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In New England, Moving Forward in Medical Groups

February 9, 2013
by Mark Hagland
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Massachusetts eHealthCollaborative’s Jeff Loughlin shares his perspectives on the road ahead in EHRs

During the MGMA Annual Conference, held in late October in San Antonio, and sponsored by the Englewood, Colo.-based Medical Group Management Association, one of the industry experts presenting to the audience of medical group executives was Jeff Loughlin, project director at the Waltham, Mass.-based Massachusetts eHealth Collaborative, and executive director of the Regional Extension Center of New Hampshire (Concord, N.H.). Loughlin presented a session titled “Making Meaningful Use Meaningful and Sustainable,” focusing on bringing forward lessons being learned among regional extension center (REC) organizations as they work to help physician groups implement EHRs and connect with health information exchanges (HIEs).

In an exclusive interview with Healthcare Informatics following that presentation, Loughlin said that, in his view, “A lot of providers think that meaningful use is about checking off items on a list. But what really is important is to focus on successful implementation and adoption of the EHR [electronic health record] by providers; when those are successful, meaningful use really just happens.”

Loughlin spoke again recently with HCI Editor-in-Chief Mark Hagland regarding the challenges facing medical groups as they move forward on meaningful use and on implementing electronic health records (EHRs), at a time of strained resources and accelerating mandates. Below are excerpts from that interview.

You had said in October that there are really two broad fundamental issues facing physician groups right now—core financial barriers, and a lack of professional staff resources, including IT staff resources. You also said that, at a very basic level, “Ninety percent of what’s involved is simply change management.”

Yes, that’s true. And, unfortunately, a lot of providers think that meaningful use is about checking off items on a list. In fact, when providers focus on the successful implementation of EHRs, meaningful use really does just happen.

Jeff Loughlin

What types of mistakes are some medical group managers and clinicians making?

When it comes to leveraging—or not leveraging—EHRs, a lot of them are still using very expensive typewriters; they may do some e-prescribing; there may be a problem list, and mostly that exists because of a link to the billing; they’re not actively managing the care of patients.

And we talk about meaningful use as a single term, but it really is three different stages. With regard to Stage 1 of meaningful use, a very basic practice can reach the objectives of MU pretty easily, without any real change to workflow. I have a personal physician who works in a practice, and they’ve attested to Stage 1, and they still take notes on paper and then input them later. In the future, however, the challenges of meeting the Stage 2 and Stage 3 requirements will really not be possible unless they bring the technology into the exam room, and focus on adopting a care-team approach, one that includes the patients and their families as part of the total solution.

What do you see as the biggest challenges for medical groups right now?

It’s two-fold. Obviously, there are financial barriers. And in states like New Hampshire, we’re seeing small practices migrate to hospital ownership. And you really can’t be profitable until you see economies of scale; and you need 10, 12, 15 providers to get to that level. Unfortunately, it’s becoming increasingly challenge to work in 1, 2, 3 doc practices—making enough money is getting to hard to live on. Limited funding leads as well to challenges in bringing in the full range of staff members needed to fully leverage the care-team concept, and to keep up with all the varied incentive programs and quality initiatives.

So that second issue is the professional staffing resources behind you. In terms of meaningful use and all this HIT stuff, 90 percent of it is simply change management. And how does a small group of 3 or 4 providers or even staff members total, go through a change management process? The REC program was a great notion; what we do is to come into a physician organization and we explain to them the change management aspects of this. We’re trying to get them to rethink the way they practice and to embrace the technology. And now that we are getting this data, obviously, the larger objectives are around care coordination and population health. But what do we do with that data locally? You obviously want to change the behaviors. But obviously, you don’t have the resources to analyze that data in these small practices. So the challenge is making that happen.

What are your key pieces of advice for the IT leaders in medical groups right now?

Per meaningful use, you still have to focus on that structured data. But the largest tenet of Stage 2 is around connectivity outside your practice to share electronic data, as well as electronic patient engagement. So whether that’s peer to peer, or whether you connect with a statewide or regional HIE, that’s critical., and must include options for connecting with your patients. I think IT folks need to think about that, along with risk analysis for privacy and security.

Are physician group leaders in Massachusetts and New Hampshire understanding what they need to do, yet?

I think it varies by organization and individual. I was surprised at the presentation at the MGMA Conference in October, that out of about 125 attendees, only half had yet achieved Stage 1 of meaningful use. And although ONC [the Office of the National Coordinator for Health IT] is out there and MU is out there, I’m more and more surprised that the message has not gotten to the specialty community. It’s kind of a shame that the funding is almost gone for REC work. Getting medical groups to understand what’s needed is so important. And we have that link through the Comprehensive Primary Care Initiative. But our connection to the specialty groups is pretty small. We were very fortunate moving forward in New Hampshire, because we used the sub-recipient model, and a lot of organizations that received some of the REC funding have done a great job including their specialty providers in their total efforts. Our REC team is now working to expand our educational sessions to include all providers in the state to really get the understanding out there on what is expected, and required.

The challenge we all face now is what I call “practice fatigue.” In recent years, many of us in the EHR implementation field faced what was known as “provider fatigue,” which referred to the abundance of erroneous reminders and alerts that would constantly notify the provider of tests or treatments to be provided. Over time, as structured data became more prevalent, and patient records became more complete, these alerts and reminders became more relevant and actionable. Today, we are starting to see “practice fatigue.” As the structured data becomes richer and richer, more and more quality initiatives, pay for performance, and other various health plan requirements are almost becoming overwhelming at the practice level. Between acronyms like MU, ACO, eRX, PQRS, CQM, P4P, etc., it is  constant challenge to keep up with the required submissions, timing, and methods of insuring that you either receive the incentives, or avoid the penalties. Many of us have moved from helping a provider navigate an EHR to helping practices navigate the healthcare system.

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