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5 Questions With Pediatrician Ashley Moss, MD

Ashley Moss, MD is founder of Ashley Moss Pediatrics (MD), and vice president of the Montgomery Pediatric Medical Society. She opened her house call-based practice in January 2017, and now sees three to five patients a day.

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What prompted you to launch a house call-focused practice?

I wanted to create a practice that was highly personalized and offered the best quality medical care for my patients. After working in a large traditional practice for nine years, I felt that the trend toward larger practices had hindered my ability to connect with my patients, and provide the continuity and individualized care that I felt was imperative to providing high-quality medical care. I had heard about similar house call-based practices in New York, California, and Texas and so I investigated and decided that not only was this type of practice feasible, it seemed like a really powerful model that could leverage new technology to improve healthcare quality, convenience, and outcomes.

What types of healthcare technology do you use on a daily basis?

I use an EHR that enables me to write notes while seeing patients in their home, email prescriptions to pharmacies, send lab orders and receive results.  I also use an electronic fax that interfaces with my Practice Fusion EHR.  I rely heavily on creative mobile devices that I can easily bring to the homes of patients. For well child check ups where vision and hearing screens are required, I use a handheld mobile device to perform visual acuity, photoscreening, and hearing screens.  The visual screening device then faxes the screening results to my EHR so that the vision screens are easily integrated into the chart. Finally, I use an online direct care practice administration platform from Hint Health that streamlines the signup process and billing for my patients.

What health IT is on your wish list?

I am considering purchasing a temperature monitor for my vaccine refrigerator that remotely monitors and records the temperatures inside my vaccine refrigerator and freezer. It also immediately alerts me by cell phone when either the refrigerator or freezer temperature is out of range. Currently, I keep handwritten temperature logs for the refrigerator and freezer.

I am also considering different telemedicine companies that would enable me to examine patients remotely via a virtual exam room. I’d like these telemedicine programs to interface more efficiently with my EHR; when I find one that does, I will probably decide to make that investment.

Are you participating in any type of value-based payment program?

I don’t participate in value-based payment programs as defined by insurance companies. I do provide my patients with high-quality medical care that is research- and experience-based, and delivered with genuine concern for each child’s wellbeing.

What are your thoughts on the role new business models like yours play in reducing physician burnout?

These models play a tremendous role in reducing physician burnout! Direct patient care practices enable physicians to do what they love and enjoy, which is establishing meaningful relationships with patients so that they can effectively care for them in a financially transparent manner. Physicians can keep patients healthier, provide better medical care, and avoid costly ER or hospital admissions when they know each patient individually. Both physicians and patients are happier with the delivery and quality of the medical care.


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Jenn, Mr. H, Lorre

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5 Questions with Dermatologist Stacia Poole, MD

Dermatologist Stacia Poole, MD employs four at her independent practice in Melbourne, FL. She attested for Stage 2 of Meaningful Use last year as a DrChrono end user.

How is your practice using health IT to improve care? How has its use evolved over the last several years?
Health IT applications are useful in our medical practice to track metrics and historical patient information, as well as for maintaining medication lists, sending electronic prescriptions, and enabling secure electronic communications with patients. Our EHR vendor is continuously refining and improving the features of its program to facilitate practice efficiency.

How have your patients embraced the use of technology as part of their care? Do they ask about apps, portals, etc.?
Unfortunately, in my geographic location and with my older patient demographics, there is a steep learning curve with regard to use of the portal and other patient-accessible features of the EHR. A limited number of patients take advantage of the patient portal, and those who do seem to find it convenient and easy to use. However, we do spend time with our patients walking them through the check-in process and helping them input their information or transferring their information for them into the EHR. I find that I do not use it as fully as I could, because of the limited number of patients who show an interest in utilizing that method of communication. I’m sure our experiences in a small town in Florida may differ greatly from those in a technologically more savvy part of the country or in a practice with younger demographics.

What are your thoughts on the role of telemedicine in dermatology practices?
Telemedicine is an emerging utility in my field. I believe its use in my area is still rather limited. I do believe that this will become a popular option for care in some capacity in the near future, but I foresee some difficulties in carrying out fully electronic consultations. Some features that are clinically useful to aid in diagnosis of skin conditions cannot be fully appreciated via electronic media – for instance, texture and subtle variations in color and thickness of lesions. This could result in less accurate diagnoses or potential delays in appropriate treatment. I have not yet taken the initiative to incorporate this technology into my practice but would consider doing so in the next one to two years.

How do you anticipate this administration’s policies will impact your practice’s ability to provide care?
It’s very difficult to predict the changes that we are likely to see in healthcare delivery and healthcare policy, but certainly the primary role of government and private insurers to determine what constitutes good quality care is troubling. The concept of “pay for performance” is an extremely difficult standard to define, let alone to implement. The numerous performance metrics outlined, many rather arbitrary, demand tremendous time on the part of the physician and the staff, and detracts from resources that should be directed toward face-to-face patient care and interaction. This is a very frustrating, as assuredly the time and effort required to complete these functions does not translate to an equivalent value to the patient in terms of increased quality of care.

Somewhere along the line there has been a decision that more information is better, but certainly it is not helpful to see page after page of non-critical data reflected in a medical record. A concise, to-the-point account of a patient’s symptoms, findings, diagnosis, and treatment plan needs to be displayed in the medical record, and it should be the physician, not the insurance company or an administrator, who decides what information needs to be collected in order to formulate this plan. Medicare requirements, protocols, and audits are actually more difficult to navigate than the ACA at present time, and unfortunately, this is not a focus for legislative change.

What health IT innovation has you excited? What’s on your health IT with list?
I would be excited to see more practical ways of digitizing, cataloguing, and tracking photos of patient lesions. I would also be very enthusiastic about the ability to have more control over customization of EHR format and features to suit the needs of individual providers and specialties.


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Jenn, Mr. H, Lorre

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5 Questions With Jon Challen, Director of IT, Atlanta Gastroenterology Associates

Jon Challen is director of IT at Atlanta Gastroenterology Associates. Seven hundred staff members care for 1,300 patients on a daily basis across the practice’s 40 locations in the metro Atlanta area and North Georgia. The practice, which uses Greenway’s EHR and MyHealthRecord.com’s patient portal, has attested for Meaningful Use for each of its physicians for the last four years and plans on participating in MIPS. “We feel we are well-positioned to submit 90 days of data,” Challen says, adding that automating data flow for such initiatives has been an ongoing initiative. AGA signed on to GaHIN – Georgia’s statewide HIE – earlier this year in an effort to connect the organization to a wider network of providers.

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What was the impetus for connecting to GaHIN? What value/benefits do you hope to realize from plugging into the HIE?
Our physicians have long desired better integration of data with hospital systems. However, given the large number of hospitals we work with, setting up individual interfaces with each hospital was unwieldy. GaHIN provided an opportunity to share data with multiple hospitals and other healthcare providers with a single connection. We hope that our participation in GaHIN will simplify data sharing between providers, reduce unnecessary duplication of testing, and allow us to provide better and more cost-effective patient care.

Did you encounter any IT hiccups along the way? How did you overcome them?
Any kind of interfacing or data sharing comes with its share of challenges, but our integration with GaHIN was one of the smoothest I have experienced in my career. The team at GaHIN and Truven are complete professionals and have a great deal of expertise. Additionally, vendor support from Greenway was top-notch. The team at Greenway had recently completed a similar integration with Truven in another region of the country. This integration provided a template for both parties to follow, which greatly simplified the process of AGA integrating with GaHIN.

You added pediatric care several years ago. Did you have to alter your IT systems in any way to accommodate the needs of your younger patients? If so, did your EHR vendor assist, or did you go out to the market to look for new tools? What did you end up implementing?
Fortunately, Greenway has a great deal of experience in pediatrics, so beginning to care for infants, children, and adolescents went very smoothly, and no additional software was needed. Internally, we have deployed a number of pediatric-specific documentation templates for our pediatric physicians to use. Greenway was an ideal partner for this new venture.

As a large practice, what would you say your biggest challenges are right now – health IT or otherwise?
The consolidation in healthcare over the past few years has created a lot of IT challenges. The growth we’ve experienced here at AGA, both organically and through acquisition, has been astounding. Keeping up with that growth is always a challenge, and we have strived to bring new providers and practices into the AGA fold as quickly and seamlessly as possible. I feel we’ve been very successful at this, but each new provider and acquisition brings with it different challenges relating to IT systems, especially regarding data integration.

Aside from connecting to GaHIN, what health IT projects are underway?
We are constantly looking for ways to improve process efficiency and provide better patient care through the use of technology. We just launched a Direct Access Colonoscopy program, which includes a patient-facing informational website and questionnaire to determine if a screening colonoscopy is appropriate for the patient. It allows the patient to schedule a very important screening test for colon cancer, all from the convenience of any Internet-enabled device. It’s available at www.screen4coloncancer.com. We’re also currently testing a comprehensive, patient-focused self-scheduling portal that will allow patients to schedule an office visit with any of our physicians without requiring a phone call.

What advances in healthcare technology are you excited about right now? What’s on your HIT shopping/wish list?
The current trend of wearables in technology has amazing promise for healthcare. Patients are now wearing devices that monitor vital signs and other data constantly. Tying this data into existing healthcare systems and having the capability to analyze the data for physicians in a meaningful way is very exciting. It is an opportunity to improve patient care in very big ways!


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Jenn, Mr. H, Lorre

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5 Questions with Cara Farooque, Practice Manager, Craft Behavioral Health

April 11, 2017 5 Questions With No Comments

Cara Farooque is practice manager of Craft Behavioral Health in Northeast Florida. The provider of outpatient psychiatric and therapy services employs, in addition to Farooque, one full-time psychiatrist, five part-time psychotherapists and two front-desk staff to care for a highly variable rate of patients. “Our therapists set their own schedule,” Farooque explains, “so some days there are four of them on site in addition to the MD; other times, it is just one. Many of our patients are dependent on public transportation, so weather also has a large impact on our no-show rate. The beginning of the month, when everyone who gets paid on a monthly basis receives their paychecks, is generally quite a bit more busy than the end.”

The practice has spent the last year backing up all of its paper charts and transitioning to Kareo’s EHR and billing platform. “Our clinicians seem pleased so far,” Farooque says, “and the crossover between EHR and billing is seamless. One of our major focuses now is making sure that all patients have follow-up care and remember their follow-up appointments. Culturally, this is sometimes a challenge, as things exist in a ‘here and now’ context rather than in a ‘week from now.’ The automated follow up emails, texts, and calls have made a huge impact on our no-show rate.”

When it comes to federal programs, CBH is in the process of transitioning from Meaningful Use to the Quality Payment Program. Quality measures have already been implemented, as well as some of Advancing Care Information and Improvement activities. A full roll out/transition is expected by April 15.

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How has healthcare technology helped to improve patient access and outcomes since the practice launched in 2010?

I am encouraged just by the QPP measures versus the MU Standards. The QPP measures are actually selected by us, and have meaning to us and our practice. Patients can access selected portions of their charts through the patient portal. The reminders have helped improve our no-show rate and helped patients stay compliant with their medication.

Are you encouraged by the increased focus the industry seems to be placing on using health IT to better integrate primary and mental healthcare?

Currently, the industry is focusing on primary care and preventative medicine. With the new leadership and the proposed changes, I’m afraid we may see some drastic changes and people who finally got coverage as a result of ACA are going to be right back where they were before – underserved and uncovered.

What challenges do mental health providers face when it comes to finding and adopting healthcare technology?

Always vetting the security. What exactly does “HIPAA compliant” mean? I read an article recently that basically said “HIPAA Compliant” wasn’t worth the paper it was printed on. Everyone claims they’re HIPAA compliant yet no one has a standard definition for it yet.

What advice can you offer other mental health practices when it comes to selecting and implementing healthcare technology?

Do your research, check with other providers, get what you need. Don’t think that because it is a standard EHR it can’t be tailored to fit a mental health practice. It is actually the best that way – you can either develop your own templates or work with the vendor to develop templates to suit your practice. Make sure they meet all documentation guidelines, and then the templates are uniquely yours.

What’s next up on your health IT shopping list? How do you hope that this will benefit your patients and staff?

I would love to upgrade all the computers, with all the scanning, eligibility checks, etc. If they don’t empty their cache several times they need to re-start. Upgrading everything from Win8 to 10. I think the facial recognition and fingerprint scanner would really give us another layer of security on both the patient and staff check-ins. Tablets – I would really like to go totally paperless for increased efficiency, as the form would upload straight into the EHR and we wouldn’t have any paper floating around as a potential HIPAA violation. That’s my wish list.


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Jenn, Mr. H, Lorre

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