1. James F. Holsinger, MD, a solo family physician in Keokuk, Iowa,
has used his e-MDs electronic health record system to improve the
quality of care in his practice. As a result, his patients are pleased;
the practice is benefiting financially from pay for performance and
pay for reporting programs; and the Holsinger Clinic is prepared to
show meaningful use and qualify for government EHR incentives.
The clinic has had the e-MDs EHR and integrated practice
management system since it opened in 2003. The system has
proved essential to Holsinger’s quality improvement program,
which has achieved big gains in adult vaccinations and cancer
screenings over the past two years. Here’s how a small practice
used e-MDs to achieve clinical quality goals that many larger
groups would envy.
A rural practice based on technology
Holsinger, who did not become a doctor until he was in his 40s,
started out as an executive in the food industry and a book retailer.
He’d always wanted to be a doctor and so he made a mid-life career
change. After completing medical school and his family practice
residency, he set up shop in Keokuk, a town in southeastern Iowa
that serves a rural community of approximately 20,000.
Before he set up practice, Dr. Holsinger decided he had to have
an EHR. “Having been a businessman before I was a doctor, I
couldn’t imagine how you could run a small business today
without a computer system,” he explains. He chose e-MDs, he
says, because “it was a fully integrated system, and it looked like
it would last.” He also liked the software’s functionality and ease of
use. “Moving from screen to screen was very intuitive.”
e-MDs provides the right tools for quality
management
e-MDs integrated EHR and practice management system also
offered a clinical quality management module. This module
includes evidence-based rules for disease management, health
maintenance, and immunizations, reminders for overdue lab tests
and other needed services, and the capability to generate reports
on patient compliance with recommended care. The rules can be
customized for practice preferences and individual patient needs.
Dr. Holsinger’s wife Kathy, the clinic’s business manager, was able
to do the additional customization work with training help from
e-MDs.
The quality module has proved invaluable, Holsinger says. For
example, if a patient is on a cholesterol-lowering medication, the
EHR will alert him or a nurse when the patient needs a liver function
test. “e-MDs has helped us build quality into our daily process of
providing care” noted Holsinger.
FAMILY PRACTICE ACHIEVES BIG QUALITY GAINS
C L I N I C P R O F I L E
S o l o f a m i l y p r a c t i c e i n r u r a l I o w a
e - M D s P R O D U C T S
S o l u t i o n S e r i e s
P R O J E C T G O A L S
S u c c e s s f u l l y p a r t i c i p a t e i n
s t a t e w i d e q u a l i t y i n i t i a t i v e s
E n g a g e s t a f f i n q u a l i t y
i m p r o v e m e n t p r o c e s s
I m p r o v e c o m p l i a n c e r a t i o s f o r
b r e a s t c a n c e r a n d c o l o r e c t a l
c a n c e r s c r e e n i n g ; a n d f o r
i n f l u e n z a a n d p n e u m o c o c c a l
v a c c i n a t i o n r a t e s .
I n c r e a s e p a t i e n t s a t i s f a c t i o n
R E S U LT S
C o m p l i a n c e f o r i n f l u e n z a v a c c i n e
i n c r e a s e d f r o m 3 8 % t o 9 7 %
C o m p l i a n c e f o r p n e u m o c o c c a l
v a c c i n e i n c r e a s e d f r o m 4 1 % t o
9 4 %
C o m p l i a n c e w i t h c o l o r e c t a l c a n c e r
s c r e e n i n g s i n c r e a s e d f r o m 4 8 % t o
7 4 %
C o m p l i a n c e f o r b r e a s t c a n c e r
s c r e e n i n g s i n c r e a s e d f r o m 6 2 % t o
7 4 %
E x c e e d e d s t a t e a n d n a t i o n a l
b e n c h m a r k s f o r b r e a s t c a n c e r,
c o l o r e c t a l c a n c e r s c r e e n i n g ,
p n e u m o c o c c a l , a n d i n f l u e n z a
v a c c i n e s b y f a c t o r o f 2 t o 3 t i m e s
CHARTING THE FUTURE OF HEALTHCARE®
CASE STUDY
HOLSINGER CLINIC, KEOKUK, IOWA
WITH E-MDS

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Participant in statewide quality improvement
program
The Holsinger Clinic launched its quality improvement effort after
the Iowa Foundation for Medical Care (IFMC) asked the practice
to participate in a statewide healthcare quality program. While
the IFMC, a Medicare-contracted, nonprofit quality improvement
organization, provided Dr. Holsinger with some consulting services,
the practice quickly took ownership of the quality initiative.
Holsinger started by focusing on raising the percentage of patients
who received flu shots. This was an obvious target since the
practice had so many elderly patients and it was the beginning of
flu season. The first thing the clinic did was to run reports in e-MDs
listing the patients
that had received
shots and when,
and which patients
still needed
them. Then Dr.
Holsinger had
his staff contact
patients who were
due for shots so
they could make
appointments to
come in.
The staff quickly
became engaged
in the project,
Holsinger says. He
shared data with
his nurses about
the low percentage
of patients who had received flu shots. He also offered them a
financial bonus if the practice surpassed national and state
benchmarks (the practice has always shared profits with its staff).
The nurses started immediately and within two weeks, they had
reached every patient who needed a flu shot. Later, Holsinger
expanded the program to include pneumococcal vaccinations and
screening tests for breast and colorectal cancer.
Impressive results in quality improvement
The results have been phenomenal: From July 2008 to May
2010, the percentage of patients complying with Holsinger’s
recommendations increased across the board. The compliance
increases were:
• 38% to 97% for flu shots
• 41% to 94% for pneumococcal shots
• 48% to 74% for colorectal cancer screenings
• 62% to 74% for mammograms
While Holsinger feels he has reached the upper limit for
vaccination compliance, he believes further gains can be achieved
in the cancer screenings. The clinic’s performance is especially
impressive when compared to state and national benchmarks for
these quality measures, exceeding them by a factor of 2 to 3 times
(SEE CHART).
PQRI and pay for performance benefits
The Holsinger Clinic is also using its e-MDs EHR to get
financial rewards
from Medicare’s
Physician Quality
Reporting Initiative
(PQRI). The
clinic has set up
a template for
the CPT II codes
required to report
quality data to
Medicare, and the
staff looks at EHR
documentation to
pick the correct
codes, which flow
into the e-MDs
billing system. As a
result of submitting
this data on
selected measures,
the clinic has received a 2% Medicare bonus – a significant amount
considering that over 30% of the Holsinger’s active patients are
on Medicare.
At the same time, Blue Cross Blue Shield of Iowa has rewarded
Dr. Holsinger for meeting its goals for preventive and chronic
disease care. The Blues plan also helps the practice contact
non-compliant patients. Dr. Holsinger plans to participate in the
government’s EHR “meaningful use” incentive program (which
offers physicians up to $44,000) starting in 2011. “Because
of the work that we have already done with our EHR and our
staff on improving quality, we feel that we are well positioned
to comply with the meaningful use program”, Holsinger noted.
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