Providing Quality Health Care for Patients: Dr. Chris Tashjian’s Perspective on EHRs and Meaningful Use
Posted Nov 15 2011 9:08am
A specialist in family medicine, Dr. Christopher Tashjian, practices in rural Ellsworth, WI. In the year since his practice switched to electronic health records (EHRs), he’s seen a number of benefits, thanks to printed visit summaries, e-prescribing, and remote, electronic access to health records. Dr.Tashjian is a Meaningful Use Vanguard (a “MUVer”) and believes achieving meaningful use of EHRs and health information technology (health IT) is the roadmap to improving health care quality and efficiency.
ONC sat down with Dr. Tashjian to talk about his perspective on EHRs and meaningful use.
Tell us about yourself.
I practice in rural Ellsworth, WI, a town of about 1,500 people. I suspect we have more cows than people! I am also President of River Falls, Ellsworth & Spring Valley Medical Clinics and am involved in setting policy for the medical community, serving on several Boards of Directors and Committees.
Your practice just transitioned to EHRs a year ago. Can you tell us about this experience?
We implemented our EHR system about a year ago, and we continue to improve it. This year, we have new capabilities that we didn’t have last year. Next year will be even better. This was not the case in more than 20 years of using a paper record!
Can you tell us your thoughts on the meaningful use requirements?
Every single meaningful use measure is aimed at improving patient care. As a practicing physician who spends most of the time in the office, I can say a lot of thought went into meaningful use. The meaningful use requirements are not hoops to jump through—these are actually things that can help us improve care and practice better medicine. I’ve seen it firsthand.
Can you give us some examples of how you feel the meaningful use requirements can help doctors provide quality health care?
One of the meaningful use requirements is an after-visit summary. When we first implemented EHRs in our practice a year ago, we didn’t have access to an after-visit summary. But our vendor implemented this feature in our EHR system, and we are now able to create and print visit summaries for every patient when they leave.
This office-visit summary includes the medications patients are taking, the ones we’ve changed, when we want them back for another office visit, a list of any lab tests done today, and any special instructions about their treatment plan. If it’s a young mother with a new child, she gets all the data on the child–including a reminder for when the next check-up and immunizations are due. If it’s an elderly parent who’s on six or eight different medications, it clears up some of that miscommunication that we had before the EHR.
And because I’m typing it and not writing it, they can actually read it! All their important health information is captured in the summary. They can take a print out of the summary to another doctor, which is also a helpful safety measure. The new doctor will be able to see what has been done previously, and can compare results of the tests they perform with the test results in the summary to see if there is a difference or change.
In addition to helping providers offer quality health care, the summaries allow patients to better remember what happened at their most recent visit and review their health data.
What about improving patient safety?
From a safety standpoint, one of the most obvious benefits is the computer physician order entry. There is no more confusion about the care instructions or the prescriptions I write because it is all done electronically.
Another meaningful use requirement that helps ensure patient safety is e-prescribing. A while ago, the U.S. Food and Drug Administration (FDA) issued a statement about a cholesterol medication. The FDA was concerned about the dosage of a common cholesterol medication when used in combination with a certain high blood pressure medication. Since my EHR has e-prescribing capabilities, I was able to search our database of patients and identify the more than 1,400 patients who were taking the cholesterol medication as well as the 250 who were taking both medications.
We contacted the patients and dropped their dosages to the appropriate level identified by the FDA. These patients are now coming in for check-ups to make sure their cholesterol is being effectively managed with the lower dosage.
This is a perfect example of something we could not carry out with paper records.
Meaningful use also requires that our system have compatibility checks to make sure the drugs we prescribe are compatible and do not interact adversely with other drugs the patient may be taking. With my current EHR system, every prescription I write is automatically checked for possible adverse drug interactions and proper dosages.
Before e-prescribing, I’d get a call back from the pharmacist who would say, “You forgot to put if you want any refills.” Now, the computer doesn’t let me submit it until everything’s filled in.
Our EHR also connects with our practice management system, so the EHR knows the patient’s health plan, which drugs are on the plan’s approved formulary list and which are not. I used to talk to the pharmacist two, three times a day. Now I don’t talk to him more than once or twice a month–and that’s because I call asking him a question.
Can you tell us about your experience in Estonia last year?
Last summer, I was in Estonia at a McDonald’s. And I had a patient email me and say, “I’m out of my high blood pressure meds.” Because I now have a mobile app for my EHR, I was able to get into the patient’s medical record through my smart phone and look up the needed prescription. Then, I refilled it in the local pharmacy, over the Web. If I can access the Internet, whether it’s on my iPad, my laptop, or my smart phone, I can access a medical record.
You can’t be available 24 hours a day, seven days a week. But the information is, and that’s the important part. So if a patient calls my partner who’s covering that night, she can go on a computer or smart phone, and look up the patient’s medical record.
What’s up next for your practice? Do you have plans to implement other health IT tools?
We’re investing in a patient portal now. Next year, we want to do something like a healthy hub, so we can start exchanging information with other providers.
I’m already able to electronically share immunization records with the State of Wisconsin. We did a beta test, and now when we record our immunizations into our EHR, this information automatically goes into the state’s immunization registry. Now that we have access to great new data, we are going to contact our patients with heart disease and diabetes who have not received the flu vaccine and advise them to come in and get a “flu shot.” Then we will be concentrating on our healthy population according to risk by age and other chronic illnesses. We could never do this kind of management on paper.
We’re also trying to work with our local public health departments to find a way to electronically report communicable diseases that we currently have to do by paper–the form is a kind of a pain to fill out. If we can do that electronically, it will be so much the better.
Anything else you’d like to share?
I’ve met a lot of docs who said that going from paper to electronic health records was tough. But I’ve never met a doc who said, “I want to go back to paper.” EHRs have clearly improved the quality of health care because you can get information when you need it. You make more informed decisions. And you can make better decisions.