Toby Sadkin, MD is Executive Committee Chair at Primary Care Health Partners, a group of eight primary care offices located in Vermont and upstate New York. She is also the managing partner of PCHP’s Vermont offices, and the recipient of MGMA’s 2014 Physician Executive of the Year Award. PCHP uses version 11.4.1 of the Allscripts Touchworks EHR, GE Healthcare’s Centricity Group Management (fka Groupcast) PM system, and Microsoft Office. It employs 165 clinical and ancillary staff, which collectively see an average of 470 patients per day.
Given that you have been overseeing EHR implementations since 2007, how have you seen that process change?
Our EHR implementation team has become more experienced and has developed a good, efficient process for training new users and for periodically updating and reviewing with current users. We continue to face challenges of periodic system errors, slowness, too many “clicks,” and the glitches (and expense) that come with upgrades and hot fixes.
Overall, our group embraced the move to the EHR and we try to use the system to its full advantage. However, we continue to struggle with some of the ongoing frustrations mentioned above. In some ways, we have lowered some of our expectations to try to tolerate the things we don’t like, trying to balance them against the many advantages of the EHR. All of our physicians and NPs are participating in Meaningful Use. At this time, some are in Stage 1 and others are in Stage 2.
In terms of workflow, what types of technology do you feel have had the most positive impact with regard to physician satisfaction and patient outcomes?
The EHR has made many significant, positive impacts. To name just a few:
- The ability for multiple clinicians and staff to view and use the same chart at the same time.
- The ability for the physician to access records remotely.
- Electronic prescribing (keeping accurate and up-to-date medication lists with built-in interaction checking).
- The ability to track quality measures for a multitude of chronic diseases and recommended health screenings.
- Quick and easy access to references and patient education material.
- The use of portals as a method to communicate with patients.
How do you feel about the current state of interoperability (or lack thereof)?
PCHP has capability to communicate among our own offices. There is currently not much for functional interoperability among different EHRs. We try to get by with interfaces for labs/results, but these are expensive and have been variable with reliability. We look forward to comprehensive interoperability among different EHRs, which will allow even better care for patients, giving physicians all the available clinical information regardless of where the services were rendered and eliminating unnecessary duplication of diagnostic tests. Very recently, HIE has become available for our region, and so PCHP is in the early stages of working through the logistics and hoping it will prove to be successfully functional.
Has your organization encountered any healthcare IT implementation challenges in the last year? Do you anticipate implementing any new technologies within the next year or two?
PCHP worked hard to be sure to get the necessary EHR update in order to meet the requirements for Meaningful Use, and also to be able to meet all the measures for high-level scores on our NCQA/patient-centered medical home recertifications. This required significant investment into hardware, software, and training. We continue to struggle with the right decision regarding disaster recovery/business continuity, as the best solutions are cost-prohibitive.
At the same time, the physician partners in PCHP have decided to do a full re-assessment of our EHR and want to compare to several other EHRs. To that end, we have a work group that will be doing this evaluation, thoroughly evaluating the advantages and disadvantages , and making a recommendation of whether to stay with our current EHR or to take on the daunting project of going through a conversion to another system.
What implementation best practices can you share with other providers?
It is important to have a dedicated EHR team, with representation that includes a variety of perspectives and expertise (We have administration, implementation staff, physicians, nurse, and IT). Our team started meeting from the time we made the decision to move to an EHR (eight years ago) and has continued this regular meeting schedule. This team guides all the decisions related to the EHR, takes in feedback and suggestions form the users, and keeps all the users informed with regard to any changes, system upgrades, and workflow recommendations. A combination of administration, IT, and implementation staff make up a help desk team that users can reach out to for troubleshooting.
Even as our group begins the process of reassessing our EHR and considering a possible change in systems, we are cautious to remember that in contemplating such a change, the grass may not be greener – just different.