ONC health IT fellow: EHR success requires provider persistence

Electronic health record use is improving as the industry transitions from paper records and silos, and providers are beginning to see better patient outcomes stemming from their use. Stakeholders, however, need to understand that EHRs are not a panacea, but simply one of many tools to help clinicians provide care.

Eugene Heslin, M.D., head of a small family practice in Saugerties, N.Y., has had ample experience with EHRs, as his practice now is on its second such system. A health IT fellow with the Office of the National Coordinator for Health IT, Heslin, who also serves on the board and executive committee of New York eHealth Collaborative, recently shared his insights in an exclusive interview with FierceEMR.

FierceEMR: What has been your experience with EHRs?

Heslin: The first [EHR] we purchased in 2006 was a good system, but we did not understand what system a smaller practice needs. We scrapped it after 18 months and got a new one in 2008. We're not satisfied where [the current system] is at, but we're thrilled how far they've come. These things are evolutionary. The EHR was an electronic secretarial system. Now we're at population health and patient safety.

FierceEMR: How has the system helped your practice?  

Heslin: It takes both the human piece and the electronic piece to be successful. The electronic piece is simply a tool to gather massive amounts of information, clinical decision support, and be able to track. We're recognized as a patient centered medical home. We're tracking our high risk patients and may be keeping them out of the hospital more. Our HEDIS scores in some areas used to be 10 percent; now they're 100 percent. The readmission rates at the local hospital are 24 to 25 percent; ours are 14 percent. A big portion of this success is due to the EHR. You also need the staff in place and a team approach to care.

FierceEMR: What kind of challenges have you run into?

Heslin: We were initially completely unprepared. We got humble, did research. It was easier to shut down and start afresh. Also, reporting measures is tough. 

FierceEMR: Will all physicians eventually implement EHRs?

Heslin: Physicians have a responsibility to practice up-to-date medicine. It's all done by rule sets. The rules sets of today may not be those of the future. The rule set has already changed for prostate cancer. We will need comparative effectiveness studies and to look at large amounts of data. We need electronic pipes to connect us.

It's an exciting time. The state health information network will be up and running soon, and the ability [to communicate] from EHR to EHR. I can't wait for that, it's so clutch.

FierceEMR: What advice do you have for others?

Heslin: You have to be persistent. These things are not always intuitive. If you wait for a perfect system, you'll never get it done. If you run into issues, you have to treat the EHR like a sick patient and look at a solution and a treatment plan. If you do nothing, like with a patient, they generally do worse.

The most important message for small providers: It can be done. You just need the intestinal fortitude.

This interview has been edited and condensed for clarity.

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