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Early Attestation in a Solo Physician Practice

May 3, 2011
by Mark Hagland
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How the Childs Medical Clinic in tiny Samson, Alabama achieved first-week attestation

Editor's Note: Following the publication of this article, Childs Medical Clinic announced on May 19 it had received its payments of meaningful use incentive funds within the Centers for Medicare and Medicaid Services (CMS) Stage 1 meaningful use Medicare incentives program.

Childs Medical Clinic received $18,000 for its attesting eligible professional (EP) Hayden Childs, M.D., having satisfied the 90-continuous days of meaningful use reporting merged with allowable tracking to achieve the incentives thresholds.

When Jule Childs, office manager in the Childs Medical Clinic in tiny (population 2,071) Samson, Alabama, says that her organization is a family affair, she really means it. The one physician in this medical practice, Hayden Childs, M.D., is her husband, while the practice’s one nurse practitioner is her sister-in-law. Later this year, the number of doctors in the practice will double, when a new physician will join the practice part-time: Jule Child’s niece’s husband. What’s more, Hayden Childs is the only doctor in this small town, whose sole facility affiliation is with Wiregrass Medical Center, a 67-bed hospital in nearby Geneva, and the only hospital in the near vicinity. (The Childs Medical Clinic has been operating since 2004.)

Yet despite the fact of the small scale and the relative isolation of the Childs Medical Clinic (Samson is located in far southeast Alabama, just a few miles north of the Florida panhandle), Jule Child and her eight colleagues in the clinic were determined early on to pursue meaningful use under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. And they’ve succeeded with regard to stage 1 of meaningful use, successfully completing attestation on April 19, the second day possible. In part, Childs says, her clinic’s success in attestation for stage 1 emerged out of the beta site status of Childs Medical Clinic for the latest version of the core electronic health record (EHR) solution from the Carrollton, Ga.-based Greenway Medical Technologies. Jule Childs spoke this week with HCI Editor-in-Chief Mark Hagland regarding her organization’s path forward on meaningful use and MU attestation. Below are excerpts from that interview.

How did you and Dr. Childs decide to go for meaningful use?
We bought the Greenway system before we ever opened this practice. And we have stayed on the cutting edge of the electronic health record since then; everything that comes out, I try for. We’re in a small town with a very poor population in a very poor part of the state, so anything I can do to be more efficient, I will do.

What made you decide to push ahead and go for meaningful use at this early stage?
Well, the money was there and available to anyone who would wish to pursue it. And we had an electronic medical record, and I knew we could do this. So I volunteered to be a beta site for PrimeSUITE 2011, which came out in January in the beta sites, and has just become available to the rest of the Greenway clients this month.

So you got a lot of help from Greenway?
Yes, we did, but it’s help that’s available to all Greenway clients. We have found that Greenway is extremely responsive; that’s why we bought Greenway—we were looking for the best product and service. The new update has a meaningful use dashboard, so I could click on that every day, since it would update every night, and it would tell me exactly where I was on each criterion. Greenway offered four training sessions in January, and Dr. Childs and I went to the training held in Las Vegas in January.

What were the biggest challenges in getting to attestation last month?
For us, it’s going to be a little different than for a larger practice. For us, one of the challenges had to do with the requirement to provide patients with clinical summaries at the conclusion of their visits. We’re in a poorer area, and most of our patients didn’t want them and didn’t want to carry around the print-outs. So I had to make sure we offered each patient their summary.

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.

I’m guessing that that still represents only a portion of your initial EHR investment?
That’s right; our first loan was for around $100,000, for the very first system, though that also included the necessary hardware, plus a monthly fee. Since then, by the way, we’ve added a website, and we have a patient portal, which I love; they can get prescriptions refilled and can schedule an appointment. Right now, about 25 percent of our patients have computers; but some of the adult children of patients have computers, and can handle the elderly patients who are not going to have computers, so their children can send requests for refills or schedule appointments.
In any case, the bottom line is that we are here to help our community; it’s a mission. We all firmly believe in it, and we do what we can to make it work.

And there are certainly elements in all this that can’t be directly quantified, correct?
Yes, that’s right. How much is Dr. Childs’ time worth, or how important is a person’s medical record? If someone needs to be sent immediately to another physician, we can click on it on the computer and immediately zeta-fax it to that doctor. How much is that worth? The whole point of this is to make medicine better for the patient; and that’s great for the patient. The growing pains are hard. So the incentive makes people who wouldn’t pursue this immediately, do so.

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