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Are Electronic Health Records a Plague or Panacea?

Richard Sine  |  Issue: January 2011  |  

The Devil in the Details

The stimulus package’s HITECH provisions contained $19.2 billion in funding intended to jump-start computerized health records. “It’s really been game changing for vendors and providers,” Empson said. The provisions contain a big incentive for independent medical professionals: Beginning in October of 2011, the government will increase Medicare and Medicaid payments by up to $44,000 per eligible provider over four years if those providers are deemed “meaningful EHR users.” It also contains a big penalty: Providers who are not deemed to be meaningful users by 2015 face Medicare payment reductions that increase every year that the provider does not demonstrate meaningful use, up to a 5% reduction.

As for what it takes to obtain the incentive and avoid the penalty, the devil is in the details, as made clear by the presenters’ discussions of what constitutes an “eligible provider” and “meaningful use.” For example, Dr. Warren noted, the definition of an eligible provider differs for Medicare and Medicaid, and physician assistants and clinical psychologists would not qualify as eligible providers.

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The definition of “meaningful use” will expand each year as physicians are expected to become more sophisticated in their use of EHR, noted Empson. In the first stage, the criteria mostly revolve around data capture and sharing. In upcoming years, meaningful users will be expected to use EHRs to facilitate advanced clinical processes, such as disease management, and eventually improved outcomes, including performance improvements and enhanced clinical decision support.

Complying with the first stage alone requires demonstrating compliance with 20 criteria, including providing patients with clinical summaries of office visits, implementing clinical decision support and maintaining an active medication list. The presenters emphasized that “meaningful use” requires going beyond simply installing a system to establishing workflows that ensure its regular use. “In your practice, it’s not just about putting in a system but adopting and using it effectively,” Empson said.

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The incentives (and disincentives) may have little impact on physicians who treat few Medicare or Medicaid patients, Warren noted. But practices that do intend to become “meaningful users” should be prepared as early as 2011 for an audit, Dr. Warren warned.

He believes that the reasons for installing EHRs go far beyond the monetary incentives. Some private insurers have already declared that EHR utilization will play a role in contracting decisions. In the future, EHR utilization could also play a role in board certification. And with the government planning to disclose lists of meaningful users, some practices could use an EHR as a competitive differentiator in their marketing. “Think about the market impact of not being a player,” he said.

Falling Short

Despite the promises of EHRs, the rate of adoption by practices has been quite low, Empson observed. One problem is the fragmented landscape of EHR vendors. More than 400 companies are competing in the market, Empson said, but that number is likely to decline quickly due to consolidation.

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