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I'm a family physician in Fort Collins, Colorado,
CEO of Miramont Family Medicine,
which is a network of patient-centered medical homes
in Colorado.
We're a level III NCQA-recognized
patient-centered medical home.
Back in 2007, my partners and I realized
that we weren't really doing anything differently
than we had been doing, uh, perhaps 10 years earlier --
we were still in paper, by and large.
We didn't have a good handle on our metrics,
had no idea how many of our diabetics,
for example, were at goal.
And we decided that we had to get out of last century
and start building for the future.
And I believed, as did my partners,
that the process starts with investing.
We basically put together a proposal,
invested about $134,000 that first year,
and cumulatively, about a quarter-million.
And from that, we improved our safety, our efficiency.
So, we were perfectly positioned, then,
to do Meaningful Use on the margin, if you will --
most of what was required, we were already doing --
we were already e-prescribing.
And, so, our incremental cost to do it were not so great.
And I would suggest that,
doing an improvement project with electronic health records
simply to get Meaningful Use dollars, is not a good strategy.
There has to be a plan to improve safety,
to improve efficiencies, to change workflows
in the practice, and that's really where
a practice gets their big returns.
And then the Meaningful Use is just the frosting on the cake.
Implementing an electronic health record changes workflows.
We were ready for the change,
and we see it now more as progress
and something to look forward to.
And, so, we're excited about deploying
patient self check-in kiosks, for example, next month,
which are going to improve our efficiencies.
And being able to implement technology in a way
that gives us a competitive advantage in the marketplace.
Well, it starts with having a PECOS number assigned
through the CMS Web site.
And then once a physician is registered,
which basically says, "Look, I'm going to do this,"
they have to start collecting data.
Now, there's a lot of different ways to collect data.
Many EHRs purport that they have registry functionality.
After 90 days for Stage I,
we had our data and we were able to go to the attestation phase.
We did that in April of 2011,
and then we were promptly paid about 30 days later,
$18,000 per physician for Stage I Meaningful Use.
It really rewarded us well.
I'm in an economy where we had 34 primary care doctors
shutter their doors in the last eight years,
eight of those were actual bankruptcies;
and the number of emergency room physician beds --
or, I'm sorry, the number of emergency room beds
increased by 100%;
the number of emergency room physicians
increased by 50%.
So, basically, more and more people
were going to high-cost centers to get their health care
at a later stage of their illness,
and yet, while that was all going on,
our practice was able to grow
from one physician and one computer
to 14 providers, four locations, about 50 employees,
over 80 computers working in a centralized data center,
and about 27,000 patients.
Well, there's two things I tell physicians --
they need leadership and they need courage.
First, they have to go to their practice and tell them,
"Look, we're going to do this,"
and they need to make certain
that everyone is involved at the team level.
If the physician tries to do it by themselves,
it's not going to work.
If the physician tells their staff,
"Look, you guys make this work
and let me know when you're done,"
that's not going to work, either.
There definitely has to be coordination
and a commitment from everyone in the back office,
the front office, billing, what have you,
to pull this off.
Um, there has to be some resolve.
People have to believe that
they're going to be able to do it,
and commit to maybe one to two years
from the time they get their EHR
before they're going to be at that level of performance.
But they're going to have a lot of other benefits along the way
before they get the incentive monies,
including those workflow enhancements
and improvements in efficiency.
The second thing they need is courage,
and a lot of times, physicians are hesitant to do things
because they feel that they need to be cautious --
and the opposite of cautious, however, is not always careless.
Sometimes, the opposite of cautious is courage.
And physicians need to ask themselves,
"Are we not doing this because it's careless,
or wouldn't be prudent,
or are we not doing it because we're kind of afraid,
and we're not willing to take the risk?"
And I would say this is the time to take risk,
if they want to evolve as opposed to being extinct.
Trying to get patients to change their behaviors, as well,
is an ongoing challenge,
just as when we try to get them to quit smoking,
or to lose weight.
But, uh, we found it very helpful
to have some care coordinators,
to have some health coaches,
and, so, we've used some of our incentive monies
not just to pay for the I/T,
but also to help make certain that we can do
the care coordination piece that comes with
the ability to use the tool to its maximum effect.
And that really helps get the patients
to buy into the process.
Many patients are aware of what we're doing.
For some of them, it's probably below the radar.
But for those who've seen the awards
or know what Miramont's been able to achieve
because they've been with us for ten years
and have seen the transformation,
they're pretty proud about it.
One of the tools I use, again, is a the patient portal.
So, I invite patients to online, to our Web site,
Miramont.us, to look at their electronic health record.
Sometimes patients come back and they say,
"Well, I saw this diagnosis, and I don't have that,"
and then we go back and we look and it turns out
maybe that was a working diagnosis from a year ago --
we can delete it from their chart.
And as patients see that, now, they have some control
over what's in that medical record --
so, we've gone from the old age
where the physician is sitting there with a paid, you know,
"Well, Mr. Jones, tell us what's going on" --
and we can do that with the computer, too, right?
I can sit there and type, and, you know,
the patient still doesn't know what's going on.
We turn the screen, we let them look on,
we show them what we're doing,
we value the technology in the workplace.
You know, if the computer's a little slow,
I don't badmouth it in front of them.
Make eye contact with the patient,
not just with the computer screen.
And, um -- and, over time,
they start to realize that this really is a fantastic tool
that gives them more power over the data, as well.
Probably the most rewarding part of it, for me,
was knowing that we were making our practice, our community,
better for our patients.
In order to maintain relevancy,
we had to get into this century,
we had to get out of paper,
we had to start being able to utilize
the new technology the way other industries have,
and, in doing so, we've created patients
that are healthier,
and environment that's safer,
a workplace that's more efficient
so that staff are happier,
it's easier to retain staff.