Dr. Tashjian practices in rural Ellsworth, WI, a town of about 1,500. “I suspect we have more cows than people!” said Dr. Tashjian. Dr. Tashjian and his staff implemented an EHR system about a year ago, and have done everything they can to make it help them provide better care for their patients.

Every single meaningful use measure for EHRs is aimed at improving patient care. As a practicing physician who spends most of the time in the office, Dr. Tashjian can say “a lot of thought went into meaningful use. The meaningful use requirements are not just hoops to jump through – these are actually things that can help us improve care and practice better medicine. I've seen it firsthand,” said Dr. Tashjian.

More Patients Take Ownership of Their Care

One of the meaningful use requirements is to provide patients with clinical summaries after each visit. “When we first implemented EHRs in our practice a year ago, we didn't have access to clinical summaries,” Dr. Tashjian explained. “But our vendor implemented this feature in our EHR system, and we are now able to create and print clinical summaries for every patient when they leave.” The clinical summary includes a list of the patient’s medications, reminders as to when they should make their next appointment, a list of laboratory tests done during the visit, and any special instructions about their treatment plan. If it's a young mother with a new child, for example, the mother gets all the data on her child – including reminders for when the next check-up and immunizations are due. If it's an elderly patient who's on six or eight different medications, the clinical summary helps clear up any miscommunication.

According to Dr. Tashjian, the average patient with diabetes is on eight different medications and visits the office for testing a minimum of twice a year. “It's really nice to say, ‘Here's your list of medicines. Here are the blood tests that we did today. And these are the things I want you to do,’” explained Dr. Tashjian. “Two things happen: Because I'm typing it and not handwriting it, they can actually read it. They put the sheet on their refrigerator, and they remember it. I see more and more people coming in with folders where they're keeping track of this. It's ownership of their care.”

The Benefits of E-Prescribing

E-prescribing is another meaningful use requirement that Dr. Tashjian praises because it helps ensure patients safety. He recalls how e-prescribing helped promote patient safety when the U.S. Food and Drug Administration (FDA) issued a warning about taking a cholesterol medication 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.”

Dr. Tashjian and his medical staff 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 at the lower dosage.

Prior to e-prescribing, pharmacists often called Dr. Tashjian when he forgot to indicate whether or not he wanted refills ordered. “Now, the computer doesn't let me submit the order until everything's filled in,” he said. Dr. Tashjian used to talk to the pharmacist two to 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.”

Meaningful use also requires compatibility checks to make sure prescribed drugs are compatible and do not interact adversely with other drugs. Dr. Tashjian remarked, “With my current EHR, every prescription I write is automatically checked for possible adverse drug interactions.”

Refilling Prescriptions from Estonia

Last summer, Dr. Tashjian was in Estonia at a McDonald's when a patient emailed him requesting a refill for his high blood pressure medication. “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,” he recalled. Then, he was able to refill the prescription at the local pharmacy, over the Web. “Thanks to my EHR system, if I can access the Internet, whether it's on my iPad, my laptop, or my smart phone, I can access a medical record.”

Although physicians aren’t always available, thanks to EHRs, patient information is. “If a patient calls my partner who's covering at night, she can go on her smart phone or on a computer, and look up the patient's medical record. I recently chaperoned a group of local Boy Scouts on a trip to Sweden. I felt confident being so far away from my patients. As long as I could access an Internet connection, I could pull up a patient's medical record if I needed to do so. You can't be available 24 hours a day, seven days a week. But the information is, and that's the important part,” said Dr. Tashjian.

Looking Forward

Dr. Tashjian has an 80-year-old patient who is waiting for the practice to launch a patient portal, so she can check her health record. Dr. Tashjian says, “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.”

The practice’s EHR system continues to improve and has new capabilities that it didn't have last year. Dr. Tashjian adds, “We have formed a great working relationship with our Regional Extension Center, the Wisconsin Health Information Technology Extension Center (WHITEC), and our vendor to continually improve our electronic records.”

Dr. Tashjian’s practice is already able to electronically share immunization records with the State of Wisconsin. When the medical staff records immunizations in the EHR, this information automatically goes into the state's immunization registry. Now that he has access to great new data, Dr. Tashjian plans to contact his patients with heart disease and diabetes who have not received the flu vaccine and advise them to come in and get a flu shot. From there he will concentrate on his healthy population according to risk by age and other chronic illnesses. “We could never do this kind of management on paper,” Dr. Tashjian remarked.

Dr. Tashjian’s practice is currently working with local public health departments to find a way to electronically report communicable diseases. “The paper form is kind of a pain to fill out. If we can do that electronically, so much the better,” said Dr. Tashjian.

Dr. Tashjian admits he has met a lot of docs who said that going from paper to electronics was tough. “But I've never met a doc who said, ‘I want to go back to paper.’” EHRs have clearly improved quality of care, because practices can get information when they need it. “You make more informed decisions. And you can make better decisions,” explained Dr. Tashjian.