How One Physician-Owned Health System Mastered its EHR

Implementing an EHR is no easy task, but learning from the success of others can help. At the HIMSS13 Conference in New Orleans, attendees had a chance to learn from leadership at Coastal Medical, Inc., a Providence, R.I.,-based private group practice that received the 2012 Ambulatory HIMSS Davies Award of Excellence. The award recognizes exemplary EHR implementations and utilizations in independent ambulatory practices, community health clinics/organizations, and enterprise clinics.

Coastal Medical implemented its fully integrated EHR in its offices in 2006 and early 2007. Since then, the group, which comprises 91 providers in 19 offices specializing in primary-care services, has leveraged its EHR to improve care quality and coordination. Its practices are recognized as Patient-Centered Medical Homes, and the group is participating in the Medicare Shared Savings Program. 

Meryl Moss, Coastal Medical’s chief operating officer, attributes much of the group’s

success in mastering the EHR, and in the shift away from traditional fee-for-service, to the way it approached EHR adoption. It was considered a clinical challenge and strategic tool, rather than solely an IT project, said Moss during her session, “Excellence in HIT-Enabled Ambulatory Care - A Davies Story,” which she co-presented with G. Alan Kurose, an internal medicine physician and Coastal Medical’s president and CEO, and  Steven M. Kempner, an internal medicine physician and the adult medical director.

“We could not move away from the fee-for-service world into shared savings, we could not be part of an ACO, we could not become Patient-Centered Medical Homes, we could not get meaningful use monies without this foundation,” said Moss.

Here are five of many driving factors Moss said contributed to the group’s success:

1. Broad perspective.  The meaningful use incentive money was not the main goal of Coastal Medical when implementing the EHR, said Moss. Rather, the goal was to use the EHR to improve care quality and to bring all of its practices together. We were “looking at the electronic health record as an actual strategic tool,” she said.

2. Physician leadership. You can’t have a successful and smooth EHR implementation without physician leadership, said Moss, noting that the group held weekly early morning planning meetings so that physicians could attend, voice concerns, and identify EHR improvement areas. “It allowed doctors to say, ‘OK, we’ll try it because if we don’t like it, they’re going to change it,’” said Moss. “We created trust.”

3. Clinical focus. Though Coastal Medical’s robust IT staff was very important in getting the EHR up and running, the clinicians were the real “superusers,” said Moss.  

4. Training. When it was suggested the medical group allocate eight hours of EHR training per user, Coastal Medical opted instead for 12 hours of training per user. Training is critical, said Moss, adding that, even now, the group is “constantly training people on the use of the record.”

5. Vendor partnership. A strong vendor relationship from the get-go is crucial, said Moss. Coastal Medical, which viewed its vendor as its partner throughout the process, is currently working with it on analytics and care management functions, she said. The EHR “is not something that you take out of a box, you have to develop collaboration and partnership with the vendor and it works very well.”