Dr. Sahgal Uses an EHR System in Six Offices to Improve Diabetes Care
In 1999, Dr. Sumir Sahgal established Essen Medical Associates , a multispecialty physician group in the Bronx, New York. The practice employs approximately 60 healthcare providers across multiple divisions, including ambulatory, house call, nursing home, and hospital services. In 2008, Dr. Sahgal implemented an EHR system throughout the practice’s six offices, which allowed him to connect all of the offices electronically and facilitated a targeted effort to improve diabetes care.
After making the decision to go electronic, the practice weighed several approaches to EHR implementation. Dr. Sahgal first considered phasing the EHR in over a period of time. The second thought was to close the office briefly during EHR implementation. In the end, Dr. Sahgal determined to “hit the ground running” and keep the practice open through the implementation process. The practice felt it was important to remain open during EHR implementation as this would allow providers to identify any potential issues during live testing.
The physicians received four to six weeks of training before the designated implementation date. But, as was to be expected, the providers still had much to learn about the EHR system once they began using their new EHR system. Dr. Saghal describes the first day the practice used the EHR system as “especially chaotic.” Providers and staff were frustrated initially. But, after six months of using the EHR, they became more comfortable with the system and morale improved. Reflecting on the transition, Dr. Sahgal notes it would have been helpful to decrease patient volume at the onset of implementation and he recommends providers consider doing so to give physicians time to adjust to a new EHR system.
Dr. Sahgal reveals the practice is planning to open additional offices and is considering offering more services. The EHR system positions the practice well to do this. First, providers are already experienced using the EHR system to communicate across offices. And, because the practice hosts the EHR system, it can easily implement it in new settings.
Establishing a Local Health Information Exchange
One of the ways Dr. Sahgal leveraged the EHR system is that he implemented it across all of the practice’s six offices. Each of the offices focuses on a different area of care, and patients routinely visit different practice locations. Now, all of the offices are connected by the EHR system and patient records are available to providers throughout the practice, regardless of location. The EHR system is also linked to a local hospital record system, which keeps providers informed about care their patients obtain outside of the medical practice. For instance, the practice receives a phone call and an electronic fax when one of the practice’s patients is admitted to or discharged from the hospital. The practice is currently in the process of developing a connection with the hospital EHR system that would allow for bidirectional information exchange.
Using the EHR System to Improve Diabetes Care
Once familiar with the EHR system, Dr. Sahgal began using it to improve diabetes care delivery. Of the 62 counties in New York, the Bronx has the highest incidence of diabetes. Dr. Sahgal, determined to improve diabetes care in the county, investigated ways the EHR could assist him. He used the EHR to identify pre-diabetic and diabetic patients. He then developed a comprehensive patient and provider education campaign. The program is designed to encourage patients to become more engaged in their own care. Patients attend group education sessions and receive individual counseling with a certified diabetes educator. On average, approximately 10% of patients who are pre-diabetic will develop diabetes within a year. Under Dr. Sahgal’s program, only 2% of the practices pre-diabetic patients go on to develop diabetes. Dr. Sahgal attributes this success to active patient monitoring with the help of EHR clinical decision support system alerts, provider follow-up after appointments, and referral to the diabetes education program. Additionally, Dr. Sahgal uses the EHR to coordinate care across providers in his practice for diabetic patients. For example, he can use the EHR to access notes from the patient’s endocrinologist, ensuring the entire care team is kept apprised of the treatment plan. In this way, the EHR helps Dr. Sahgal, track, monitor, and ultimately provide better healthcare to his patients.