James F. Holsinger, MD, a solo family physician in Keokuk, Iowa, has used his eMDs electronic health record system to improve the quality of care in his practice. As a result, his patients are pleased and the practice has benefited financially from pay for performance and pay for reporting programs. Dr. James Holsinger was recognized as the first physician in his state to attest for Meaningful Use and quality for government EHR incentives. In 2011, the practice also won a prestigious HIMSS Ambulatory Davies Award of Excellence for achievement in the implementation and value from health information technology.

The clinic has had the eMDs EHR and integrated practice management system since it opened in 2003. The software has been 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 eMDs to achieve clinical quality goals that many larger groups would envy.


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 eMDs, 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.”


eMDs 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.

Kathy Holsinger, the clinic’s business manager, was able to do the additional customization work with training help from eMDs.

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. “eMDs has helped us build quality into our daily process of providing care” noted Holsinger.


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 use eMDs to run reports 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.


The results have been phenomenal: During the initial program period of July 2008 to May 2010, the percentage of patients compliant with these prevention measures increased across the board. Flu shots were at 97%, pneumococcal 94%, colorectal cancer screenings 74%, and mammograms reached 74%. Since then, the numbers have continued to climb. After 3 years, the improvement gains were:

  • 38% to 97% for flu shots
  • 41% to 96% for pneumococcal shots
  • 48% to 82% for colorectal cancer screenings
  • 62% to 91% 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.


The Holsinger Clinic is also using its eMDs EHR to get financial rewards from Medicare’s Physician Quality Reporting System (PQRS). The clinic found it easy to submit quality reporting codes to Medicare using the claims based system. eMDs is now one of the few EHR vendors that is qualified to submit quality data to CMS for PQRS so the clinic looks forward to doing this electronically in the future. 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 and Blue Shield of Iowa has rewarded Dr. Holsinger for participation in quality incentive programs. Like many eMDs users, his experience had positioned him very well to take advantage of the incentives. He was the first family physician in Iowa to attest for and receive an $18,000 Medicare incentive payment in 2011 and is a widely known Meaningful Use Vanguard member (MUVer) who helps other practices understand the benefits of technology.

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