Meaningful Use Interview with HVCA Administrator Barbara Watkins, R.N.

My last meaningful use interview went over so well, that I decided that I should do some more. When I saw the news that a GE Centricity customer met meaningful use, I decided that would be a good opportunity for my next meaningful use interview.

I’m certainly interested in doing more interviews from a variety of EMR vendors, specialties, and regions. I’d be happy to interview someone who’s deciding to wait or to forgo meaningful use completely. If you are a doctor or practice manager interested in being interviewed, just drop me a note on the EMR and HIPAA contact us page. Now some background on Barbara Watkins and HVCA.

Heart & Vascular Center of Arizona (HVCA) Administrator Barbara Watkins, R.N., helped lead the practice’s six cardiologists through the process of preparing for attestation to meet Stage 1 of Meaningful Use. The practice serves more than 15,000 patients and the providers started preparing for attestation actively in fall 2010.

An interview with Heart & Vascular Center of Arizona (HVCA) Administrator Barbara Watkins, R.N.

How long have you been using an EMR? Which EMR do you use?

We’ve been using GE Healthcare’s Centricity Practice Solution since June 2008.

Did you have to upgrade your EMR to meet the certified EHR and meaningful use requirements? How much did it cost for you to do that if you had to?

Yes, we upgraded to Centricity 9.5. We spent around $60,000 to upgrade our servers and laptops.

How long did it take you to select and implement your EHR? What criteria did you find most important in your selection of an EHR?

We went on the Practice Management software in September 2007, and then implemented the EMR in June 2008. It’s interesting that many of the components I purchased we did not fully implement until we went live on the EMR. The patient portal was one of those products, as well as the Indexing Client that facilitates the movement of scanned documents into the charts. Centricity has a wide spectrum of products that fully integrate and compliment the PM/EMR software.

How many hours of extra effort do you estimate it took for you and your staff to meet meaningful use criteria?

We began to actively prepare for attestation in the fall of 2010 when the CMS issued their final rule. Towards December, we were honing in on our workflows and consulting with our physicians to ensure that they were capturing all the necessary data within the EMR. In total, we estimate that 60 extra hours were spent on this project.

What were some of the changes you had to make to your practice style or documentation methods to meet meaningful use?

Ensuring that we were careful and precise with our documentation was certainly critical, since the Centers for Medicare and Medicaid Services (CMS) require specific tracking of criteria. For example, medication reconciliation is done in our practice at every office visit because we’re specialists. However, CMS views medication reconciliation only in the context of “transition of care,” so that’s how we have to document it – even when we are seeing the patient in a post-op visit. Our providers had to be trained to use a specific code to identify a post-op visit as a “transition of care” event in order to satisfy the medication reconciliation criteria.

Overall, the most important factor for us in meeting meaningful use requirements was understanding how certain data was being captured and recorded. We also made sure to match the new reporting requirements with our workflows, which naturally takes a little time.

Were there any surprises in the meaningful use attestation process?

I was very excited when we ran the first reports – our physicians were actually doing most of the processes that were required and at very high percentages. But the biggest surprise was that we would need to modify our workflows to prove some of the measures.

Who helped you through the process (your vendor, a consultant, your REC, etc.)?

We’re thrilled that we have a strong vendor partnership with GE Healthcare – they were extraordinarily supportive throughout the process of helping us prepare for attestation and run the necessary meaningful use reports.

I believe dependable vendor support is especially important for physician practices who do not have IT departments at their disposal to help troubleshoot the EMR and ensure that all the meaningful use reporting requirements are met.

Were there any unique challenges for cardiologists in showing meaningful use?

Actually, I feel cardiology is one specialty that easily meets meaningful use, barring the immunization requirements. We easily met the core measures and many of the quality measures as well. We have been participating in PQRI (now PQRS) and e-Prescribing with GE’s MQIC product. MQIC’s reporting tools keep us on track with many quality measures and protocols that we have instituted in our practice on our own.

Meaningful use Stage 1 has a relatively low bar. Are you concerned that stages 2 and 3 might be a much harder challenge?

I’m optimistic about meeting the requirements for stage 2, although I do have concerns about exchanging data between disparate providers. Given my knowledge of the Phoenix market, I don’t believe that level of data exchange has gained real traction yet in our region. We will have to work hard to encourage data exchange with our referring doctors.

What do you say to your fellow doctors who are concerned about implementing an EHR in their practice?

EHR is a necessity in today’s time. We have found a real scale of efficiency in using the Centricity product. It has improved communication within our practice. With the patient portal, we have improved communication with our patients as well. Our physicians love the ability to login to the system from anywhere and access patient data to facilitate communication with hospitals and other physicians in an instant!

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

6 Comments

  • I am a primary care physician in an enterprise also using GE’s Centricity and where MU is being pursued.

    I am struck by her comment about the need to alter work flows, which I understand to mean changed processes to capture/prove work that was being done. I would like some further explanation, because this is an extremely important and potentially contention issue.

    For example, in our practice we have had a process for documenting our assessment of smoking status and behavioral recommendations based on the patient’s current status and motivation. While we have been quite good about doing this consistently, it is NOT done with a methodology that is captured by Centricity or in a way that can be measured except by chart review. We are struggling with the fact that the replacement process for documentation developed by IT is considered disruptive by providers, and that the provider-centric process is considered inefficient (in terms of data collection) by management. The providers are 100% supportive of the goal (smoking cessation) and enthusiastic about the clinical process, but feel that if they are told to use IT or management derived workflows that conflict with their clinical work flow, the message is that actual quality is less important than theoretical quality and that IT’s needs trump clinical needs. We are having quite a number of heated discussions about a number of issues like this.

    I am curious how you made workflows acceptable to clinicians? Additional support from staff? Longer appointments? Coercion?

    Peter Elias, MD

  • Peter has an excellent point. How did the practitioners who have to use the system for directly providing patient care need to change what they were doing previously?

  • Hi Dr. Elias,
    I’ve asked Barbara to answer if possible. I hope that she does reply in the comments.

    Certainly you’re describing a common issue. Although, I’d say the biggest issue is the government requirement. The government requires that you be able to report on the issue if you wans the EHR incentive money. The really hard choice is whether the changes that you mention are worth making the change because you know you’ll be getting the government incentive money. Yes, that’s why I don’t personally like the EHR incentive money.

    From my experience, there are a few things that happen. A decision is made on whether the financial incentive money is worth the change. If it is, then the process has to be changed so that it can be reported. However, the discussions you’re having above often aren’t as black and white as you describe. I’ve found that those discussions will often lead to a grey area which minimizes the impact on the doctors while still satisfying the reporting requirements. Often this is where a good relationship with your EHR vendor can be a real benefit because they can see it from a different angle and/or provide other solutions that help to meet both parties.

  • One of the major areas we needed to tune up was in regard to Medication Reconciliation and Transition of Care. We implemented in the Centricity World a quick text with an obs term embedded when we have a transition of care into and out of the practice. This process we are monitoring quite closely. There have only been a few areas where we needed to make a drastic change. Most of our typical forms record the metrics we needed.

    One of providers did not meet the e-Prescibing goal…so we needed to make sure all our providers were educated on the measures and the percentages off the reports. Some of the providers met all measures without a problem, others needed to change workflows to include providing patient instructions and patient education handouts.

    As for some of the other measures, we also have our medical assistants asking the patients about smoking status during the preload process. The physician then is responsible for documenting smoking cessation counseling and any actions they need to address. Again, we had several meetings to discuss areas that are paramount that we document on. Plus many reminder email communiques from me. You are are welcome to contact me off line if you would like. 🙂

  • I would like to thank everyone’s comments. I can say that the only way to implement meaningful use in any significant way is to have a strong administrator, such as Barb Watkins, who has taken on this project with tremendous passion. This project is not for a casual observer. It can only be accomplished by strong leadership who can motivate the rest of the staff and physicians, as Barb has done in a most effective way. Great job, Barb!

  • Barbara and Nathan,
    Thanks for your participation in the interview and insights. Not to mention stopping by to reply to people’s comments.

    I echo Nathan’s sentiments that it does require strong leadership to make an EMR implementation successful. Sometimes this is the administrator like Barb Watkins in this case and other times it’s a doctor or couple doctors that provide the leadership. Either way, having it makes everything go smoother.

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