For the last three years, much of the publicity granted to the Hawaii Island Beacon Community has focused on how a federal grant has been helping island doctors make the switch from paper to electronic health records.
But during the same period, Beacon employees have been teaching doctors and their staff ways to be more effective in reaching and treating patients with chronic disease, said Susan Hunt, Hawaii Island Beacon Community CEO and project director.
The result? A limited study of 76 patients in Kona and Hilo showed that by increasing contact with care providers, providing medical equipment, such as blood pressure and blood sugar monitors, for patients to use at home on a daily basis, coaching on how and when to take medications and helping organize contact with family members to provide support and meeting transportation needs, half of participants showed health improvements. Those improvements included more than 50 percent recording decreases in blood pressure and 45 percent losing a significant amount of weight.
“The majority of them really liked (having the equipment at home),” Hunt said. “They liked having the case manager and extra attention. They liked the immediate feedback.”
Some of the patients were initially intimidated by the equipment, but by the end of the study were asking if they could keep it or purchase something similar, she added.
The study also showed more than 50 percent of participating Hawaii Medical Service Association, or HMSA, customers also reporting a drop in medical costs.
That drop was attributed to the patients being readmitted to the hospital after a stay there less frequently and by having to visit the emergency room less often, the study said.
Hunt said patients were not able to easily measure their cholesterol levels on a daily basis, but the study also showed a significant improvement in those levels as well.
She’s also seen reports of blood sugar level decreases, with about 30 percent of patients beginning the study with levels in an acceptable range and about 59 percent of patients completing the study with blood sugar levels in that range.
That last figure, she said, works directly toward the program’s goal of averting the onset of diabetes on the island.
The Beacon program also tracked 500 patients — a group that included the 76 from the other case study — and their health outcomes.
Federal officials awarded Hawaii County a $16 million grant to increase use of electronic medical records and improve medical care and the results of that care. The grant was one of 17 awarded around the country.
Federal officials said in 2010 one reason Hawaii Island was a strong candidate was that, at the time, about 40 percent of physicians were already using electronic records.
The figure is now closer to 84 percent for primary care doctors, those in general, family, pediatrics and some obstetrics and gynocology practices, Hunt said. Switching to electronic records can be a difficult transition — one West Hawaii pediatrician asked federal officials when the program began who would see his patients while thousands of records were converted — but the change comes with many benefits, Hunt said.
“There is a legible document you can actually read,” she said. “There are up to date issues, it may have advance directives. It sets the stage for connectivity between hospitals and physicians, as well as between primary care physicians and specialists.”
The records can quickly relay lab test results and information on when and how often prescriptions have been refilled, Hunt added.
The federal grant allowed the program to provide computer support for doctors willing to switch to electronic records.
And making the switch came with financial motivation for many physicians, because the Medicare program offers $18,000 in incentives for doctors who reach a certain level of electronic medical record keeping, she said.
Beacon’s goal was to have 60 percent of doctors eligible for Medicare incentives to achieve that status; the program actually was only able to reach about 40 percent, Hunt said. A number of factors, including delays at the state level, kept the program from reaching that goal, she added.
The program offered more than just computer support. Nineteen practices, most of which had just one physician, although a few had two, signed up for a clinic makeover of sorts.
“We were really starting at ground zero,” Clinical Program Manager Melinda Nugent said. “In many cases, the practices didn’t even have an email address.”
Nugent’s first step was to assign the office a Gmail account, then begin moving toward the electronic records.
At the same time, the doctors and staff members watched webinars and completed a curriculum that included writing out the job description for each employee.
The doctors were a little skeptical of the exercise at first, but they saw the value when they realized they often had more than one employee duplicating tasks, while other jobs weren’t getting done, Nugent said.
Doctors also reviewed their patient rolls and began making routine check-in phone calls with patients with chronic diseases, such as diabetes.
“The real move is to move away from a passive stance to wait for a patient to call you when they’re sick,” Nugent said. “It helps them stay on track, manage the big issues of diabetes.”
Nugent also explained to doctors how to better schedule patients, leaving a few open appointments every day to allow for emergency visits.
That was a step toward increasing patients’ access to care, she said.
The grant period ends Sept. 30.
