Electronic Health Reporter

Serving patients is a fundamental value of White Rose Family Practice and so is maintaining a work/life balance for the practice’s physicians and physician assistants. To make this combination of values work, Cathy Carpenter, MD, founder of the York, PA, practice, was naturally drawn to using new technology to improve patient care while finding efficiencies in delivering that care.

From its founding in the 1990s, White Rose has been ahead of the curve: adopting electronic prescribing before pharmacies had ever heard of the technology, assigning one of the earliest-available tablet computers to its physicians, and hiring part-time physicians long before that was considered acceptable.

According to Whitney Almquist, Business Manager, even in the transition from a paper record to the clinical module, White Rose went against the grain.

In converting some 14,000 charts from paper to electronic encounter notes, White Rose decided to scan entire charts, not just recent visits. It took about four years for a crew of several part-time college students using high-speed scanners to complete the task.

The payoff is two-fold: 1) no more paper charts in the building, and 2) all the data White Rose physicians need to determine how their patients are doing – and how the physicians are doing in treating them – is as close as the nearest computer, thanks to the reporting capabilities of the electronic record.

“Now there is so much clinical data that we can mine and report on,” Almquist says.

White Rose had a yen for reporting well before the purchase of its system. Using a practice management system in the years leading up to the EHR purchase in 2003, Almquist admits she was entranced by the practice management system’s power to easily produce custom reports based on claims data, patient visits and other practice management data.

Reporting is essential for the White Rose physicians. It’s also been key to the practice’s successful participation in a statewide Chronic Care Initiative led by the Pennsylvania Governor’s Office of Health Care Reform. Taking part in the program and its intensive training has paid off in the form of new insights into the care of diabetic and other patients with chronic conditions, as well as experience in quality reporting.

Since beginning participation with the program, the practice has created and used clinical reports to monitor its patients. For example, with diabetes patients, the practice’s care manager uses reports to track those patients’ blood pressure, cholesterol, and A1C levels, among other measures.

Almquist can quickly determine what percentage of the practice’s diabetic patients have had an annual flu shot or recently received an eye exam. She and the staff then can run reports showing the names of those who have not had the exams and contact those who need to come in – something not practical to do without an electronic health record.

Almquist also can quickly run a report to show providers exactly where each one stands compared to others in the practice care results and, importantly, how they match up to the goals the practice has set for chronic care.

If there was any doubt as to the usefulness of an electronic record, that was all expunged when White Rose applied to participate in the Governor’s Chronic Care Initiative, which was built on a model developed by Dr. Ed Wagner of Seattle, Washington.

From the beginning, White Rose did a good job of getting its diabetes patients back into the office for regular follow-up exams, Almquist says.

“What we did not realize, until we looked at the data as a whole, was that some of our patients had high A1Cs, high LDL cholesterol [and] blood pressure that needed better control,” she admits. “There has been improvement and I credit the reporting capacity of our EHR in helping us fight against clinical inertia – not taking more aggressive action. It’s helping us continue to push our patients to make changes in their behavior.”

Some practices have struggled to get on board with chronic care initiatives, like Pennsylvania’s, because their EHR was simply not designed to do population management or patient registries, says Colleen M. Schwartz, RN, Quality Improvement Coach for Improving Performance In Practice (IPIP). The national program, which trains chronic care providers in team-oriented approaches to treating patients with asthma and diabetes, is sponsored in part by the Robert Wood Johnson Foundation and the American Board of Medical Specialties.

“I’m not sure you can be a highly successful medical home without an EHR,” Schwartz says. “White Rose has been able to do incredible things and leapfrogged to the head of the group of practices we’re training.” Schwartz concludes: “White Rose Family Practice has been an incredible beacon and leader for the South Central Pennsylvania Region collaborative teams.”

Almquist says the increased focus on reporting has some unexpected side benefits, too. It has helped the practice to solidify its own care team by spreading around more of the duties to staff who haven’t always had a direct role to play in patient care. In the front office at White Rose, for example, a receptionist runs a weekly report that shows which diabetic patients, who are scheduled for near-term a follow-up appointment, have not yet had lab work done. She calls those patients, which allows her to get involved in care management, a key part of the chronic care model, as well as expands the variety of work roles she experiences.

“What is the purpose of collecting the data if you’re not going to use it to improve patient care?” asks Almquist. Good question.

White Rose Family Practice plans to begin tracking its success in scheduling colorectal screenings for patients. The plan is to have one of the practice’s nurses to follow up on patients who were scheduled for colonoscopy but didn’t get one.

Additional areas where the practice is doing more intensive follow up are immunizations and medication reconciliation for patients discharged from the hospital or seen in the emergency department within the past 24 hours. That reporting is helping improve staff productivity, too. Almquist says nurses use the reports to hone in on patients who most need the counseling.

Schwartz agrees with the utility of an EHR and adds that it also extends to improve patient care and education: “People are visual. When you have a report card from the EHR, people can see their blood pressure is trending down, their A1C going down. They can see that they have met most of the measures and are doing a good job of self management.”

Cathy Carpenter, MD, founder of White Rose, sums up the practice’s experience in using the EHR to manage and involve the practice’s providers and chronic disease patients in working as a team.

“We use the clinical data that we have created to provide better patient care. With an EHR, we are in position to cut down on healthcare costs, and to make people’s lives better.”