blankev wrote on Friday, May 15, 2009:
May 14, 2009 — The federal government is offering physicians tens of thousands of dollars in incentives beginning in 2011 to use electronic health records (EHRs). Opportunistic software vendors are trumpeting "now is the time" to buy their products.
However, experts on digital medicine caution physicians to resist a hasty decision. After all, the Department of Health and Human Services has yet to define what kind of systems physicians will need to buy — and how they should use them — to qualify for the incentives. That payout is a maximum $44,000 over 5 years under Medicare or nearly $64,000 over 6 years under Medicaid.
More important, physicians need to carefully lay the groundwork for acquiring an EHR system, which includes having a strong reason to buy one, such as managing chronically ill patients, or simply spending less time looking for lost charts.
“You shouldn’t buy an EHR just to get $44,000,” said Steven Waldren, MD, director for the Center for Health Information Technology at the American Academy of Family Physicians. “If you don’t do your due diligence, there’s the potential for big problems.”
“You’re not just purchasing hardware and software,” added Michael Barr, MD, vice president of practice advocacy and improvement at the American College of Physicians. “You’re reinventing how you work.”
Medscape Medical News interviewed Dr. Barr, Dr. Waldren, and other experts for advice on how to go paperless in light of the federal incentive money.
Don’t Fixate on 2011 Deadline
The EHR incentives, also available to hospitals, are authorized by a section of the recently passed American Recovery and Reinvestment Act called the Health Information Technology for Economic and Clinical Health (HITECH) Act. Providers receive them only after they’ve shelled out their own money to buy the technology — in other words, the incentives are not up-front subsidies. The payouts progressively shrink for late adopters. A physician who qualifies for the Medicare incentive beginning in 2014, for example, would receive only $24,000 over 3 years. Incentive payments cease after 2016 under Medicare and after 2021 under Medicaid.
These rewards are coupled with penalties for continuing to use paper charts. Physicians who treat Medicare patients in 2015 without an EHR will experience a 1% Medicare pay cut that year. The penalty increases to 2% in 2016 and 3% in 2017, with the potential to get even bigger in subsequent years. There are no such penalties on the Medicaid side.
To earn the carrot and avoid the stick, physicians must demonstrate "meaningful use" of an EHR program, which HITECH defines as prescribing electronically, generating reports to HHS on as yet unspecified "clinical quality measures," and exchanging patient data with other providers. Plus, the system must be a certified one.
By year’s end, HHS is supposed to spell out the exact nature of data exchange, the clinical quality measures (they could be something like ordering annual eye examinations for diabetic patients), and the process for certifying EHR programs. HHS could rely on a private group called the Certification Commission for Healthcare Information Technology (CCHIT), but that’s not a foregone conclusion, experts say.
These question marks create a quandary for physicians hoping to earn incentive payments in 2011. If they buy an EHR system before December 31, their system may not satisfy the HITECH fine print that everyone’s waiting for. To be sure, some vendors promise to comply with whatever requirements emerge, and physicians can even attempt to require such compliance in sales contracts, said Jeffrey Daigrepont, a healthcare information technology consultant with The Coker Group in Alpharetta, Georgia. However, if physicians play it safe and wait until 2010 to make their purchase, they may not qualify for an incentive payment in 2011, since the process of buying, implementing, and getting up to speed on an EHR system can take more than a year, according to Dr. Waldren.
Then again, it’s not crucial to beat the 2011 deadline, since physicians who begin to demonstrate meaningful EHR use in 2012 can still qualify for the full $44,000 under Medicare over 5 years. And waiting until 2013 yields $39,000 over 4 years, just $5000 shy of the maximum. Consequently, it’s better to carefully select the right EHR and forgo a few thousand dollars than to hurriedly purchase a system that will cost the practice even more in inefficiency, said Dr. Waldren. “The wrong EHR might reduce the number of patients that a physician can see per day.” Frustrated physicians often abandon their new tool; 4 years ago HHS estimated that the failure rate for EHR roll-outs exceeded 30%.
How to Do EHR Homework
What physicians should do immediately, experts say, is the homework for implementing an EHR. This job begins with assessing a practice’s needs and setting goals.
"What do you want to improve?" asked Dr. Waldren. "Some practices want to take better care of their diabetic or hypertensive patients. Others want to increase the rate of preventive services. Some doctors simply want to electronically access their charts from home."
Physicians also need to envision how an EHR will transform office routines and job descriptions, added Dr. Barr. Consider, for example, the handling of patient phone messages. Traditionally, receptionists or medical assistants write them down on a sticky note, pull the paper chart, and give the note and chart to the physician. With the internal messaging capability that comes with many EHRs, these staffers can electronically relay the patient’s questions to the physician without a chart pull, said Dr. Barr. “It’s a simpler workflow.”
Learning what EHRs can do — and which systems are the easiest to use — is an essential but not daunting task. Many national and state medical societies provide EHR education at their Web sites — including lists of preferred products, member forums, special selection tools, and product ratings. For Consumer Reports–style intelligence, a research firm called KLAS (http://www.klasresearch.com) surveys EHR users to rate vendors on issues like implementation, training, and support. The AC Group (http://www.acgroup.org) offers similar ratings but at a lower cost.
There’s also up-close and personal homework to do — comparing EHR systems on the exhibit hall of medical conferences, visiting other practices that have implemented the technology, inviting individual vendors to demonstrate their products, and giving them a test run. Experts recommend that a physician involve his employees in the evaluation process since they’ll be using the system too.
Advice for Physicians Now Using EHRs
Physicians who have already converted to electronic charts are in a better position to qualify for the federal incentives, but they can’t necessarily rest on their digital laurels.
Many physicians use their EHRs, for example, to create prescriptions, but then they fax them to the pharmacy — and flunk the electronic prescribing requirement of HITECH, said Dr. Waldren. To be compliant, they must electronically transmit scripts from their computer to the pharmacy’s computer. Visit the Web site of Surescripts (http://www.surescripts.com), a pharmacy industry group that has created a network for electronic prescribing, to learn how to make the necessary connection. Likewise, to report their performance on clinical quality measures to HHS, physicians with EHRs must learn to use any patient registry or report-generating tools that may have come with their software, or else have them added, said Barb Drury, a healthcare IT consultant in Larkspur, Colorado.
Even bigger and more expensive changes may be in store for EHR users if HHS decides to make CCHIT certification its stamp of approval for these programs, said Ms. Drury. That’s because CCHIT revises its certification standards each year, making them more rigorous. Programs certified under the 2006 or 2007 standards may not qualify for incentive payments if HHS sets the bar at the levels of the more rigorous 2008 standards or the forthcoming 2009 standards.
The solution is upgrading to a newer version of a particular program boasting the necessary certification pedigree, assuming the vendor has kept pace with CCHIT requirements. Because some programs have been drastically redesigned in recent years, Ms. Drury said, such an upgrade could force physicians to buy new hardware and ancillary database software.
Having an EHR system that fails to satisfy HITECH, of course, will trigger financial penalties under Medicare beginning in 2015. The good news is that whether physicians are veteran EHR users or first-time shoppers, they have a few years to get their act together. And they’ll need that time, because implementing healthcare information technology poses a lot of tough decisions, said Ms. Drury. “It’s not like going to the store and buying a pair of socks.”
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There is some time left to show what OpenEMR can be for this project.