Ms. Drury outlines the EHR world for these Davies Winners before ARRA and the EHR Incentive Program existed, sharing the environment and the motivation for these privately owned physician practices who have been recognized by HIMSS as Davies Ambulatory Award Winners. The HIMSS Nicholas E. Davies Award of Excellence recognizes excellence in the implementation and use of health information technology, specifically electronic health records (EHRs), for healthcare organizations, independent physician practices and public health systems. The HIMSS process of evaluating applications from these practices and validating the use and value of HIT is rigorous for the applicants and for the HIMSS Ambulatory Award Committee.

1. If NOT for “meaningful use”,
then…….Why?
San Luis Valley Health Information Technology
Symposium, November 4, 2011 1

2. San Luis Valley AHEC Legal Notice
The material in this tutorial is copyrighted as indicated in each slide footer and any
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Companies and individuals may only use this material in accordance with copyrights
expressly stated. Contact the speaker directly for further information
Neither the Author nor the Presenter is an attorney and nothing in this presentation
is intended to be nor should be construed as legal advice or opinion. If you need
legal advice or legal opinion, please contact an attorney.
The information presented herein represents the Author’s personal opinion and
current understanding of the issues involved. The Author, the Presenter and the San
Luis Valley AHEC do not assume any responsibility or liability for damages arising out
of any reliance on or use of this information.
NO WARRANTIES, EXPRESS OR IMPLIED. USE AT YOUR OWN RISK.
2

3. If NOT for “meaningful use”,
then……Why
Barbara Drury, FHIMSS
President, Pricare Inc.
Professional Development Chair,
Colorado Chapter of HIMSS
3

4. • Independent consultant, national practice,
Speaker: primarily for physician offices, since 1982
Barbara • EHR Risk Manager for COPIC (Colorado) and TDC
(Oregon/Washington/Idaho)
Drury
• HIMSS Fellow, new appointee for 2011-2013
HIMSS Public Policy Committee, Current
member of Davies Ambulatory Award
Committee, Professional Development Chair for
the Colorado Chapter, Spirit of HIMSS 2004,
2009.
• Appointed to the ONC’s Technical Expert Panel
on Unintended Consequences of HIT/EHR.
• Author of many of the Colorado Medical Society
ARRA tools, webinars. Editor of the COPIC
Benchmarks for EMRs.
4

5. Talking Points
• The EHR world ‘before and without ARRA’
– What’s different
– What’s the same
• Highlights from Davies Ambulatory winners
– Practices ‘like yours’
– Common reasons to adopt
– Degrees of success
• Some insights and reflections
5

6. Before Incentives & Meaningful Use
• Adoption of EHRs was at a natural pace and
evolutionary (COPIC = 10 yrs, 5% to 30%)
• Practices determined important issues to
develop ‘reasons’ to consider an EHR solution
• Capability of paying for the system and
keeping staff were paramount
• Vendors could respond naturally to the
market
• Your practice was your kingdom
6

7. After Incentives (Stark, PQRI, ARRA, MU)
• Adoption of EHRs has been
artificially accelerated
• Incentives (or penalties)
have become the over-riding
‘reason’ to consider an EHR solution
• Meeting someone else’s criteria for the system is
now paramount
• Vendors must delay or abandon market needs to
respond to other requirements
• Your practice is one cog in a complex healthcare
‘wheel’
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8. And these Davies Winners?
• They excel without external incentives (and may
not be MUs)
• They improve the health of their patients and
the wealth of their practices
• They measure everything
• They actively engage with their chosen vendors
• They always have a plan “B” (or create it)
• MU is too narrow for the goals of these
Winners and the benefits continue to be
advantageous to clinicians and their patients!
8

9. Talking Points
• The EHR world ‘before and without ARRA’
– What’s different
– What’s the same
• Highlights from Davies Ambulatory winners
– Practices ‘like yours’
– Common reasons to adopt
– Degrees of success
• Some insights and reflections
9

10. HIMSS Davies Award for Excellence:
• The HIMSS Ambulatory Care Davies Award: designed to
recognize the most exemplary implementations and utilizations of
electronic health records in independent ambulatory practices.
• Applicants must be independent, physician-owned (not hospital-
owned) ambulatory practices and must have leveraged
technology to impact patient-centric practice of medicine and
derived value.
• The four categories of the HIMSS Davies Awards program are:
hospitals and health systems, independent physician practices,
public health, and community health organizations.
• Each winner has successfully achieved value from
electronic health records to improve healthcare delivery.
10

11. Update from HIMSS for 2012 Davies
• Case-study format rather than ‘your story’
– You get to pick area where you excel
• Two categories = two committees
– Enterprise (5 case studies)
– Ambulatory: Enterprise-owned, physician-owned,
community health organizations, and public health (4
case studies)
• Rolling application, anytime throughout year
• Virtual and some on-site visits by HIMSS
Committee
• www.himss.org/davies/
11

12. Practice Metrics
Year of Implementation
Davies Winner Year
Number of Physicians/Mid-
“Practices levels
Number of Others
Number of Sites
like me?” Method of Paying for Initial
Costs
Go-live Team 'old' roles
OB/Gyn, Rheumatology, Go-live Approach
Family Practice,
Orthopaedics Go-live Schedule/Patient Flow
Planning
Full Davies Applications at: Expanded Services: tests,
http://himss.org/davies/pastRecipients_ambulatory.asp subspecialty
Technical interaction with PMS
Two winners from Colorado (2006- System
Alpenglow, 2010 Miramont) PMS from same or different
vendor
Personal or Practice Standards
12
Form-factor for EHR use

13. Virginia Women’s Center
VA Women's
Practice Metrics
Year of Implementation 2005
Davies Winner Year 2009
Number of Physicians/Mid-
levels 37
Number of Others 161
Number of Sites 5
Method of Paying for Initial
Costs Loan/7 yrs
Go-live Team 'old' roles
MD, MA, Operations
Go-live Approach
Module or two at a time
Month 1 at 50%, Mo. 2 at
Go-live Schedule/Patient Flow
66%, Mo. 3 at 100% pre-
Planning
EHR volume.
Expanded Services: tests, Research, US, Mammo,
subspecialty Nutrition, Psych
Technical interaction with PMS
System Bidirectional
PMS from same or different
vendor Same vendor
Practice standard,
Personal or Practice Standards
customized
13
Form-factor for EHR use Notebook, wireless, stylus,
cell cards

14. Oklahoma Arthritis Center
OK Arthritis
Practice Metrics
Year of Implementation 2006
Davies Winner Year 2008
Number of Physicians/Mid-
levels 5
Number of Others 26
Number of Sites 1
Method of Paying for Initial
Costs Self-funded
MD, OffMgr, RN, Part-time
Go-live Team 'old' roles
IT
Go-live Approach
Module or two at a time
Go-live Schedule/Patient Flow
Two months of reduced
Planning
schedule
Expanded Services: tests, Infusion, Radiology,
subspecialty Clinical Lab
Technical interaction with PMS One-way to EHR. Tickets
System used.
PMS from same or different
vendor Same vendor
Practice standard,
Personal or Practice Standards
customized
14
Form-factor for EHR use Convertible notebook,
wireless, stylus

15. Village Health Partners
Village Health
Practice Metrics Partners, TX
Year of Implementation 2003
Davies Winner Year 2007
Number of Physicians/Mid-
levels 3
Number of Others 7
Number of Sites 1
Method of Paying for Initial
Costs Loan/4 yrs
Go-live Team 'old' roles
MD plus ALL
Big Bang (100% of users
Go-live Approach
and visits)
Picked a 'light' month, no
Go-live Schedule/Patient Flow
FU appts allowed, 6 weeks
Planning
back to 100%
Expanded Services: tests,
subspecialty Traditional Family Practice
Technical interaction with PMS
System Bidirectional
PMS from same or different
vendor Same vendor
Practice standard, minimal
Personal or Practice Standards
customization
15
Form-factor for EHR use
Thick client (PCs), monitor

16. Sports Medicine & Orthopedics of Birmingham
Sports Medicine &
Practice Metrics Ortho, AL
Year of Implementation 2003
Davies Winner Year 2005
Number of Physicians/Mid-
levels 4
Number of Others 15
Number of Sites 1
Method of Paying for Initial
Costs Loan/60 mos low interest
Go-live Team 'old' roles
MD, RN
Big Bang (100% of users
Go-live Approach
and visits)
Go-live Schedule/Patient Flow
2 weeks at 50%, back to
Planning
100% at 6 weeks
Expanded Services: tests,
subspecialty Digital X-ray
Technical interaction with PMS
System Bidirectional
PMS from same or different
vendor Different vendor
Personal or Practice Standards
Personal
Notebook docked outside 16
Form-factor for EHR use exam rooms - unreliable
wireless.

17. Village Sports
Common Threads for "why did VA OK Health medicine
Women's Arthritis Partners, & Ortho,
you do it?" TX AL
If NOT for Access in office, remote, everywhere
“meaningful Quality of Documentation, organization,
completeness, defensibility
use”, then
MU Information Exchange outside the practice
WHY?
Patient Safety, including care management,
deliquencies
MU Monitoring of in-house adherence to clinical
guidelines and metrics
Reduce costs or be more efficient with staff,
transcription, supplies, space
Forward-thinking planning
MU Point of Care clinical support and planning
Customer service and communication
(patient and/or referral sources)
17
Practice and individual user "happiness
quotient"

18. Degree of success, based
Common Threads for "why did VA OK
Village
Health
Sports
Medicine
on “why”:
you do it?" Women's Arthritis Partners,
TX
& Ortho,
AL
Access in office, remote, everywhere
Nailed Quality of Documentation, organization,
completeness, defensibility
it! Information Exchange outside the practice
Patient Safety, including care management,
Not deliquencies
Monitoring of in-house adherence to clinical
quite! guidelines and metrics
Reduce costs or be more efficient with staff,
transcription, supplies, space
Forward-thinking planning
Point of Care clinical support and planning
Customer service and communication
(patient and/or referral sources)
18
Practice and individual user "happiness
quotient"

19. Talking Points
• The EHR world ‘before and without ARRA’
– What’s different
– What’s the same
• Highlights from Davies Ambulatory winners
– Practices ‘like yours’
– Common reasons to adopt
– Degrees of success
• Some insights and reflections
19

20. 23 HIMSS Winners and Incentive $$$ ?
• Family Practice/Internal Medicine = 7, YES
• Multi-specialty = 3, YES
• Cardiology = 2, YES
• Ortho/Sports Medicine = 1, NO
• OB/Gyn = 3, (1 Y, 2 N)
• Peds = 5, NO
• Rheumatology = 1, YES
• Diabetes = 1, NO
20

21. On the ‘lighter’ side, from these winners:
• EHR implementation is a commitment to a process, not
necessarily to perfection (Craig Carson MD, OK Arthritis)
• It was difficult to accept failure and financial burden of the
unused technology. Knowing when to quit was a challenge.
(Kay Stout MD, VA Women’s)
• I was finishing my MBA in May, 2003. My wife was
expecting our first child a few months later in
September. Everything had to be done in-between. (Chris
Crow MD, Village Partners, TX)
• In spite of recommendations from others, the Managing Physician
refused to reduce the schedule. The number of patients
scheduled at implementation was not adjusted significantly. This
would later be a decision that we regretted. (Sam Goldstein MD,
Sports Med & Ortho, AL) 21

22. And Some Questions for Your Practice:
• What are your ‘right’ reasons and
how will you know?
• It’s too expensive to change your
mind, so are you prepared for a long-
term arrangement?
• How well do you (and your practice)
handle course corrections?
22

23. In spite of incentives, you must find
YOUR “right reason”
23

24. Talking Points
• The EHR world ‘before and without ARRA’
– What’s different
– What’s the same
• Highlights from Davies Ambulatory winners
– Practices ‘like yours’
– Common reasons to adopt
– Degrees of success
• Some insights and reflections
• Discussion
24

25. Discussion?
 Barbara Drury
 Pricare Inc.
 bdrury28@earthlink.net
 303-681-3117
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26. Please fill out your evaluations on this talk and leave
the completed form in the box next to the door
before you leave today.
Please send any questions or comments to:
Email address of author
Thank You!
THANK YOU!
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