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Explore This IssueDecember 2011
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Editor’s Note: One of the ways the government is attempting to influence positive change in healthcare is through the Medicare and Medicaid electronic health record (EHR) incentive programs. These programs provide a financial incentive for the meaningful use of certified EHR technology to improve patient care. Demonstrating meaningful use of an EHR system enables providers to reap benefits beyond financial incentives, including reduction in errors, greater availability and usability of clinical data, reminders and alerts that can facilitate patient care, and automated e-prescribing/refills.
The road to meaningful use, however, is not without obstacles. Organizations that are attempting to demonstrate meaningful use face challenges related to the time required for implementation and training for these systems and the cost to acquire or upgrade EHR systems. Rheumatologists are at different states of readiness to meet meaningful use objectives, and organization size and current status of EHR use are important factors to consider when planning for attestation of meaningful use.
This article is a follow-up to “Behind the Digital Door” (April 2011, p. 52), and the latest in a series of articles about preparing your practice. To read more about getting ready for meaningful use, visit www.The-Rheumatologist.org and search for “meaningful use,” or check out “Road Map to Meaningful Use.”
Four months after signing on with a vendor for a new EHR system, Deborah Wasser is not yet ready to hit the live switch with the “cloud” service that she chose for the solo rheumatology practice of her husband, Kenneth B. Wasser, MD.
The administrator of her husband’s New Jersey practice, Wasser has been working with the vendor on the conversion part of the process to get the office up and running as a fully compliant electronic records user. For an idea of what that’s like, imagine a tall stepladder reaching high into the sky. Already Wasser has logged a few lengthy phone calls with her trainer, who walked her through data migration of office records onto the Internet-based “cloud” system that is maintained on a remote server. She’s finished with conversion and has been told the next step is mapping, although she’s not yet sure what that is.
Medicine’s Digital Revolution
The Wassers are among the many rheumatology practices nationwide attempting to convert their operations to electronic records in order to take advantage of the funds made available through the HITECH Act, up to $44,000 per provider, for the meaningful use of EHR systems.
The U.S. government plans to allocate roughly $27 billion during the first half of this decade as part of the federal economic recovery package to encourage digital conversion to EHR systems, also referred to as electronic health records (EHRs). The Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program includes both incentives and penalties with incentive payments beginning in 2011 and offered through 2016. Payment penalties begin in 2015 at 1% of the providers Medicare Part B fee schedule and will increase to a 5% adjustment by 2020.
The medical world is going digital, but for many, getting there is a rough road.
This is the first year that providers who meet certification for meaningful use of electronic records can apply for federal money to help with the transition to electronic data capture for more efficient patient care. Wide-scale digital conversion is a multilayered undertaking involving hospitals, doctors, and other medical providers across the country. The mission is to reduce errors and increase efficiency, and improve the overall U.S. healthcare system with computer-assisted analysis of shared information on medical conditions and diseases nationwide.
Some in the trenches say the size and uncertainty of the task leaves them frequently aggravated or reluctant to even get started.
Taking the First Steps
Wasser says she just wants to get through the set-up process so she can begin to attest to meaningful use. To be eligible for the incentives, a provider must register and show meaningful use of its EHR system for 90 consecutive days during the provider’s first reporting year and the entire calendar year thereafter.
Earlier this year, James Singleton, MD, a rheumatologist based in Denver, decided to take part in the program. His practice already had an EHR system in place that was certified to meet the standards supporting the meaningful use objectives so he thought, “Why not go ahead and get involved now and get it done?” Devoting the time to fully understand the government requirements was crucial to completing the process, says Dr. Singleton. “I didn’t talk to anybody. I just did a lot of reading and rereading to figure it out.”
The first stage of the meaningful use program sets forth a listing of objectives and measures addressing the collection of structured data to support patient engagement, care coordination, quality improvement, and clinical decision support.
Craig W. Carson, MD, an Oklahoma-based rheumatologist, backed off of his plans to implement meaningful use at the beginning of 2012 after deciding that the office would benefit more from focusing on e-prescribing and Physician Quality Reporting Initiative incentive programs.
Dr. Carson’s office is already fully electronic and his staff formed a meaningful use task force earlier this year to address compliance with federal requirements. About two months into the process, it was clear to Dr. Carson that his idea of meaningful use was different from that of the government, he says. For example, the Meaningful Use program requires providers to record the preferred language, race, and ethnicity of patients, and Dr. Carson’s office was not routinely collecting that data.
The office’s meaningful use task force is now temporarily decommissioned. They have decided to upgrade the office’s software in the first quarter of 2012 independent of meaningful use, and will reactivate the meaningful use committee and start tracking its compliance once again next year. He is not sure yet whether the office will apply for meaningful use 2012 or delay until 2013—they are still analyzing the various incentive programs available and how close the practice is to being compliant with meaningful use.
Slow Progress for Some Practices
Despite the complications, Wasser is determined to succeed with the transition to an all-digital office setting. In the spring of 2011 after extensive research that included interviews with potential vendors, the Wassers chose an Internet-based “cloud” service that maintains electronic records on a remote server offsite from their practice.
“My intention, and they had me write this down, was to get up and running sometime in the spring, so we could have several months of practice—maybe practice all summer and then get on and be live so we could do the last three months of the year in meaningful use,” she says. “You have to do 90 days consecutively to get credit for it, which means we would have to do October, November, and December.”
As they worked to implement the system that would allow the practice to attest to meaningful use, Wasser realized that they would not be ready to start attestation this year. “There’s just no way that we’ll get this system in place and learn how to use it and be proficient in it to be able to do 90 days consecutively in 2011,” she says.
However, the delay won’t necessarily mean that Wasser’s practice will miss out on the full incentive. With this program, 2011 and, to a certain extent, the beginning of 2012 can be used to plan and prepare your practice for the transition to demonstrating meaningful use. The CMS EHR Incentive Program is designed so that providers can begin participation in the program in years 2011 or 2012 and still be eligible for up to $44,000 in incentives.
In hindsight, Wasser also learned some valuable lessons related to managing the EHR vendor you choose for implementation. For example, it didn’t occur to her to ask for specifically defined titles of vendor employees, but now she knows that she didn’t pay for a project manager, and she’s been told that the project coordinator included in her contract “does not manage.” Asking the vendor upfront for a very detailed timeline with specific milestones is also a good idea, she says
Thomas D. Geppert, MD, and his group of 10 Dallas-based rheumatologists had expected to begin the 90-day reporting period for meaningful use on a similar schedule but instead decided to delay participation until next year.
“From a financial point of view…we would do better to take a year of writing the e-prescriptions and then start the [EHR Incentive Program] next year,” says Dr. Geppert. You can’t get federal money for doing meaningful use and electronic prescriptions in the same year, he adds—it’s one or the other. Dr. Geppert’s practice will also need to upgrade to a new software version that is certified for meaningful use, which will take some time and training. He acknowledges that, “once you get the bugs worked out, it’s probably a good thing,” but his practice has been reluctant to upgrade since it doesn’t need to at the moment.
Dr. Geppert says his practice has moved the projected start date for the first reporting period of EHR to sometime in January 2012. “We could probably rush it and get it done but I think this gives us a little more time. I think it just worked out better for our group.”
Many providers have decided to maximize incentives received through the CMS program by submitting for the e-prescribing bonus payments in 2011, and then beginning the Meaningful Use program in 2012 when the eRx incentive payments expire. Providers are eligible for the same total bonus regardless of whether they start Meaningful Use in 2011 or 2012, so there is no financial penalty for delaying attestation until next year.
Wasser watches and reads online tutorials to learn more about the cloud system her office will eventually adopt while she waits for the vendor to contact her for the next step. But it’s like learning in a vacuum since she does not yet have access to the real system, she says. “It’s out there and they’re working on it. They are getting it all in shape for me to use. And then I know there will be a whole set of steps to set it up to function the way we want it to function, which is great,” she says. “It’s just taking so doggone long.”
Dr. Singleton, who began his 90-day reporting period in the spring, agrees that one of the most frustrating aspects of undertaking compliance is the extensive amount of time it takes to get everything in place correctly. But it can be done. Last month he completed attestation of meaningful use through a web-based application submitted to CMS to demonstrate he has met meaningful use criteria using EHR technology. Providers must complete attestation of meaningful use to be eligible for incentive payments.
Dr. Singleton says the process often felt like trying to shoot a moving target but, in the long run, persistence paid off. “Most of what I’ve learned … I’ve incorporated now but it’s still something that we are in the process of implementing as we go, with new patients and so forth,” says Dr. Singleton. “A lot more of it is automatic now but it took a lot of time to get that way.”
It is clear that it is a long road to meaningful use and to achieving a return on investment for implementation of health information technology; however, investments in these areas will start to bear fruit. Organizations that address this need early and head-on will be better positioned for a smoother transition and better able to adapt to the ongoing changes in the US healthcare system.
Catherine Kolonko is a medical writer based in California.