In 10 months, USF’s Paper Free Florida moves from nation’s No. 57 to No. 6 REC; already, operation is fully sustainable
|USF Health’s Jay Wolfson, MdPH, JD, a professor and the director of the Florida Health Information Center, is the principal investigator for USF’s REC, Paper Free Florida.
TAMPA, FLA.—In less than 10 months, Paper Free Florida, one of the nation’s 62 grant-based Regional Extension Centers (RECs) funded by federal grants covered under American Recovery & Reinvestment Act (ARRA), has climbed from the nation’s bottom 10 to a leader of the pack.
“Right now, we’re at 76 percent of our overall requirement,” said Gary A. Hendrickson, project manager of USF Health’s REC. “We’re at 65 percent of the timeline we’re allowed to do it; we’re ahead of schedule. We hear all the time that we’re the best-kept secret in Florida.”
So how did Hendrickson, who never planned to direct such an extensive program, find success so quickly in a program that’s baffled the most cerebral industry leaders?
Two important points, noted Hendrickson, who worked in the field before taking the project manager post.
“One, I have a very effective assistant project manager, Becky Brown, who keeps our field crew of seven very task-oriented,” he said. “Two, we studied the regulations of the healthcare laws that make up the guidelines for the entire government program and decided it was so complicated that nobody could understand it. So we grossly oversimplified it to the point where everyone involved completely understands what they have to do. We turned it into English!” (See sidebar: ‘7 Tips to Meet Mandates.’)
Paper Free Florida also took a different tact to reach 1,000 providers.
“Our goal isn’t to get people to sign up. It’s to assist physicians in achieving meaningful use,” said Hendrickson. “We focused on the end instead of the beginning. Instead of enrolling people, we asked the ones we were already helping to provide us with referrals. We used our good reputation of being successful with others to encourage the rest to come on board.”
Hendrickson also made another directional change to improve the outcome.
“The main goal of Paper Free Florida is to improve wellness, improve the outcome of the patients, increase their safety, and improve healthcare-related costs,” he said. “Notice it doesn’t say anything about helping doctors? But that’s who we focus on, because we quickly realized that if we helped show doctors how to really use these tools to their best interest that it would help with their best interest, which is actually the reason they’re in business: to help patients. We’re probably helping close to 1 million people through our program.”
The USF REC is so efficient that a primary care provider (PCP) needing help could receive it within days. Getting providers into a routine of expecting a field worker at a certain time helps prepare both parties to streamline the process, said Hendrickson.
Gastroenterologist Louis S. Saco, MD, CEO of The Watson Clinic, agrees.
“We have a need for a tremendous amount of efficiencies,” he said. “Paper Free Florida has helped us extremely well. In fact, without paper, we’ve become far more efficient, decreased our costs considerably, and … we’re far more green, which is better for the environment. We like that.”
Pediatrician Mike Jordan, MD, of East Lake Pediatrics, whose practice also received assistance from Paper Free Florida, often gets questions from patients and their parents about the tablet he carries around as his chart. Is it an iPad? No, he assures them, and then explains: With the tablet, “I have everyone’s records at my fingertips. Whether I’m at the office or at home or somewhere else, as long as I have access, I can access their records. The patients find it very helpful, especially in case there’s miscommunication about a prescription that’s been called in, or if they have a question and I didn’t personally see them. I can see what my colleague wrote about them and know what they were thinking at the time so that eliminates the guesswork. Having electronic health records is something that patients get a lot of benefit from.”
Saco said having an EHR system in place has taken a lot of guesswork out of healthcare issues.
“In the past, patients could go to several different doctors, and those physicians would have no idea what the other physician had prescribed,” he explained. “And the patient may not be accurate in telling the physician that they have another medication they were given from another physician.”
Saco encouraged PCPs who have not yet begun the EHR journey to contact Paper Free Florida.
“If the physician doesn’t have an EHR and doesn’t benefit from Paper Free Florida, they’re going to be entering into an era where they’ll have a practice that will suffer from a lack of information and a lack of perceived value by not only the patients, but also other practices and at one point down the road, insurers and the federal government – people who reimburse you for the work that you do, people who rely on you to show proof that you’ve done what you’ve said you’ve done,” he said. “And you have outcomes to prove that. They’re going to look at information that they can actually make measurements of. Without Paper Free Florida and EHRs, it’ll be much harder to prove that you’ve done the things you need to do to be compliant and to take good care of patients.” After a pause, he emphasized: “It’ll be much harder.”
Despite Paper Free Florida’s success, a much greater task lies ahead, said Hendrickson.
“There are two things I consider remarkable about this federal program,” he said. “The government considers it a six-year program running through 2016. I consider it a 15-year program because it will go on for years after the incentive program runs out. Every day, our greatest challenge is to dispel rumors and deal only with facts.”
Initially bound geographically to 11 counties in the Tampa Bay area – “we don’t go south of the skyway or north of Ocala,” said Hendrickson – Paper Free Florida has, quite remarkably, already achieved sustainability for our specialist services, meaning that it operates as its own entity without needing full government funding. As a result, healthcare providers in key markets in Florida and around the country have called Hendrickson on fee-for-service projects.
“RECs were supposed to stay in operation until April 2014, but a large majority of the RECs are under an acceleration order to spend all grant funds and terminate operations by September 2013,” he said. “We may be one of the only RECs in the country that did everything totally for free – no mileage fees, nothing. We didn’t even charge for copies or paper. We’re continuing to do it for free for the PCPs provided for under the grant.”
Because it’s a government-mandated market filled with regulations and compliance requirements, healthcare providers are required to switch to EHRs “whether they want their incentive money or not.”
“They still have to achieve meaningful use because we’re in the first of three stages,” he added. “Stage 1 says to put 100,000 primary care-only providers on EHR systems across the country. To my knowledge, the ONC (Office of the National Coordinator for Health Information Technology) has exceeded that number with all of us working on 163,000 providers. They did a really good job. But Stages 2 and 3 say to tighten up on requirements to achieve meaningful use and interconnect all of those providers through the Health Information Exchange. Once it’s in place, patients would have access to their healthcare records on a highly secure basis. That’s the intent.”