Beyond the Nuts and Bolts: One Doctor’s Vision for the Perfect Pediatric Electronic Health Record
CareMount MedicalNew York State
Is necessity the mother of invention and innovation, or does intellectual curiosity drive these advancements? For Dr. William Zurhellen, a pediatrician of nearly 40 years, it was a little of both.
In September 1981, Dr. Zurhellen was the managing partner of a thriving, three-doctor pediatric practice near New York City when he discovered his biggest payer owed him thousands of dollars.
“Our local health care plan had just started its own managed care program, and by September, I was going broke,” Dr. Zurhellen said. “When I finally tracked down our payments, I saw that the carrier hadn’t paid a penny since March.”
Mailing bills and tracking payments had already become a burden for the growing practice. The office used ubiquitous ledger cards (adequate, back then) for posting payments. At the time, most claims were still submitted by patients, so practices knew every charge and every balance on the ledger card was due from the patient.
But with the new medical plan, patients sometimes only owed a portion of the total charge, and the carrier was responsible for the balance. Trying to determine from a ledger card who owed what had become even more time-consuming, not to mention a recipe for error.
The practice eventually recovered its payments of nearly $20,000, but Dr. Zurhellen said he regarded the snafu as a pivotal moment.
“That’s when I started thinking about writing my own practice management system,” said Dr. Zurhellen.
If necessity became the “why,” Dr. Zurhellen’s intellectual curiosity fed the “how” in his project to develop a computer-driven financial tool for making billing more efficient and fool-proof.
“Preventive care is looking forward, not just looking at today.”Dr. Zurhellen
Word of his EHR spread among the pediatric community, though Dr. Zurhellen said it was never his intention to aggressively market the system. By the mid-1990s, 16 other practices from around the country were using the EHR. Those with the system were all computer hobbyists, like Dr. Zurhellen, who liked the idea of using technology for more than tracking financials.
EHR use on the practice level in the 1990s was cutting edge. Its application then was mainly limited to academic medical centers. It would be another decade before the American Recovery and Reinvestment Act (ARRA) drove use of the EHR on a grand scale.
Despite his own success with EHR technology, Dr. Zurhellen is adamant that no current EHR system is equipped to meaningfully track and quantify clinical outcomes for patient care.
“If you look at the EHR in terms of Meaningful Use, you’re asking it to collect data on whether you did something or not. It doesn’t tell you whether the patient is better or not,” Dr. Zurhellen says. “It’s not in real time. By the time you write a report, it’s based on old data.”
An expert with the Certification Commission for Health Information Technology (CCHIT), Dr. Zurhellen took his argument to the White House in 2012, filing a national petition to move EHR strategy away from a pay-for-performance-based model to improving outcome and costs.
The petition noted that current systems “are not designed properly to assess clinical outcome and perform true quality improvement, nor does a national health information network yet exist.” The petition also argued that “the two issues are the major roadblocks to the deployment of electronic health record technology in primary care practice.” The petition did not succeed.
Dr. Zurhellen is no longer working to advance his own system but continues to rally for EHR improvement. Of the original 17 doctors who used the home-grown EHR, only its creator and one other pediatrician continue to practice. And Dr. Zurhellen, who recently joined a large physician group as part of an exit strategy for retirement, must now use the group’s EHR of choice.
The trade off, he says, was worth it.
“Finding a young pediatrician who wants to go into a small practice is more difficult these days,” says Zurhellen, now 68. “I didn’t want to work for two more years, then just leave and risk leaving 3,000 families to go find someplace else.”
As it turns out, the decision has helped secure Dr. Zurhellen’s future as well. His physician group is free of any hospital affiliation, and fewer administrative duties means more clinical time.
“The group negotiates better contracts than I ever could on my own, and I’m now earning what a pediatrician should be earning,” he says.
Meanwhile, Dr. Zurhellen continues to proselytize for a pediatric EHR that improves patient outcomes.
“Preventive care is looking forward, not just looking at today,” Dr. Zurhellen said. “My vision for the EHR is one that makes patient outcomes better and gives practicing pediatricians an effective and user-friendly electronic tool to be able to do that in real time.”
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