Enid, Oklahoma-based Reliant Direct Primary Care, which has two offices in northern Oklahoma and three providers, is a direct primary care provider that sees far fewer patients than a traditional practice.

THE PROBLEM

Dr. Jonathan Bushman, one of the three providers, previously worked for a health system, using an EHR designed to support fee-for-service billing and engineered around serving patients through a transactional delivery model.

"Being held captive by this system, I felt I had lost the ability to focus on the patient and earn patient trust, and the challenges caused by the EHR made my day-to-day activities of caring for patients feel more like a chore," he recalled. "My main focus at the time was on creating documentation to support billing for specific services, not on what was best for the patient. The process was burdensome and exhausting."

PROPOSAL

Bushman and one of his colleagues had spoken at length about different practice models and software. The colleague had mentioned his success with Elation Health, a vendor of an EHR for independent primary care practices, and its integration with other major technology platforms, including Hint and Spruce, for direct primary care.

"I took a look at a demo of Elation and was immediately impressed," Bushman said. "Elation was the most simple EHR I had seen. It was just all there – everything I needed, right in front of me, on one screen. I almost felt like I didn't need to have an orientation on how to use it.

"I had come from a large health system that had been required to use Epic and it is this massive EHR that is overwhelming. Elation is just so intuitive," he continued. "Using it has made both record-keeping and taking care of patients seamless."

When Bushman transitioned to the DPC model, he knew he wanted an EHR that was built to support the clinical care he provides to patients, not coding and billing. He also wanted an EHR that was easy to use and felt natural with his primary care workflow.

"With Elation, creating clinical documentation; keeping careful patient records; managing tasks, results and messages; and collaborating with other physicians are as easy as they need to be, and the visual experience is uncluttered with a sleek and simple design," he described. "For years in my previous employment, I had said, 'I wish my EHR would work for me. I'm tired of working for it.'

"And to me, Elation is that type of EHR," he continued. "Unlike others, it is designed for the way physicians think. The intuitive design and ease of documentation gave me back more time to spend with my patients."

MEETING THE CHALLENGE

Implementation of the EHR was fast and easy, Bushman said, and required minimal training.

"I am able to capture all the important information about my patients in an easy-to-read clinical profile, swiftly review the chronological record for my patients, see all items requiring action, and quickly document an accurate and meaningful patient story and encounter note – all in a simple three-panel view that gives me complete situational awareness of all the clinically relevant information about each patient," he said.

"Fewer clicks, no more hard-to-find information, no more jumping around between screens and multiple browser tabs per patient," he added. "Using the practice home page, I am able to easily manage all of my pending tasks, documents for review, messages, medication renewal requests and unfinished notes."

RESULTS

Accessibility is the greatest result achieved so far, Bushman said.

"Using Elation's EHR, I have the ability to extrapolate the data I want that makes a difference to my patients," he explained. "While I no longer have to report, I have all the alerts turned on as if I was reporting MIPS, so I remain aware and can address anything my patients need.

"For example, when I'm seeing many patients within an organization, I can export specific data about patients tagged by organization in a new task list and know within seconds who from this group was 'last seen' in the past six months, which is of huge value for direct pay and direct consulting."

The number of cases solved with patients is increasing while the amount of visits is decreasing, showing an increase in efficiency, he added.

"I'm doing what I want to do. I'm doing it for all the right reasons. It is very satisfying," he said. "I now have an emotional peace of mind that my colleagues ask about achieving. And while I'm not reporting for MIPS and metrics, the on-demand reports that I can create allow me to monitor and empower touch-points with patients.

"Within the DPC model, the more I can add to communication and reminders for patients, the better. The EHR's reporting tools allow me to basically create my own metrics, including both touch-points and accessibility."

ADVICE FOR OTHERS

"When I talk to colleagues struggling with similar EHR challenges, I tell them to look for an EHR that isn't built around coding and billing, especially if you've chosen to go outside the traditional fee-for-service billing model," Bushman advised.

"Look for an EHR that maximizes clinical context for each patient, makes documentation easy – helpful even – and produces a useful encounter note.

"Find a platform that helps you manage your day-to-day work, gives you tools to proactively manage a panel or population of patients – not just one patient at a time – and doesn't add to the cognitive burden of the hard work of patient care," he suggested.

"Find a vendor with an open architecture that makes integration of other software solutions quick, easy and seamless in the workflow."

Using an EHR should feel easy, he added. There should be options to customize it to one's practice needs, and it should not distract one from patients, he said.

"It should support the needs of other members of your primary care team and allow for delegation of tasks and responsibilities across the care team," he said. "Information should be easy to file and retrieve, and health information sharing should be a key feature.

"There should be an easy prescribing process and there should be integration of external pharmacy data as well as individual patient formulary information.

"There should be easy, effective and efficient integrations with laboratories for orders and results," he concluded. "It should be easy to manage the patient relationship through secure communications and refer patients outside your practice, sharing pertinent information between collaborators in a patient's care journey.

"The legacy I hope I can leave is a practice that centers my patients, thanks to the DPC model and an EHR that enables, rather than erodes, the care experience."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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