Sample Case Study - Family Practitioner Demonstrates Care Coordination with Referring Physicians

To use the EHR to improve care coordination within the local referral network.

After the Meaningful Use Stage 1 regulations for electronic health records (EHRs) were released in July 2010, Dr. Brull contacted her state’s Regional Extension Center (REC) to obtain their assistance in achieving the Meaningful Use Stage 1 objectives. The REC sent a field representative to work with Dr. Brull on achieving the core meaningful use objectives. She first assessed the security of her EHR system and developed documentation to meet the risk analysis and data security requirements in the recent Health Information Technology for Economic and Clinical Health (HITECH) Act.

“The policies and procedures she developed were a big help and took a load off my shoulders,” said Dr. Brull. “Although this is the main assistance I have received so far from the REC, we have been working on all the meaningful use objectives and they have helped us across-the board.”

Dr. Brull also worked with the REC representative on what data fields are required and how to capture the required structured data within her EHR. For example, smoking data for adolescents was captured at intake and codified using CPT codes, which allows for reporting of structured data.

Dr. Brull’s EHR system, once upgraded to a certified EHR, will enable her to meet Meaningful Use Stage 1 objectives for care coordination. She views this as just the first step toward achieving fully electronic care coordination.

• Exchanging Key Clinical Information. Dr. Brull’s EHR system is fully integrated with the systems at two other solo practices, allowing these physicians to share clinical information and coordinate patient care. She also exchanges key clinical information such as patient histories and medication and allergy lists with referring physicians via integrated FAX as part of the EHR referral process.

• Clinical Summaries at Transitions of Care. Dr. Brull exchanges clinical summaries using her EHR in different ways depending upon the capabilities of the receiving facility or provider. The EHR is connected to a FAX server which lets her easily send or receive clinical summaries by FAX . When she receives a paper discharge summary, staff scan it into the patients’ EHRs.

• Medication Reconciliation. Dr. Brull uses the EHR system to perform medication reconciliation across care settings by updating patient medication lists received from referring physicians and/or the local critical access hospital. The e-prescribing system she uses (SureScripts) also facilitates medication reconciliation by enabling her to verify what prescriptions the pharmacy has filled for her patients rather than relying solely on her medication list. Patients also play a role by bringing their current medications to their appointments, which the nurse records in their EHRs at intake.