Virginia Practice’s MU Journey Leading to a Loftier Goal – PCMH

Regina Federspiel, Richmond, Virginia


For Commonwealth Pediatrics in Richmond, VA, successfully navigating through Meaningful Use was the first big step on the path to certification as a Patient-Centered Medical Home (PCMH). They have been dedicated from the beginning in taking the necessary steps to meet Meaningful Use measures, and the entire staff pitched in so that no one person felt bogged down in the complex journey.

“There is nothing fun about Meaningful Use but you have to make it seem not so overwhelming,” said Office Manager Regina Federspiel.

Keeping the mindset that everyone, from frontline staff, to doctors and managers, is working toward the common goal of PCMH has kept them determined. Becoming a PCMH shows that a practice organizes primary care to emphasize patient-centered care coordination that ultimately leads to higher quality care and lower costs.

Commonwealth Pediatrics, which has three offices in the Richmond area, will mark its 10th anniversary of using an EHR system in August 2016. Federspiel said physicians and staff committed from the beginning to train and become fully functional with an EHR system rather than scramble to find one at the last minute. In fact, their vendor (Allscripts) recognizes the practice as a super-user and occasionally requests that they host site visits to share their best practices.


Federspiel said they have met the many measures put forth by the Centers for Medicare & Medicare Services over the years by creating processes for both how they run their office and how they learn to meet new measures. Frontline and administrative staff are the first to learn the information. They use themselves as test patients, acting out visits and taking screen shots to naturally integrate the EHR system into a provider’s routine. Federspiel said making EHR commonplace for physicians is important so they can focus on patient care and not just “getting through the clicks” in the system. “Doctors don’t like clicks,” she said.

The doctors were even more concerned that “getting through the clicks” would prevent them from connecting with their patients, said Office Manager Ashley Encinas. As a result of this concern, administrative and frontline staff worked with the doctors and nurse practitioners to increase their proficiency and comfort level using the EHR while capturing the needed measures.

“We looked to separate the ‘business’ aspect of Meaningful Use when it came time to get the providers up to speed, so we focused on what it means for their role as a provider to care for the patients,” Encinas said. The results? Encinas and Federspiel said physicians are collecting information to meet measures while retaining their patient-centered approach.

Lessons Learned:

In preparing to ultimately become a PCMH, Commonwealth Pediatrics has not shied away from integrating technology to better serve their patients, but they also know that the promises of technology can fail. Federspiel said practices should have a contingency plan for when things go wrong. The obvious move to counter downtime is to revert to paper records, but Federspiel said they took it a step further and revamped the “old school” system to collect information that can be easily re-entered into their EHR system once it comes back online.

Next-Steps/Future Vision:

Federspiel also recommends practices save everything and keep it organized to make audits less stressful. On display in her office are pictures of her family, drawings from her child and several large binders, one for each of their nine doctors and six certified nurse practitioners. She saves every piece of information related to each provider in the office and organizes them chronologically.

“There can be a high-level of anxiety when a government agency says it wants to perform an audit that could cost us thousands of dollars,” she said, adding that the practice appreciates its partnership with VHQC, the Regional Extension Center for Virginia, which provides an extra knowledge base when they need in-depth guidance. “Keeping files organized and using resources like VHQC helps alleviate some of the stress.”

About VHQC

For more than 30 years, VHQC has been leading the way to better healthcare for providers  and other clients by offering expertise in quality improvement, utilization management, analytic services and health information technology support that improves patient outcomes — and often results in cost savings. In addition to its role as the Maryland and Virginia Quality Innovation Network-Quality Innovation Organization, VHQC is the Health IT Regional Extension Center for Virginia and leads the Virginia Practice Transformation Network. For more information, visit

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