Dr. James Parker, an internist at the multi-specialty physician group practice Texas Health Care, is not a chief medical information officer, although he certainly performs the duties of one. In 2009, Parker cut back on his own practice hours in order to spearhead an effort to not only get virtually all of the organization's doctors using electronic health records, but also to get them through the Meaningful Use attestation process.
The Fort Worth-based group, which consists of 130 doctors in 65 offices, is making steady progress toward its goals. Aside from a handful of hospital-based doctors, all of its physicians are on EHRs. As of November, 96 physicians have achieved attestation. Another 10 to 20 should do so within the next month.
FierceHealthIT interviewed Parker about the organization's journey toward Meaningful Use attestation. Like others, they faced their share of hurdles--from reluctant docs to a mountain of server-crashing data. Key among their success factors, he says, was an education program that explained the benefits of Meaningful Use to doctors, many of whom didn't have any idea how it was going to affect their practice.
FierceHealthIT: At Texas Health Care, you're known as "The Meaningful Use Doctor." Why was it important to have a physician head up this initiative?
Parker: As a corporate initiative we decided that if we did Meaningful Use that this was not going to be something that the IT department would be able to take to the doctors. The simple reality is doctors are too busy. They're always going to tell the IT guy "You do this; I don't have time for it." We needed a physician to go in and shepherd this process.
FHIT: When you first undertook the Meaningful Use attestation process, how well prepared were physicians?
Parker: Out of the 130 members, many knew very little about Meaningful Use. They knew nothing about the process, nothing about the criteria and nothing about where it was going to be. Doctors had been hearing about it and they knew about it, but they didn't understand how it was going to impact them. We needed to get this knowledge out there about what Meaningful Use really was going to be about.
We spent much of April, May and June internally here in the IT department getting our heads around what it is we need to do. We then took the summer and started an aggressive education program with our doctors.
FHIT: What did the education entail?
Parker: As we started doing daily reporting in July we went back to individual doctors and said "OK, here's where your deficits are. Here's the workflow that you're not doing to get the data in the right information slot." We were able to tell a doctor if he or she was not capturing the diagnosis date or recorded medication date. And then we were able to look at their workflow and say what they needed to change in their office in order to make that better. We needed this level of education and intervention in order to get there.
FHIT: What kind of messaging resonated with the physicians?
Parker: One of the first things I focused on was the fact that by doing Meaningful Use we weren't going to be doing it just for the money--although the money's nice--we focused on the fact that by the year 2015 or 2016 every insurance company we used, whether Medicare/Medicaid or Blue Cross, United or Aetna; they're going to be looking at your Meaningful Use status and your EHR and seeing a justification for improved reimbursement.
Once you're able to get people to see this is not just about coding for dollars, but about your ability to contract and improve your position in the community down the line, there is going to be a time where whether your are Meaningful Use certified or not is going to determine whether or not you are able to participate in the contract for another company. We already see this. Blue Cross Blue Shield and United are both very much into the performance-based reimbursement initiatives, where shared savings performance helps to get there.
We spent a lot of time with our doctors not only talking about potential reimbursement, but also about the reality that this was the way of the future. And if we were going to have EHRs, then it was not only Meaningful Use, but also using them meaningfully--and the two are widely divergent.
FHIT: How did you overcome remaining physician resistance?
There's always a cohort of victims. They look at me and say "I'm too busy." And my first response is "And I'm not?" When they tell me they don't have time for this, I say "Well, I don't have time either. We're talking about a corporate initiative and you're going to get on board." When they tell me "Why would I do this?" I tell them "Because in five years I want us to still be able to contract with United, Aetna, and Blue Cross and be at an advantage by our Meaningful Use status."
FHIT: What role did your EHR vendor, NextGen, play in the process?
Parker: We needed to understand more about NextGen's attestation capabilities. The platform itself has to be certified, which NextGen was. And we realized that NextGen needed to develop the reports. Because if we developed the reports there was no guarantee that we would get them in a certified fashion. So we were really focused on getting NextGen's reporting modules in and getting those working.
FHIT: Describe the attestation process itself--how did you prepare and how did it go?
Parker: When we got ready to send our first attestation application I insisted it be me. I had met the criteria. I wanted to be real sure that I wasn't going to cost someone else the Meaningful Use money. We had used the NextGen reporting module and came up with a summary report that allowed us to have all of the core criteria, and we also went through and identified those metrics from the menu set that we were going to use.
We started by going to the CMS attestation calculator--you can run your numbers through it to see how you do. When it said we passed, we went back to the actual attestation website and went through the same process. Some of the criteria are simple "yes" or "no" questions. For example, "Do you have a health interchange? Do you have connectivity to the public health department? Do you have a drug interaction module? Do you have a formulary interaction?" We made sure we had done all those yesses before we even started.
One of the 15 core requirements has to do with quality measures. NextGen had a reporting form to generate quality data. Some of the quality parameters that were defined by the government included have you done obesity counseling, have you monitored blood pressure, have you looked at asthma medication? There are about 40 of them. We had to have that data in there.
All of that went to answer just one of the core criteria for each doctor.
For every doctor, we created a file back on our common drive and had their core reporting menu, we had their menu reporting menu and metrics, we had their quality data summary and then we generated a list based on diagnosis that allows for discrepancy correction, research, outreach (one of the core measures.)
When we attested all of the doctors, end of the process says you're done, you passed. When you finish the process you are locked for payment.
FHIT: What other kind of physician outreach do you do?
Parker: Each office has a practice team liaison (PTL) who interfaces with the central business office. We also have about five practice consultants. Each practice consultant has about 10 to 12 sites that they shepherd and watch.
We use these consultants aggressively. They were already used to going to the doctors' offices and the doctors were used to seeing them. They viewed them as being a step above their PTL. Many of the consultants are nurses and have experience in healthcare practice management. So they had a different response to them and respect for them. So we gave them a new role as testers and champions and they worked with the doctors and got into the nitty gritty of how to do this.
FHIT: What are the technological requirements for tracking all the data required to achieve Meaningful Use attestation?
Parker: We can currently run 10 provider reports at a time. If we try to do 20 it will time out and crash. [This month] we'll probably being doing only one at a time because of the volume of data. In 2012 it's not just a 90-day period--we'll have to report on 365 days of work per doctor for 130 doctors. That's 15 core measures and five menu measures. Next year we budgeted for a server dedicated to reporting. Otherwise the volume of data is going to take the system down.
Physically it's a huge volume. It requires a lot of memory and processing power.
This interview has been edited and condensed for clarity.