Dr. Holsinger Discusses EHRs and Health Care Quality Improvement in a Rural Practice
In 2003, Dr. James Holsinger opened his solo family practice in Keokuk, Iowa. His rural health care practice has been paperless from the beginning. "We opened the doors with a computer system in place. I just couldn't envision having a business these days without having a computer in the process," said Dr. Holsinger.
When Telligen Health Information Technology Regional Extension Center , Dr. Holsinger’s local Regional Extension Center, asked Dr. Holsinger to participate in a Centers for Medicare & Medicaid Services Quality Improvement Organization project aimed at measuring and improving breast cancer screening, colon cancer screening, influenza vaccination, and pneumococcal vaccination, Dr. Holsinger jumped at the opportunity to use his electronic health record (EHR) system to improve health care quality in his rural health care practice.
Using Electronic Health Records for Preventive Care
Dr. Holsinger’s first step was to establish current benchmarks for breast cancer screening, colon cancer screening, influenza vaccination, and pneumococcal vaccination. Using his EHR, Dr. Holsinger saw that while his practice was exceeding state and national averages, there was room for improvement. Dr. Holsinger knew his practice could use patient reminders to engage patients, reduce missed preventive care appointments, and improve patient outcomes.
To initiate regular communication with patients, Dr. Holsinger’s staff uses the EHR to identify and create lists of patients needing preventive screenings. The staff also uses automated EHR reminders to prompt staff to follow up with patients after annual visits to ensure no patient fails to comply with their treatment plans or misses preventive screening appointments. With the patients identified, Dr. Holsinger’s staff uses their patient portal, phone calls, and paper mail messages to proactively reach out to patients and schedule preventive screenings.
Improving Rural Health Care Quality
Through patient reminders, Dr. Holsinger’s practice is improving health care quality and making a difference for patients. After two years of implementing patient reminders, Dr. Holsinger’s practice exceeded state and national benchmarks for breast cancer screening, colon cancer screening, influenza vaccination, and pneumococcal vaccination. For breast cancer screening, for example, 92% percent of Dr. Holsinger’s patients were compliant with screening standards, an improvement of over 30% from the project’s start.
Most importantly, Dr. Holsinger’s staff members and patients have embraced the culture of continuous health care quality improvement. As Dr. Holsinger explains, “Continuous improvement is now the practice’s culture.” According to Dr. Holsinger, patients have come to expect the practice’s message if they are not meeting their treatment goals and are cooperating in the quality improvement process.
Achieving Meaningful Use
Dr. Holsinger’s rural health care practice achieved meaningful use in 2011 and was the 54th organization in the nation to receive an incentive payment made under the Medicare and Medicaid EHR Incentive Programs.