The Block Island Times

A challenging transition to EMR at the Medical Center

By Gloria S. Redlich | Nov 22, 2013

The conversion from traditional to electronic medical record-keeping (EMR) “continues to be frustrating,” as Executive Director Barbara Baldwin reported at the Nov. 18 meeting of Block Island Health Services. “It takes hours to enter records and it has been a painful process,” she said.

Agreeing that it is challenging, Dr. Janice Miller noted, “What used to take minutes to write in, is now taking hours. The other night I was here until midnight.” RN Linda Closter and Nurse Practitioner Liz Dyer have also been putting in significant time, inserting patient records into the new system.

Board member Dr. Al Casazza commiserated with Miller. “The software is totalitarian. I share your frustration, but if we can get you some help, you’d be surprised at how much easier it can be... “ Miller declined assistance stressing that she needed to learn how to do it herself.

The success of implementation is tied to incentives from the Medicare program. In order to be eligible for these Medicare incentives, BIHS must comply with certified government criteria over a period of 90 consecutive days during which records are verified. If the local medical center does comply with this criteria by the end of December of 2013, it will be eligible for a $13,000 incentive; if not, it will eligible for an incentive of $11,000 starting in January, 2014.

Under the American Recovery and Reinvestment Act (ARRA) of 2009, the Center for Medicare and Medicaid Services (CMS) is authorized to provide reimbursement incentives to eligible practitioners.

President Bob Fallon said, “We should have an implementation person or guide.” Miller replied, “There are just too many glitches with the computer; it will take a lot of time.” Nevertheless, Fallon thought there should be people to help.

He asked Miller, “Just tell us what you know and we’ll decide about getting help.”

Meeting with SAC

On another matter, Baldwin said that she had met with members of the Senior Advisory Committee (SAC), who “expressed concern about older persons living alone on island” and meeting the needs of those individuals. Baldwin said that SAC members “suggested that we start a health-referral list and wanted us to create a Certified Nursing Assistant (CNA) program,” In response, Baldwin told them the medical center couldn’t get involved in that type of program. “The health center is not an assisted living (facility),” she added.

Secretary Sue Hagedorn asked, “Did you have any suggestions for them?”

Baldwin said, “I suggested that the Senior Advisory speak with South County Community Actions.” Miller added, “We just don’t have the capacity for taking care of people [in those ways].” Hagedorn said, “I do think there’s a need for following up. We’ve presented this view of us around the island that we’re here for people. We’re an older population. It feels as if we should respond.”

Baldwin felt it was “a community issue,” and Casazza asked, “Shouldn’t people put together services?”

Member Cindy Baute said, “The Senior Advisory Committee may think the medical center can take care of all this; it can’t.”

Working with DTF and the DOH

Another item Baldwin reported on was a meeting of the Deer Task Force (DTF) that she and Fallon attended, at which that group outlined a proposal by the Department of Environmental Management (DEM). It was for a professional hunt eradicating between 80 and 90 percent of the deer population for which the DEM is asking the town to pay. She said the DEM would be “coming out to the island to do a public presentation in early December.”

Fallon noted that he, Baldwin, BIHS health providers had recently engaged in a conference call with Dr. Michael Fine, Director of the state Department of Health (DOH) as well as other members of the DOH. Fallon said, “We asked Dr. Fine what the Health Department could do to help us educate people about Lyme disease. However, Fine responded that the staff at BIHS had more experience than others in the state.

Furthermore, compared with other areas of the state, Fine said there was a disproportionate number of cases on the island than in other corners of the state. Fallon said, “As a result of our letter to him [Fine], the state joined [a New England] task force on Lyme disease.” Looking for funding to support testing, Fallon said he was hopeful the state DOH would “use their bully pulpit’ and go to legislators for money. However, as Baldwin pointed out it would be up to BIHS to do so. In the end, Fallon thought it was “a good meeting.”

Patient count and tracking revenues

Treasurer Pete Tweedy presented a comparative list of patient visits for years since 2006, in which there were 3839 recorded visits. By 2009, there were 51,000; in 2010: 49,000; 2011: 46,000; 2012: 49,000 and to the end of October in 2013: 39,000. The general decline in numbers of patient visits was a matter of serious concern for board members.

There was also some question about how patient visits and revenues from them are tracked. Casazza wanted to know about delays in receipt of revenues and suggested, “You might not have the right billing company.”

Fallon said, “We don’t have the income we need. We do have decreasing numbers of visits, and we’re still running a $300,000 deficit; this is the constant challenge we have.” Co-chair of the Fundraising Committee, Hagedorn felt that meant a greater reliance on fundraising.

Fallon said, “I think we need to carry the message of the expertise of our practitioners [and the services BIHS provides] to the public through the newspaper. I think the medical center needs advocates for its medical services on island. We need to reach out to the public.”

Member Bill McCombe agreed with the need to find a new billing company. However, Baldwin said, “We realized there was no way we could change the billing system at the same time we are developing an EMR system.”

Fundraising and media coverage

Fundraising Co-Chair Cindy Baute reported that 2,000 mailings for the annual winter fundraiser “Lights of Love” had gone out. Hagedorn expressed the thanks of all to Baute and many others who had worked on that project. She said, “At the beginning of next year, we’ll talk about a special appeal to deal with the deficit, i.e., after the “Lights of Love” campaign.


After the board went into executive session on personnel matters, Fallon reported that the group had passed a motion to offer bonuses for the two health care providers—both the doctor and nurse practitioner. Fallon also announced that the board agreed to pay accrued vacation time currently, although under a new policy, the criteria would change.

Concerning the repair of the doctor’s house, Baldwin identified two priorities: “to insulate the basement and to re-do the kitchen.”

She also attended a work session with the Town Council on improving Internet connectivity on island. She said, “We talked about options like fiber optics.”

After revisions to the employee handbook, the board voted to approve it.

After a year or so of convening in Town Hall, the board discussed holding their meetings in the basement of the medical center. Baldwin expressed the general feeling of the group that this approach allowed health providers to be present and that it was important to do so. McCombe said in the interest of providing the community access to board meetings, “I do think we should meet at Town Hall, but I certainly defer to the majority.”

The next meeting is set for Dec. 16 at 3 p.m.

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