In Mississippi, we have seen primary care providers embrace the idea of adopting electronic health records. Specifically, since we began operating our Regional Extension Center in March of 2010, we were able to (relatively quickly) exceed our goal of enrolling 1,000 priority primary care providers (PPCPs).
Clearly, there was a desire by Mississippi providers to enter the electronic age of information exchange and better health care quality.
These providers were all highly motivated about the idea of electronic medical records, and they have worked hard to adopt a certified system. In fact, as of today, Mississippi was the second REC to meet its second milestone measure of having 100 percent of their providers adopt an Electronic Health Record (EHR) with quality reporting and electronic prescribing capabilities.
So, everything is going great in Mississippi, right? Not so fast.
Although our state’s providers have shown an enthusiastic willingness to purchase an EHR, as well as the patience to redesign practice workflows, educate their staff and adapt them to the new tool, they have not been as quick to take the next steps toward achieving meaningful use. There are barriers that are proving difficult to overcome.
The Office of the National Coordinator (that oversees the work of RECs such as ours) has started to track what they identified as practice-level barriers. So far, responses have been tracked for more than 4,000 practices. This represents feedback from about half of the RECs. The top three barriers include vender selection issues, system upgrades that are still needed, practices using non-certified EHRs and difficulties related to state’s slow progress in developing their information exchanges.
Indeed, these are all barriers, but what I believe is occurring in Mississippi, based on the practices that my team is assisting, is many have simply reached a level of fatigue they are finding difficult to overcome.
Overcoming fatigue and getting that second wind
I have seen some providers experience fatigue and frustration because they are not allowing themselves enough time to achieve “meaningful use” resulting in subpar outcomes. This is due to putting too much emphasis on receiving an incentive payment. As the REC, we must find ways to remove this frustration barrier when a provider is hastily trying to only meet a requirement and not truly meaningfully use their system.
In this case, our REC attempts to focus the provider more on the meaningful use criteria and less on the payments. By making the process the key, we can help them demonstrate success at achieving small steps that will ultimately lead to gold at the end of the rainbow – the enhanced payments from the EHR Incentive Program.
Giving into fatigue will also cause successful EHR adopters to lose their valuable momentum. We try and keep the momentum by constantly reminding providers that meeting Meaningful Use requirements is only part of the clinical transformation which is enabled by effectively using the EHR. The major focus of Meaningful Use is to improve the quality of care delivery to patients.
Another strategy to help providers maintain the momentum is a reminder that because the EHR Incentive Program is time-limited, the amount of extra money a provider can receive can be greater the sooner each stage of Meaningful Use is attained. The MS REC continually assists by providing education on stages of Meaningful Use and payments tied to the EHR Incentive Program.
Fatigue can also be minimized as the providers and their staffs become comfortable with the EHR system. The old adage, practice makes perfect, truly applies. As they become more and more comfortable with the system, it is no longer an obstacle. Thus, there is less fatigue.
The MS REC tries to identify providers that may be fatigued, and we step in and offer more education and training that is specific to each practice’s issue. In all instances, it is up to the REC to recognize fatigue and take the steps to help our providers gain their second wind.
Chris Williams is an EHR/HIT Regional Team Leader with the Mississippi REC. He and his team work with providers along the MS Gulf Coast.