Patients First puts EHR to work on diabetes care

By Bernie Monegain
11:27 AM

Missouri healthcare system improves care, boosts revenue

WASHINGTON, MO. – The point of the government’s meaningful use program is to transform healthcare. Usually that transformation is incremental – improvements here, improvements there that together can lead to giant strides.

That seems to be the case for Patients First Health Care, a Washington, Mo.-based system that serves more than 215,000 patients through 21 locations in east central Missouri.

Patients First rolled out its NextGen electronic health record system five years ago. Today, all but a few of its 57 primary care physicians have attested to meaningful use of EHRs and Patients First is holding up its diabetes program as one of those giant steps toward big change.

The EHR has become central to building a comprehensive care program for diabetic patients that has resulted in better control over the disease and better outcomes for patients, says Pam Pavely, RN, director of health information technology for Patients First Health Care. There have been some financial benefits as well, she adds.

One of the most critical features of the NextGen EHR Pavely says, is that users can change the templates.

“So we updated the NextGen template to be able to automatically pull in their last hemoglobin a1c, Pavely says. “We document the last foot exam, the last eye exam – those types of things. So that information is right there in front of the provider during the visit, and they can make any adjustments necessary.

It made the billing process a lot easier and cleaner, too, she adds. “We weren’t submitting for things we shouldn’t be submitting for and we were only submitting charges when it was appropriate. So that also improved the reimbursement as well.”

Patients First also gave the local optometrist remote access to the patient’s record in a way that is secure and HIPAA compliant.

“It’s very important to them to be able to see their medication list, their problem list, the most recent office notes especially on a diabetic patient when they’re doing an eye exam,” Pavely says. “We set up a way for them to be able to drop their office notes into the patient’s chart even though they’re not part of our system.

“It gave them access to what they needed, and it helped us because it decreased the amount of paper coming in, and it also got the information in the chart immediately. There was no delay.”

The focused, timely care and collaboration earned Patients First NCQA certification for diabetes care.

The American Diabetes Association recently called for greater effort in not only managing diabetes, but also preventing it.

"We now know how to prevent type 2 diabetes and have the data to show that doing so is not only safe, it is cost-effective," Vivian Fonseca, MD, president, medicine and science, American Diabetes Association, said last month as she released two new reports.

A study funded by the National Institutes of Health and released last month concluded that programs to prevent or delay type 2 diabetes would lower healthcare cost over time.

The study “demonstrated that the diabetes epidemic, with more than 1.9 million new cases per year in the United States, can be curtailed,” said study chair David M. Nathan, MD, director of the Diabetes Research Center at Massachusetts General Hospital, Boston. “We now show that these interventions also represent good value for the money.”

Meaningful use

Sixty-eight physicians at Patients First attested and qualified for meaningful use last October.

Nine physicians didn’t make it the first go round – for various reasons. “But they will meet it,” Pavely says.

Having to attest for meaningful use helped to improve care at Patients First.

“We found a lot of deficiencies in some areas,” says Pavely, “some as simple as getting the height on a patient, which then allow you to get the BMI. Those things were not being done consistently. We were not really good about obtaining preferred language, and those types of things. We had to do a lot of re-education of our staff and change workflows in order to meet all of the requirements. Those workflows have to be maintained. We can’t let them just slack off and think ‘Ok, well we did it, we’re done.’” We’re making sure that we don’t lose the momentum there. “

What’s next?

“Now that we’re kind of around the curve of the newness of it all,” Pavely says, we want to try to get more efficiency out of it.

So Patients First is looking at doctors’ workflow to see “who is really singing with this application.”

What the organization has discovered, says Pavely, is there are doctors that can see 30 to 40 patients in a day. They start at 8:30 and they leave at 5:30 and all their charts are finished, while others are still struggling even though they’ve been on it for two or more years. They might be seeing only 18 to 20 patients a day.

They’ve not getting their notes done by the end of the day.

So we’re trying at look at these ones that are just blazing along – what are they doing that’s making it work.
One consistent thing is they let their staff work to the top of their license, and not all of them are willing to do that. It makes a big difference. The more the doctors have to do themselves, of course, it’s going to slow them down. They’re going to see fewer patients, They’re not going to get their notes done.