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First-Day Attestation: Barbara Watkins, R.N.

April 26, 2011
by Mark Hagland
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While some of the patient care organizations completing the meaningful use attestation process on April 18—the first day on which attestation of the fulfillment of the stage 1 requirements for MU under the Health Information Technology for Economic and Clinical Health (HITECH) Act was possible—were hospitals, there were also medical groups completing the process as well. Of course, technically, medical groups don’t have a formal role in the process—only their “eligible providers” (physicians and some mid-level professionals) can apply for and receive the stimulus funds.

But of course, it is physician group administrators and IT leaders who are guiding their “eligible providers” every step of the way. One such medical group in which attestation has been successful is the six-physician Heart & Vascular Center of Arizona in Phoenix. There, Administrator Barbara Watkins, R.N., has helped lead her six cardiologists through the process of preparing for attestation, which they completed on April 18 and 19.

Watkins spoke with HCI Editor-in-Chief Mark Hagland this week regarding his organization’s attestation last week. For its electronic health record, the Heart & Vascular Center of Arizona uses the Centricity system from the Chalfont St. Giles, U.K.-based GE Healthcare.

Tell us about your organization.
We’re a six-physician cardiology practice, including interventional and non-interventional cardiologists, and one electrophysiologist. We have three main offices and two outreach offices. One of our doctors is actually a pilot, and flies to one of those offices once a month to see quite a few patients on that day.

How many patients are in your total portfolio?
In terms of active patients, we have somewhere between 15,000 and 20,000.

Though you certainly facilitated attestation at every level, don’t physicians technically have to attest individually?
Yes, we attested them all individually. Each physician registers uniquely him- or herself, and then you go in and attest for each, so you have to run reports for each doctor. I did it on the 18th and finished on the 19th. Part of the problem is that you’re constantly running reports to make sure you’re ready.

It’s a little different for a small group. We’re really very, very dependent on our vendor. Really, GE has pulled out the stops on the meaningful use reports; it’s a whole new bailiwick of reports we need to run to prepare for this meaningful use attestation.

What have been the challenges, and has anything been easier than you thought?
Well, I’m very proud of the physicians and of how they practice. I’m a nurse myself. And when I ran the first pass of the reports, I was really pleased, because they were meeting some of the goals without a blink of an eye, some of the requirements around things like CPOE [computerized physician order entry] for medication orders, and documenting drug-to-drug and drug-allergy interactions, e-prescribing, allergies, demographics, those demographic requirements. That was a kind of big hurdle. Ethnicity wasn’t something we normally had collected; we had collected race. But now, CMS [the federal Centers for Medicare and Medicaid Services] is not only looking at race, but also ethnicity. And vital signs are another area to cover; those are all examples of core measures.

And when I ran those reports—even smoking status, you want everyone to ask that question and to document—but are they really doing it? And they were! So I was very, very pleased. And when we reviewed the criteria in the fall for meaningful use and then actually got into the nitty-gritty of it, we analyzed all of the requirements together. And some things we’re already doing—we already have a patient portal, and are already exchanging data with patients in real time. But I’m not really getting credit for any of that in CMS’s eyes; because the patient has to request an electronic copy of their health information, whereas in fact, I’m already proactively providing it.

When did you begin the really active preparation?
During the fall, when they came out with the final rule, we began our planning; and then towards December, we started actively honing in on how we were doing things; and workflows were exceptionally important. You actually need to sit down with the physicians while they’re using the EMR. The EMR is a very powerful tool; and Centricity is an amazing product. And part of it is making sure the “obs” [observation] terms—that we were using the right ones, because the reports can pick up one term, while we might be using a different one. So that’s really an important exchange of information between our office and Centricity.