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The history of that actually goes back
to my own clinic's adoption of electronic health records
in about 2001,
where this preceded a Meaningful Use program,
but where we, as a group,
got together and indicated
our interest and our commitment to working together
to try to improve quality
by using the best technology available.
We saw electronic health records becoming increasingly available.
We saw enough early evidence of their benefit
to quality, safety, and efficiency,
and we saw that it was the future of health care
with the Institute of Medicine report,
and we saw an obligation to our students,
our residents in training, and our patients
to try to use the latest technology
to help them with their health care needs.
Because of that, we decided to work together
to align our practices and to use the technology
so we would have the information we need
whenever we needed it to care for patients.
We saw this as an opportunity to improve patient care quality,
to help us with our own efficiencies,
and to help solve some of the top problems
we had in our clinic with our ability
to deliver high-quality care
in a timely manner to our patients.
So, to try to help make sure patients --
who, by the way, come first and whose needs matter most --
to make sure that their care needs inspires my work,
I stay connected to my patients
by seeing them on a regular basis.
I use electronic medical records
because they help facilitate high-quality patient care.
And I use the electronic health record every day in my work.
Having said that, I also see that my best ability
to help care for patients is through helping other doctors
provide the best care with all the tools
that are available to help them in that process.
So, whether it's patient-specific information
or whether it's medical knowledge information
from libraries and journals and other sources,
my job as I see it is to help bring that information together
to be best applied to the needs of patients
and populations in the here and now.
In terms of registering for Meaningful Use,
I think the biggest part was making sure
that you understand all the pieces that you need
to be able to register.
The CMS website, the health care, the HealthIT.gov site,
is very helpful.
The Meaningful Use final rule is fairly hard to read,
and so that has been a challenge traditionally,
but the Table of Contents document
on the various Meaningful Use measures
and how you translate the objectives into the measures,
the additional information needed,
and links to Frequently Asked Questions,
that's a very helpful document that I bookmark
for anybody who needs to know it on their browser.
Similarly, the consolidated
Frequently Asked Questions document
is a very helpful document to know
in one single source and one single site
all of the questions that have been asked,
and something that lets you
word-search for the question you're interested in
and anything about the answers.
So those are two really helpful sources.
I would suggest, for practices that would like
to jump into the Meaningful Use opportunity,
is to find a buddy and use the buddy system.
There are now enough practices out there who have done this
that can provide assistance and advice.
When it's hard to find a buddy, the Regional Extension Centers
are particularly relevant and helpful resources.
When an organization or practice
is part of a professional society,
it often has experts in that area.
I think most physicians, just like they consult
with other physicians when they need help,
like to be able to turn to a physician colleague and say,
"So, how did you do that?
Do you have any slides that you can share with me
to make it real, to make it easy for me to see what I need to do?
And do you have any advice for how I should use my EHR
to be able to do this right?"
Because most people want to do it right.
So getting help basically
is finding somebody that you consider an expert,
and then having them help you along the way.
Patients, in general, and certainly in my experience,
are very happy with the fact
that physicians are using technology to inform care,
and particularly information technology.
They especially like it
when they're a participant in the process, which means
they can see the work that you're doing on the computer,
and you're orienting them to their health information
and anything required to help them make a decision.
So, for example, the patient
with diabetes and high blood pressure
and maybe smoking and maybe some weight issues
who can see the impact of their current issues on their health
and can start to see the care that's needed,
that hasn't been delivered yet,
or the impact that improvements in health behaviors
could have on their expected outcomes,
is very, very powerful, and it also allows you
to talk about the thorny aspects of care --
a medication's side effect,
making sure people understand how they're supposed to
take their medications or do their exercise.
That opportunity for conversation
by having the information resource in front of you
is very much like having
the floor plan or a blueprint to a house
when you're talking to the person
who's going to help you build the house
to make sure everyone understands
and that everybody ends up with the outcome they're looking for.
We actually saw, interestingly enough,
a cost of about $44,000 per physician, FTE,
to implement the EMR in its first year.
But we saw an approximately $63,000 savings
due to efficiencies and improvements
in various aspects of the cost of delivering care.
So, for us, it was a reinforcing principle to say,
"If you invest in the technology
to that amount, you can expect, if you work together,
if you strive to achieve appropriate use --
which, when the Meaningful Use requirements came out,
actually looked very, very close to the same expectations
that were in the Meaningful Use regulations.
So, for us, it was a small process of adjusting
the way we were using the EMR
to make sure that all those elements counted.
But it was easy to see the business benefits,
which reinforced the quality benefits,
and fulfilled our hope in the early days
that this was not only the right thing to do for quality,
but that it actually might improve
our practice's financial health.
It helped us with care coordination,
it helped us implement a patient portal
so we could communicate with our patients.
It helped us with some of the interfaces we needed
to be able to make sure information was flowing,
and again, happened to align quite nicely
with what turned out to be some of the core
menu and quality measure components
of the Meaningful Use regulations.