Dr. Sonnenberg Leverages Clinical Summaries to Improve Care Delivery
Dr. Frank Sonnenberg is a Professor of Medicine at the Rutgers Robert Wood Johnson Medical School in New Jersey and the Medical Director of Clinical Information Systems at the Robert Wood Johnson Medical Group, the faculty practice of the Robert Wood Johnson Medical School. Dr. Sonnenberg led the EHR implementation at The Robert Wood Johnson Medical Group, which is a large multi-specialty group with over 500 providers and more than 40 specialty practices.
EHR Implementation Challenges and Solutions
The biggest obstacle Dr. Sonnenberg faced during the EHR implementation process was physician resistance. Many of the providers in the medical group feared they would have to change the style of the medical practice and documentation that they had become accustomed to. Additionally, there was a perception that an EHR would create more work for the clinicians. Two efforts helped mitigate these concerns. First, the EHR implementation effort was led and managed by clinicians. The fact that the impetus for change was internal helped assure providers that the EHR system could be integrated into the practice’s workflow without too much difficulty. Second, practice leadership had a strong commitment to implementing the EHR. As Dr. Sonnenberg says, they realized it “was not optional, but absolutely essential” in order to keep up with the evolving health care environment.
Achieving Meaningful Use: Focus on Tobacco Use
As the medical group sought to achieve meaningful use stage 1, it initially focused on improving adherence to recording smoking status in the EHR. Dr. Sonnenberg prioritized this measure because reports indicated that providers addressed smoking habits in only a small percent of visits. Despite the low compliance rate, Dr. Sonnenberg convinced physicians in all specialties that smoking was relevant to their patients. Within a few months of asking providers to discuss smoking status with their patients, the medical group achieved nearly 100% compliance with the measure.
Overcoming Barriers to Meaningful Use: Clinical Summaries
For other measures, the medical group found it more difficult to achieve compliance. Generating clinical summaries proved most challenging. Support from the leadership was critical in overcoming this barrier. The president of the group issued a directive that all practices were obligated to meet all meaningful use requirements. Monthly reports of providers’ performance were distributed and the leadership personally contacted those who were not compliant. Additionally, to minimize the burden on providers, the medical group worked with the vendor to automate every part of the summary that it could. The EHR system now automatically populates visit summaries with key clinical observations such as vital signs, prescriptions, allergies, and problems assessed during the visit. Furthermore, Dr. Sonnenberg engaged the entire care team, including practice managers and nurses, in implementing the clinical summaries. Providers were encouraged to populate the clinical summaries and other staff members assisted by printing them out and ensuring patients received them before leaving the office.
A Holistic View of Meaningful Use
Once providers began to regularly provide clinical summaries to patients, the medical group linked the documentation of smoking status to the clinical summary functionality. Thus, when a provider counsels a patient on smoking cessation, the visit summary automatically includes information about participating in the medical group’s smoking cessation program. As a result, referrals to the program have increased significantly. This exemplifies how meaningful use is more than just a series of independent measures; it is an integrated framework that supports the provision of better healthcare through care coordination.
Demonstrated Success and Lessons Learned
Through Dr. Sonnenberg’s leadership, the medical group achieved full compliance with meaningful use in more than 98% of its eligible Medicare providers. Reflecting on the path to meaningful use, Dr. Sonnenberg identifies several lessons learned:
- Individual provider performance feedback is essential in improving compliance with core measures.
- It is important to involve all members of the practice in planning for and implementing Health IT and meaningful use.
- And, EHRs can serve as a powerful tool for integrating care processes and improving communication and collaboration among members of the care team.
As the practice has embraced the EHR system, it has transformed from a federation of forty independent specialty practices to a thoroughly integrated group. Through the meaningful use framework, the medical group improved care coordination, which ultimately increased patient satisfaction.