Providers consider how to overcome EHR meaningful use obstacles

Incorporating the proposed meaningful use criteria into EHRs means challenges, but the struggle is worth the reward, doctors say.

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Interruptions of workflow seem to top the list of concerns providers have about implementing electronic health records (EHRs) and complying with meaningful use requirements under federal regulations, but some doctors say the struggle is worth the potential reward.

The Centers for Medicare & Medicaid Services (CMS) in late December released its proposed rule governing how hospitals and doctors have to use EHRs and other technology for it to be deemed “meaningful,” and therefore eligible for financial incentives. The program is expected to begin in 2011, and providers not using health IT by 2015 will be subject to penalties.

Individual doctors and eligible hospitals will mostly follow the same meaningful use criteria. Among some of the most discussed requirements are using computer physician order entry, maintaining medical information in structured electronic records, reporting quality data and providing patients with electronic copies of information upon request.

Doctors will have to choose whether they participate in the incentive program through Medicare or Medicaid, but they cannot qualify for funds through both. According to the proposed rule, each doctor could be eligible for up to $44,000 over the five years of the program.

But meaningful use is more than just the incentives or even the information technology, and doctors need to keep the big picture in mind as they move forward, said Joseph Fortuna, a physician who is CEO of Prism, a consulting company that helps physician practices identify and eliminate operational inefficiencies. Meaningful use “is all about how you’re practicing medicine,” he said.

Acknowledging that “change is hell,” Fortuna said the federal Office of the National Coordinator for Health Information Technology understands the challenges doctors face, and is trying to establish several programs that help physicians on all fronts of an EHR installation. “Yes, it’s an intrusion; yes it’s an enormous change in culture,” said Fortuna. But “you’ve got to start somewhere.”

Incentives for doctors to implement technology and follow meaningful use criteria have been allocated through the American Recovery and Reinvestment Act of 2009. The stimulus package included $34 billion in payments to help ensure providers implement health information technology with the goal of improving care and efficiency. Additional money from the stimulus is being made available through various grants programs to help support implementation, such as infrastructure and workforce training.

[Meaningful use] is all about how you’re practicing medicine.

Joseph Fortuna, M.D., CEO, Prism

Some of those support programs will come in handy for doctors who can’t take on costly implementations themselves, or who need help in understanding what type of technology they need to purchase, said Bruce Taffel, vice president and chief medical officer (CMO) at Shared Health Inc. The Chattanooga, Tenn.-based organization develops health information exchange applications for participants.

The proposed meaningful use criteria are a “mixed bag” for doctors, Taffel said. Physicians recognize that they have to incorporate technology in their practices, but the criteria will require significant changes to how they do business. The devil is in the details: for example, doctors under the proposed rule will have to count every prescription ordered to determine the percentages they write electronically -- a daunting task, he said. “Physicians don’t have easy access to a record of their total prescriptions for the year.”

In addition, the rule estimates how much time it takes to perform each task; in the federal rule, the CMS says it will take about a half hour to gather data for certain measures that have to be reported. “I don’t think it’s consistent with what you’d get in the field,” Taffel said.

Still, some of the technology, including sending prescriptions and lab tests, and capturing vital signs electronically, are pretty straightforward for doctors, said Jim Levett, CMO at Physicians’ Clinic of Iowa P.C. in Cedar Rapids. Where it gets a little tougher for doctors unaccustomed to using health IT is in developing patient registries or providing real-time reports of medical information for patients who request it.

Physicians’ Clinic began implementing an EHR system across all its locations more than a year ago and estimates that it’s spending about $2.5 million on the project. Deploying the technology is a “work in progress,” Levett said. “I can name 10 things I’d change in it tomorrow.”

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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