With such a large practice weren’t you dealing with widely divergent degrees of technical proficiency and acceptance, or resistance?

Dr. Khakmahd: The system we chose has a nice feature called the Meaningful Use “dashboard,” which can track everybody’s progress using the system. So we knew that after one month of having the system, only three physicians were meeting the Meaningful Use criteria. But by encouraging everybody and praising them for their hard work, and by my sending out those weekly reports, and through teamwork with the staff as well as the physicians, all 18 physicians met the criteria for meaningful use by the end of December 2011.

What unique characteristics of a nephrology practice make EHR adoption particularly challenging?

Dr. Khakmahd: As nephrologists we go to the dialysis units, we go to the office, we go to the hospital, and we go to some community clinics and access centers, so we are all over the place. We wanted something that would be available online and available everywhere we go, so everybody could do their documentation in one place, from wherever they are.

Patients also move from place to place—they come to the office, they get hospitalized and they go to the dialysis unit, and they go to the access center, and they go back to dialysis. Having all the documentation and charting in one readily available place leads to better patient care.


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How did it work before you had your EHR system in place, with everybody moving around?

Dr. Khakmahd: We had to gather data from variety of sources. For example, the labs are interfaced into the system, so a patient’s lab report will automatically come into our system and appear in the doctor’s [electronic] in-box. Nobody has to call the lab and ask what happened to the paperwork and then have it faxed over and have it sit in the doctor’s in-box for a few days until the doctor has time to look at it. Falcon is available online, so every time you have Internet access you can access the system and the labs and are right there in your online inbox and the chart contains data from variety of sources. [Editor’s note: Falcon EHR expects to have a mobile app for iPads and iPhones available later this summer.]

Does EHR adoption really make sense for small nephrology practices and solo practitioners?

Dr. Khakmahd: As nephrologists, we deal with complex patients on lots of medications and a lot of lab work. Having those lab interfaces and being able to analyze the reports in one place and being able to track and reconcile medications for the patient is a big advantage, whether you’re one physician or one of 18 physicians.

It improves patient care promises to decrease errors and improve safety over the long term. CMS and the government have a lot of new regulations nowadays, and if you’re in an era of accountable care, you need an infrastructure that supports those mandates. It is crucial for all practices to look at their infrastructure, and having an electronic medical record system is one part of that infrastructure.

The government incentives are a good reason for everybody to try to convert to an electronic record system. CMS has already warned all of us that reimbursements will be reduced if we don’t adopt electronic records by 2015, but has also promised some incentives for early adoption.

So each practice has a choice of adopting early and getting the incentives that can help pay for the electronic medical records system, or procrastinating and paying out of pocket and facing cuts in reimbursements. It’s better to do it now.

What advice can you give the nephrologist who doesn’t know where to begin?

Dr. Khakmahd: As with any type of adoption, at the beginning everything is scary. Start with a project plan in place, look at your workflows in advance, and engage everyone in your office, including the office staff and support services.

Everybody in the office needs to be on the same page in order to move forward successfully. You need to have meetings with your staff and your vendor so you can find the problems and solutions to the problems. If you want to have a successful implementation, everybody on the team must be involved and those falling behind should be encouraged. CMS EHR incentive website has a lot of good resources and education material.