Early Attestation in a Solo Physician Practice

So as long as you’ve offered a clinical summary to the patient and shown it to them on the screen, you’re OK?
Yes, that’s my understanding. And some of the functionality with meaningful use is not things we would use for a while. For example, our system is capable of sending information to the hospital, but they’re not quite ready for it yet; they’re just getting ready to implement their EHR. Right now, the lab is almost ready to send the clinical lab reports to us electronically, instead of faxing them. We do have that with LabCore; we get live data from them. One functionality we already use has to do with the availability of live flow sheets onscreen. You can tap on any part of the flow sheets while sitting in the exam room with a patient. For instance, if the patient wants to know what’s been going on with their blood pressure, the physician can show them a graphical representation of that, live, on screen, or can tap on the summary of their lab data and provide lab-related information to them in graph form.

When did you begin using the meaningful use dashboard provided by the Greenway solution?
I had really started when we upgraded, which was on January 3; that’s when the dashboard became active, and we could see whether what we thought was being saved, was being saved or not. For example, under medical reconciliation, I was getting a “0,” and so I called Greenway. Well, it turned out, we were a beta system, and that was just something that needed to be fixed. And in terms of lab results, I had to figure out where our numbers were off; you had to click this particular thing or that particular thing. The training took place during the third week of January. And I ended up with a start date of January 19, which ran through April 18, for the prescribed 90 days of testing, as we attested on the 19th.

Julie Childs (second from right, above) and her colleagues in the Childs Medical Clinic in Samson, Alabama, seized the opportunity to attest to stage 1 meaningful use within the first week that attestation was possible.

What’s Dr. Childs’ feeling about having gone through this?
Well, there are some areas where we felt we were very good, and some areas where we feel it’s just a matter of accounting for what we were already doing. He wanted to do this, and has learned anything that needed to be learned. And some physicians really don’t want to do that, and they can protest and protest, but eventually, if they’re not on electronic records, it will hurt them.

On a scale of 1-10, with 10 being the most difficult, where did this fall on that scale in terms of difficulty?
I’d give it a 3. [chuckles] Some things were a little bit difficult, and some were very easy. But every time I’d have a problem, I’d call the Greenway people, and they’d help me figure it out. I think a system’s only as good as its customer support, and theirs is very good.

But it does require a little bit of perseverance and a little bit of flexibility, right?
Oh, yes, and the whole office had to get involved. Let me give you one example of a little glitch that had to be fixed through engaging everyone. In the area of the clinical summary, one requirement is to have the “preferred physician” line filled out within the demographic information for each patient. Well, I hadn’t been putting down the preferred provider, as there’s only one eligible provider here! So I had never thought to do anything with that; but once I found out that that was the stumbling block, I made it a required field, so that the front office wouldn’t skip that click.

So a lot of it has to do with adjusting little process things?
Right. One requirement has to do with noting the ethnicity of each patient, which isn’t related to patient care, as far as I can tell—so it’s an added step among others that had to be done under meaningful use.

So the front office really had to be trained for this, too?
Right, everybody had to be trained for their part. For example, tobacco assessment had to be included; and it had to be done in a certain way—you have to click on “tobacco,” and select “current,” “former,” “never,” etc. And most of our patients are not smokers, but some are. And you had to put in there how many packs a day, etc. But if I left it as “non-smoker,” it would not pick up on the assessment. So the nurse had to make sure the proper link on “social history” was clicked. It was things like that.

How do you all feel now that it’s done for stage 1?
We’re still working on doing these things [completing required tasks] with our new patients. And this is an ongoing process; and once you do things for this year, you have to prepare for the next level.

When will the first payment come to you?
I think [the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program Web Portal] indicated four to six weeks. There’s a place on the website where we attested, for status. And we can look that up; it does show timeframe and all that.

What will be this year’s payout?
It’s $18,000. And I know what we’re going to do with it; we need a new floor in our building! And everybody will get a bonus.