I have written in the past that I was chosen as a “super user” of our hospital’s EHR. I tend to gravitate towards new technology, excited by new toys, and their application in hopefully making my life better and easier fascinate me. In healthcare, we want to make our patients lives’ better and safer, and this is the promise of EHRs. There has been a lot of attention placed on the EHR by the federal government in recent years. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, provides monetary incentives to physicians and others though CMS for the adoption of EHRs that meet what is known as meaningful use. Meaningful use has 15 required core components (e.g., e-prescribing, electronic exchange of medical information, active medication list, etc.) and a menu set recommendation (you must have five out of 10 components). The EHR must be certified by CMS to make the practice eligible for incentive payments. Unfortunately, physician assistants were not included in HITECH except in “PA-led” rural health clinics and federally qualified health centers. The American Academy of Physician Assistants, along with U.S.
Rep. Karen Bass (D-Calif.) — the first PA in Congress — are working to remedy this omission. Our practice recently adopted an EHR called drcrhrono, after waiting a long time for the software to become more robust, and for something significant to be developed on our preferred platform, the iPad. Secondary issues have been the meaningful use incentives, although it is always good to get paid for doing something that is in the best interest of our patients and patient care. We were fortunate to adopt something at an early point of our private practice as we avoided a lot of the transitional issues that must be staggering for large, established practices with significant investments in technology. These are not to be minimized or discounted as some practices are heavily invested in aging technology, and the incentive payments are a good thing to help practices modernize and pay for parts of the transition. Our platform meets all of the meaningful use criteria making us eligible for incentive payments. More important, is that the EHR meets our day-to-day needs of a small but busy surgically oriented practice. I spend a lot of time in our clinician lounge between cases, and am exposed to other EHRs in use by our community’s physicians. There are numerous PC and web-based EHRs that meet meaningful use criteria, but drchrono is the only one that I know that is entirely based on the iPad. While there are computers and Internet available to access EHR in the office, pre-op, post anesthesia care unit, etc., having the EHR in your hand on a portable device is a definite plus. For us, any EHR platform had to be very customizable, as the types of medical data that we collect and record — and the types of documents and order sets we generate — are very specific to a plastic and reconstructive surgical practice. As the resident technology guru in our practice, it has fallen to me to customize our implementation of the EHR, and I’m thankful that the web portal for this software was intuitive and easy to manipulate. We have gone from handwritten, paper records, to an electronic, cloud-based record, in a few short months without too much pain. Our EHR is set up and customizable to the way we flow patients, and we didn’t have to adapt our flow and practice to the record. We have a number of patients that we see for the first time as inpatients, and drchrono allows me to create a record for them at bedside, gather essential medical information, and schedule them for a follow-up appointment in a few simple steps. The when and where of the appointment is forwarded to them electronically by e-mail and text message. Our histories and physical exams (H and Ps) have never looked better, nor been more complete, with full sets of surgical orders that can be electronically signed and faxed to pre-op (or any where else) directly from the iPad. These features are very convenient for a small practice, and it makes us look larger and more professional that our size would initially indicate. The promise of the EHR is to do the administrative work of recordkeeping in a medical practice better, and easier, than paper records. So far, our EHR is meeting that promise, and I will write about this again as we continue to invest in and use technology in our practice of medicine. The original posting can be found here.