Dr. Firpo Guerrero talks about preparing for Hurricane Sandy, i mp lemen ting EHRs, and serving three generations of patients
When Hurricane Sandy slammed into the East Coast, especially New York and New J er se y, m any doctors and other health care providers learned—the hard way—about the benefits o f el ectronic health records (EHRs) in ensuring the safety of patient records.
The New Jersey Health Information Extension Center (NJ-HITEC) conducted the follo wing interview with one doctor in Newark, NJ who was among the lucky health care providers who le arned the importance of having an EHR after being hit by a natural disa ster.
About Dr. Firpo E. Guerrero
Firpo E. Guerrero, M.D., has been practicing medicine in the Ironbound section of Newark, NJ for 26 years. Newark is the largest city in the Garden State with a diverse population of approximately 277,000 and a median annual income of $35,000, well below the national median annual income of $50,000 (2010 U.S. Census Bureau).
Dr. Guerrero’s practice, Essex Gastro Associates, P.A., is solely gastroenterology. His patient population is approximately 80% Spanish and Portuguese speakers. His clients are mainly immigrant blue-collar workers who are employed in construction, work at Port Newark, or are local merchants. He treats a small population of professionals as well.
The Interview with Dr. Guerrero
In an interview with the tri-lingual doctor who speaks English, Spanish, and Portuguese, Dr. Guerrero talks about being prepared for Hurricane Sandy as well as describes how he, his staff, and his three generations of patients are adapting to EHR technology and how NJ-HITEC, the Garden State’s Regional Extension Center, is assisting him in attaining Stage 1 Meaningful Use .
What made you decide to implement an Electronic Health Record system into your practice?
Dr. Guerrero: We were early adopters of EHR technology. Our earliest office-side electronic record is dated October 20, 2003, and that is when we went “live” with Medent, our EHR vendor. It was an expensive endeavor, because there weren’t many EHR vendors or options. We implemented the EHR system, because I wanted to get away from the clumsy, cumbersome paper records; it’s a more efficient way to handle patient’s charts, and I anticipated that it would eventually be mandated.
Hurricane Sandy wreaked havoc on the East Coast, especially New Jersey. How were you prepared for this storm?
Dr. Guerrero: The Sunday before the storm, we called our scheduled patients to check in on them and to let them know that we would be closed. The office was closed on Monday, October 29 and Tuesday, October 30, but we saw patients on Wednesday, October 31.
We have a natural gas generator that powered our EHR system, lights, phones, and heat—everything that runs on electricity in our office. Once we powered up the generator, all of our patient records were accessible. We didn’t lose any patient files or patient data.
The best advice I can give my colleagues about preparing for a storm or any other type of disaster is to continuously back up your files, invest in a generator, and select an IT company that is customer service-focused to answer all your questions and walk you through any problems.
You opened your practice in July 1986 and now you are treating three generations of patients. Describe a typical day in your office.
Dr. Guerrero: I am treating the 75-year-old grandfather, and his son, and his grandson—the older generation who barely speaks English to the grandchild who is totally assimilated into the American culture and new technology. Moreover, I may go three to four days treating 20 to 25 patients daily and hardly speak any English. What is so rewarding is that I see the multi-generational success of the college-educated grandchild accompanying his grandmother or grandfather for an office visit.
How did you get connected to NJ-HITEC?
Dr. Guerrero: I was introduced to NJ-HITEC through one of the labs we use—Miraca Life Sciences. My lab representative was encouraging me to begin the Meaningful Use process so I could receive the EHR incentive payments . NJ-HITEC works with Miraca as well, so that is how we connected. NJ-HITEC’s North Jersey Regional Director Ron Manke visited our office to discuss the EHR Medicare Incentive Program and explained to us how to get started.
I have two parts to my office—the office side that has been electronic for nine years and the endoscopy center where we perform the medical procedures. On the medical procedure side, we partnered with ProVation MD to provide an EHR interface to connect with our Medent system. It’s a perfect system connection, because when we schedule endoscopy appointments, the data is automatically populated in the ProVation system. On the flip side, when I write my report including the photographs, the information automatically populates into the patient’s chart on Medent, so I have all the patient’s information in one electronic file.
As a solo practitioner, there is so much to do to meet all the federal requirements. We had been collecting the correct data, but how to run the proper reports and demonstrate that you are meeting the federal requirements is not straightforward. NJ-HITEC stepped in to assist my office manager, Catarina, and my staff to help us meet those criteria to attain Stage 1 Meaningful Use . I am happy to state that because of NJ-HITEC, we plan to attest by the end of year to gain the full Medicare incentive.
What were some of the challenges that you encountered during EHR implementation?
Dr. Guerrero: The biggest challenge was to get the 20,000 paper records scanned into our EHR system. The data for new patients are entered in the EHR system during their first visit. For follow-up visits, my staff scanned the patient’s chart into the EHR system the day before the visit. I could at least flip through the patient’s chart electronically, although I was unable to pull some reports, because they were part of the progress notes. For my patients dating back to 1986, the paper files were too large to be scanned the day before the appointment. However, over last summer, we scanned every last paper chart into our system-opening up two rooms for the practice.
The other key challenge is that anytime you implement a new system, it slows you down. In turn, I saw less patients and worked longer hours until I learned how to use the technology effectively. Overall, it took about two months.
Lastly, when we first began EHR implementation, I worked very hard to concentrate on keeping my eye contact with the patient while I was looking at the computer screen and inputting information. It was a challenge to make the patient feel that I was paying attention and listening. This does get easier with practice.
What are the benefits of electronic health records (EHRs)?
Dr. Guerrero: The benefits of electronic health records are amazing—more than one person can view a chart, we don’t spend hours looking for a patient’s chart, and lab results and tests are delivered electronically. However, no report or test result gets placed in a patient’s EHR until I review it and transfer it into his or her file.
Moreover, if a doctor calls me for information or has a question about one of my patients, I don’t have to put him or her on hold and ask my staff to find the chart. I ask for the patient’s date of birth, and I can pull up chart in seconds. The chart also includes a picture of my patient, so I immediately know who the patient is and his or her medical history. There are many common names in my patient population, so seeing a face helps tremendously.
The amount of time my staff and I save is another one of the benefits of EHRs. I don’t have piles of paper around my office, with lab reports attached that I have to pick up, review, initial, and re-file. If I have a few minutes between patients, I go to my computer, review the reports, approve them, and place them in the patient’s electronic health record.
How have your patients adapted to your use of EHR technology?
Dr. Guerrero: At the beginning, they were a little leery of the new technology, but now the patients see how easy it is to bring up their name and check their information. We can send prescriptions directly to the pharmacy, which at first, some of my older patients did not feel comfortable with. Now they understand and welcome the convenience. Once the system works well, it’s easier to get the patients on board.
I think the biggest benefit for my patients, which they realize, is that their information and chart are not going to get lost. They are not going to get mixed up with someone else.
How has your staff adapted to the new EHR technology?
Dr. Guerrero: My staff has had to learn a lot, but I have a relatively young staff who welcome technology. Even those who aren’t as tech savvy realize that it makes their job much easier. You do have to keep in mind that when you train a new staff member, it does take a little longer, even to make an appointment, but once he or she gets it, it works out fine.