1. Acquire the technology. The Center for Bone and Joint Surgery of the Palm Beaches began its meaningful use journey by acquiring electronic health record software from Vitera Healthcare Solutions. While seemingly simple, having the correct infrastructure is crucial to meeting meaningful use requirements. "Almost half the measures are typically met by just having an ONC-certified EHR and [other] appropriate equipment," Mr. Klebonis says. For example, he says computerized physician order entry, drug interactions and medication reconciliation can be accomplished through the technological infrastructure without having to disrupt the physician's workflow. Nashville, Tenn.-based Hospital Corporation of America provided the center with financial support for much of its meaningful use-related systems, according to Mr. Klebonis.
2. Complete one-time events. Mr. Klebonis estimates a quarter of meaningful use requirements can be achieved through one-time events. For example, disease management and registry updates are one-time exports, he says.
3. Implement new practices. The remaining quarter or so of meaningful use requirements necessitate new practices that will impact daily operations, according to Mr. Klebonis. This step requires expert planning, training and support for physicians as they transition to different processes. One strategy the Center for Bone and Joint Surgery of the Palm Beaches is using to facilitate this transition is planning to implement changes in the summer, when roughly 30 percent of the local area's population vacations somewhere else. Having fewer patients lessens the strain on physicians as they learn to adjust their workflows as necessary.
The orthopedic practice has already realized some of the benefits of meeting meaningful use standards, including some unexpected benefits. For example, the practice started using the new decision-support programs to review all female patients over the age of 65 for osteoporosis risk factors. Physicians can reach out to these patients to encourage a bone density scan and suggest a calcium supplement. In addition to helping prevent osteoporosis, this strategy gains patients' loyalty by proactively contacting and educating them.
The technology required for meaningful use is also helping the orthopedic practice to move away from dictation and transcription. Currently, the practice spends roughly $60,000 each month on transcription. Mr. Klebonis estimates the center can reduce that cost by nearly half over time as physicians use the new technology more.
Another meaningful use benefit for the center was its requirement to record patients' height, weight and blood pressure. While this process was not standard for the orthopedic practice before meaningful use, physicians can now use this information to pre-screen patients for surgery. Information such as blood pressure and body mass index can predict which patients will be unlikely to pass medical clearance for surgery. "We're not taking the six hours to schedule that case with all the different vendors and hospital and providers; we know beforehand the patient is likely to not get clearance, so we wait to get a more thorough evaluation from the primary care provider, Mr. Klebonis says.
A common challenge for healthcare organizations implementing new processes, such as those required under meaningful use, is gaining physician buy-in and minimizing short-term slowing of processes and reduced productivity as clinicians adjust. The Center for Bone and Joint Surgery of the Palm Beaches is overcoming these challenges by providing on-site support for physicians and meeting with physicians to discuss the changes. "If we didn't have physician buy-in, we wouldn't have reached the benefits," Mr. Klebonis says. In addition, the center joined a health information exchange to meet some otherwise challenging measures. For instance, the measure requiring lab results to be structured in a certain format was initially an obstacle for the practice, Mr. Klebonis says. However, after connecting with HCA and its local affiliate Palms West Hospital in Loxahatchee, Fla., through the HIE, the physicians were able to have all lab results delivered directly to their EHR in the correct format.
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