eventually, that process will be computerized, but they need to make sure no biopsies are lost in the shuffle, she said.
"You really have to run parallel for a while," she said.
The switch also has been costly because they have to pay a retainer fee for technical support and have hired help to make sure they are meeting all of the Centers for Medicare & Medicaid Services' standards to get incentive payments, Meier said.
"We spent a lot and the incentives we get back will not cover anywhere close to it," she said.
About 2,930 medical care providers in Kansas have adopted electronic records and are using them in a meaningful way, qualifying them for incentive payments related to electronic medical records, said Rebecca Bailey, spokeswoman for the Kansas Foundation for Medical Care. Medicare and Medicaid have paid out $58.6 million in incentives in Kansas so far.
KFMC is working with about 1,600 priority primary care providers, Bailey said. Priority primary care providers work in small practices, community health centers, public or critical access hospitals or underserved areas. When that funding runs out, the providers who work with KFMC can still get help from Synovim, a nonprofit group created to provide technological help for the health sector.
Mary Monasmith, a health information technology consultant with KFMC, works with practices transitioning to electronic health records, including Meier's Kansas Medical Clinic. Issues they work with include helping to assess a practice's security risk and how to handle the need for technical support.
The first stage of implementation involves standardizing how patient data is collected and stored, Monahan said. The second stage involves changes to doctor and patient communication, such as setting up an online portal where patients can contact their doctors and get other information, she said.
Part of her role is to make sure they not only meet the goals they have to, but can document them to receive incentives, Monasmith said. For example, a doctor may hand a patient a pamphlet about managing their asthma, but if that isn't recorded, the practice may not get credit for providing patient education, she said.
"A lot of the providers may be doing the right thing, but if they're not clicking the right button they may not get credit for it," she said.
The two Topeka hospital systems, which began the transition process several years ago, pointed to benefits after full implementation, including reductions in the time it takes to transmit patient information from one doctor to another.
Sally Pierce, clinical informatics site manager for St. Francis Health, said St. Francis Hospital's records have been all- electronic since 2012. The clinics were on another system and could transfer lab results and medical images to the hospital, she said, but they are transitioning so they will be able to more easily transfer full records.
The interfaces have to be able to connect, and staff need to be trained on the new system, which takes three eight-hour sessions for some nurses, Pierce said. They are starting with the heart and vascular clinics and gradually moving to the others, she said.
"It's a huge transition to make," she said.
Electronic records have alerts if a patient is allergic to a medication the doctor has ordered, takes drugs that may interact with it or recently underwent a test the doctor plans to order, Pierce said. The system also can suggest medications or procedures that might benefit the patient, but the doctor isn't obligated to follow them, she said.
Doctors and nurses have to learn new ways to keep records, order medications and do other paperwork, but the goal is not to let the machine become the focus, Pierce said.
"You don't want to let the computer get in the way of the patient," she said.
Judy Corzine, administrative director and chief information officer for Stormont-Vail HealthCare, said the health system has had electronic records since about 2006, but in 2012 they switched all of the clinics to the same system to ease record transfers between them and the hospital.
Doug Rose, vice president and chief medical quality officer for Stormont-Vail, said the transition took several years because they had to set up infrastructure for the electronic records, train thousands of employees and give them time to adjust to each change, including adding staff or reducing doctors' appointment schedules so they had extra time to wrangle with new processes at the beginning.
"We try to take a realistic, humanistic approach that it's going to take some time," he said.
The system makes work faster because they no longer need to take time to transcribe handwritten notes, sometimes even using voice recognition software instead of typing, Corzine said. It also eliminated problems that could arise from unclear handwriting, she said.
They also have been able to customize the systems for the different clinics, Corzine said. Some parts of the software, like the modules for prescribing medications, are the same, but can provide a list of the drugs a specific doctor most often needs, she said. The workflow also can be customized as needed.
"What an oncologist needs and what a neurosurgeon needs and what a primary care doctor needs are very different," she said.
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