A Model For Her Peers
In 2005, Dr. Jennifer Brull figured that she needed to get on board with health IT, even though it might be expensive and difficult for a family physician in a rural Kansas solo practice. A younger physician with whom she was collaborating suggested that having an EHR was the wave of the future, and would likely be a necessity going forward. She also had a practice-sharing arrangement with another physician, who was older. He wasn’t as sure, said Dr. Brull in an interview.
Courtesy of Kathryn Mayes, Everyday You Photography
Dr. Jennifer Brull
But they moved ahead and spent 3 years selecting, buying, and implementing an EHR system that they could all use, said Dr. Brull, who practices in Plainview. She took out a loan for $50,000 to buy the equipment; her colleagues contributed to the software and other costs.
Because they practice in a rural area, there was no possibility of using a web-based model; broadband access in her area is still not robust enough, said Dr. Brull. So she has a server onsite at her office, and recently purchased a second server for $3,000. The net cost so far has been about $30,000 per physician, Dr. Brull said.
The first 6 months were a challenge, she said. "Anytime you do something that’s a complete paradigm shift, it’s hard. It’s hard mentally to think about all those changes, hard physically because you’re investing more time and effort, and hard emotionally because your staff gets freaked out."
In addition to allowing the practice to meet meaningful use criteria, the system also has a patient portal. The physicians are preparing to be able to participate in the state’s health information exchange.
Dr. Brull said that she disagrees with physicians who say that adopting an EHR interrupts the workflow or comes between the physician and patient.
"I’ve found it easier to be more collaborative [with my patients]," she said. One example: She recently used an EHR-generated graph to show a patient that she had gained 40 pounds over 3 years. The graph made much more of an impression on the patient than Dr. Brull could have done by reading numbers off a paper chart, she said.
"This whole project has resulted in dramatic quality improvement for my practice," Dr. Brull added.
Another example: She implemented a quality measure on breast cancer screening. Just by having a flag in the EHR, she went from screening 50% of patients to almost 100%. "Having the data at your fingertips makes you aware of where you do a good job and where you don’t," Dr. Brull said.
In April, Dr. Brull collected the full Medicare incentive payment for 2011. Her colleagues weren’t ready, but that didn’t matter. Physicians can choose to attest to meaningful use on their own time frame, regardless of where their colleagues might be, she said.
Dr. Brull has become an evangelist for the power of the EHR and meaningful use. She was chosen to speak at a CMS press conference announcing the first round of Medicare incentive payments. And she is a member of the regional extension center in Kansas. The ONC also named her a "MUVer" – someone who serves as a local leader and adviser.
The Reluctant Adopter
Dr. Michael Machen is one of the physicians who consulted with Dr. Brull. He practices with four other family physicians in nearby Quinter, Kan. (population, 980). The impetus for taking on an EHR came from his younger partners, Dr. Machen said in an interview. They were also motivated by the meaningful use program, and got started in July 2010.
One junior partner became the EHR champion, doing much of the legwork to find appropriate vendors and systems. The physicians also attended seminars and webinars offered by the Kansas Medical Society and the Kansas chapter of the AAFP. A team from the regional extension center visited their practice too, Dr. Machen said.
They borrowed $75,000 to purchase hardware and software. The biggest cost is the $2,000-$4,000 they spend monthly on IT support – a necessity when there is no one with such expertise in the practice or locally. The IT help comes from more than an hour away. Dr. Machen and his colleagues house the server themselves; broadband is no better in Quinter than it is in Plainview.
Dr. Machen said that the younger physicians have all done well with the system, but he is struggling.
"I’m not technically inclined, and I have very little computer knowledge," he said.