Health care providers are indeed motivated to optimize their use of electronic health records (EHRs), but recent research suggests that the challenge of addressing meaningful use objectives has convinced many providers to wait before applying for the EHR Incentive Programs.
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Surveys of the members of the College of Healthcare Information Management Executives, the Medical Group Management Association and SearchHealthIT.com all indicate that the vast majority of providers intend to receive federal incentives -- more than 90% of CHIME members, more than 80% of MGMA members and nearly 60% of SearchHealthIT.com readers, respectively.
Optimism is waning, though. The CHIME survey, which was conducted in February and is the organization's third since the passage of the HITECH Act, noted that fewer than 10% of members expected to qualify for the EHR Incentive Programs by April 1, the earliest date that hospitals could attest to meeting the Stage 1 meaningful use objectives. This percentage has dropped from 15% in November and 28% in August.
Quality measures, electronic notes toughest meaningful use objectives to meet
In an April 13 press webinar announcing the survey results, Pamela McNutt, chairwoman of the CHIME policy steering committee, said the "sticky wicket for everyone" is the set of meaningful use objectives that require quality data to be pulled directly from an EHR system. This is particularly troublesome because electronic documentation of physician notes, which is needed to create quality reports from EHR data, is not required until Stage 2 of meaningful use, McNutt said, adding that most quality data is currently collected through abstraction.
The MGMA survey, conducted in the fall of 2010, told a similar story. Respondents -- the majority of whom worked in independent practices -- were asked to identify which of the core, or mandatory, Stage 1 meaningful use objectives their EHR system could address.
Ranking highest was functionality that supported active medication lists, medication allergy lists, problem lists and patient demographics; nearly 95% of respondents had an EHR system with each of these features. Ranking lowest was the ability to report clinical quality measures, which fewer than 40% of respondents could do.
SearchHealthIT.com readers, also surveyed in the fall of 2010, expect to struggle with the same issues. When asked to describe how certain EHR features would affect core IT systems, 59% of respondents said quality reporting would have a "major" or "moderate" impact on IT, while 66% said electronic clinical documentation would also have such an impact. The only other functionalities to rank so highly was viewing electronic lab results, at 63%, and computerized physician order entry, or CPOE, at 62%.
McNutt noted that CPOE implementation, along with EHR certification, had been the top concern of respondents in CHIME's first two surveys. The sheer complexity of the quality measures has caused concern to shift, she said.
Dr. Christopher H. Tashjian, president of the River Falls, Ellsworth and Spring Valley Medical Clinics in western Wisconsin, noted that pulling quality reports from an EHR system can be hard, but, in comparison, "doing it by hand is really, really hard."
Tashjian -- who has completed meaningful use attestation for the Medicare EHR Incentive Program -- is able to compile quality reports in one day. Paper-based reports, on the other hand, took three months to complete. The transition to EHR-based quality reports was not completely smooth, he said, "but I think you have to look at your reference point."
In addition, Tashjian's clinics have moved to electronic documentation of all clinical notes, from prescriptions to lab results to appointment reminders. Not only does this reduce miscommunication and confusion, it helps patients better manage their care. "We can give patients information about their visit at the time they leave. We can hand them something right then and there," he said. "From my standpoint, it's amazing."
Uncertain future of EHR Incentive Programs not affecting strategies
The CHIME survey was the lone questionnaire of the three sent after the 112th United States Congress convened and promptly debated the repeal of health care reform and the defunding of the HITECH Act. Neither has happened, but it has nonetheless cast EHR implementation and the meaningful use objectives in a more cautious light.
Roughly 75% of CHIME members expressed concern that HITECH Act funding would be repealed, while 45% reported having "lingering questions" about the EHR Incentive Programs. Of particular concern is the state-run Medicaid EHR Incentive Program, according to the organization. Some states are already handing out incentive checks, while others have yet to even indicate when participating hospitals and eligible professionals can submit reports.
This uncertainty, though, does not seem to have affected providers' strategic plans. Nearly 41% of respondents to the CHIME survey suggested that they are accelerating EHR implementation plans in order to meet meaningful use objectives, while only 4% planned to make no changes to their implementation plans. Among the respondents to the MGMA who are still using paper records, 63% said the promise of financial incentives had convinced them to buy an EHR system.
Above all, implementing an EHR system seems to be about more than simply meeting meaningful use objectives. Nearly 70% of SearchHealthIT.com readers said a desire to improve care quality and efficiency motivated them to use EHRs. The desire to obtain HITECH Act funding came in a distant second at 14%.
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