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In Tennessee, Stage 2 Attestation Poses Few Challenges

July 2, 2014
by Rajiv Leventhal
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Provider says attesting “wasn’t difficult at all”

For most hospitals and providers, attesting to Stage 2 of the meaningful use (MU) program is no piece of cake. A few weeks ago, data released by the Centers for Medicare & Medicaid Services (CMS) revealed that only eight hospitals, out of a scheduled 2000, had managed to meet the requirements of Stage 2 meaningful use in 2014. Among physicians, only 447 eligible providers out of 1,497 have attested for MU Stage 2, according to the data.

Additionally, in May, the American Medical Association (AMA) sent a letter to CMS and the Office of the National Coordinator for Health Information Technology (ONC) asking for an overhaul of the meaningful use program and electronic health record (EHR) certification process. The letter stated that unless significant changes are made to the incentive program and future stages, it would increase the likelihood of even more physicians dropping out of the program; CMS data from 2013 revealed a 20 percent meaningful use dropout rate.

That being said, some organizations find the work to be less burdensome than others. On the physician practice side, for example, Healthstar Physicians, based in Morristown, Tenn.—providing care for 330,000 people located in six contiguous counties—attested to Stage 2 about two months ago in what Peter Sutherland, M.D., of Healthstar called a “pretty seamless process that wasn’t very difficult at all.”

Healthstar’s physician network is comprised of more than 60 providers in eight offices, having more than 250,000 patient visits each year. So needless to say, the organization’s doctors are quite busy. That’s why, in 2005, Sutherland, four or five other physicians, and one IT person headed a process to figure out if an EHR would prove valuable for the practice. However, after some time, it was decided that the software would be too robust, and the entire process would be far too comprehensive, which would affect clinical workflow, Sutherland says.

But then in 2010, with healthcare reform underway and MU dollars being put up by government, Sutherland says they gave technology another shot. After about a year, he says, the organization chose the Watertown, Mass.-based athenahealth’s athenaClinicals EHR amongst a group of KLAS-recognized vendors. The software was then implemented in six different practice sites, rolled out in sections.

The aforementioned 2014 data from CMS revealed that while athenahealth’s athenaClinicals EHR is used by fewer than three percent of providers across the U.S., the technology leads the industry in Stage 2 attestations— athenahealth recently announced that 59.2 percent of providers (287) who have successfully attested to Stage 2 are using its EHR.

With this technology, Healthstar Physicians had little to no trouble in attesting to either Stage 1 or 2, says Sutherland, citing the patient engagement “view, download, transmit” piece as the only thing that gave the organization any difficulty. This shouldn’t come as much of a surprise, however— at the May 6 Health IT Policy Committee meeting, Jennifer King, research and evaluation branch chief for ONC, revealed that only 10 percent of hospital reported the capability to let patients view, download and transmit their data, with transmit being the least common.

Healthstar worked around this common challenge by using two seemingly simple strategies: getting the front office to be very active with patients when they came in, and having the providers themselves explain the significance of portals to patients during appointments. “All of the staff was provided with educational materials on the portal, and when the patient came in, nurses would bring it up right away,” says Sutherland. “And at the end of the appointment, I would bring it up to for about 60 seconds to discuss the importance. Patients stand up and listen when providers show them how important something is.”

Peter Sutherland, M.D.

Sutherland feels that it’s the patient portal adoption that has separated Healthstar from other organizations. He thinks that many organizations are struggling with the patient engagement piece because of vendor issues, varying patient demographics, and because physicians don’t like change.

As such, another piece to the puzzle when it came to succeeding in the MU program was embracing a cultural shift throughout the organization, Sutherland says. “Our practice has providers with all different levels of experience, so for the older generation, it’s a huge change for them, and that can be very difficult. But computers just organize a physician’s practice much better, and that makes my time with patients more productive,” he says.

With paper charts, Sutherland admits that this organization wasn’t “as great” as it is today, as computers quickly became a tool that organized clinicians’ charts in a concise and comprehensive way, making reviewing information quicker, as opposed to the time it previously took to find what you were looking for, Sutherland explains.

athenahealth’s clinical module also has a lot of flow chart abilities, which has optimized the workflow, says Sutherland. “For instance, if you’re following a diabetic who needs to monitor his or her A1CS or body mass index, all of that information is interfaced with Healthstar’s lab now, which goes directly into the flowcharts,” he says. “It used to take so much time to put that data into the flowchart. Now I can open a flowchart that is specific to the patient’s disease state, show them their progress, and show them the data. That’s exciting for me and for them, and the patients are recognizing it.”

As a result, Sutherland says he feels like his job is much more worthwhile now that he can show patients the data. “A 15-minute visit is much more meaningful than it was even two years ago. When you have been doing this for 20 years like I have, this change is refreshing, and frankly, it has invigorated my practice,” he says.

Sutherland also notes how he has taken on more of an educator-type role as of late, developing patient education information that he puts into personalized educational files for patients based on disease state. “You can copy and paste it into the system, label it, and attach to an ICD-9 code. And you can quickly access it whenever a patient comes in. All this has made things more productive and enjoyable for me.”

Sutherland admits that success with technology depends on your philosophy of how you practice and what you understand in the changing healthcare environment. “For me, I understood that if I wanted to continue to practice medicine, I would have to make some changes,” he says. “We were falling behind and had to be proactive. You also need leadership that deploys forward thinking and thinks about what the industry will be like in 20 years. Some groups have stopped practicing, but the younger ones have embraced the computer era,” Sutherland says. “Computers are becoming another employee, and that will make us better physicians—not just because of our knowledge base but also because we know how to access the technology.”

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