Halfway into the first year of the Electronic Health Record (EHR) Incentive Programs, not much has changed since health IT professionals began discussing their concerns about the meaningful use criteria two years ago. Productivity losses, implementation costs and quality reporting measures remain top concerns among providers, who are realizing that fulfilling the criteria requires IT readiness; expansive, detailed documentation, and a commitment to reporting.
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Whether everyone can achieve that is still up for debate, but some providers charging out of the starting gate have already completed meaningful use attestation and say they are getting meaningful use money now. While the path to reaching attestation wasn't simple, they say that being prepared made reporting to the Centers for Medicare & Medicaid Services (CMS) the easiest step.
Organizations participating under the Medicaid portion of the program began receiving incentive dollars earlier this year, and to date, states have paid out about $83 million to providers. CMS announced it will begin sending out incentive payments this week to hospitals and doctors attesting under the Medicare portion of the program.
Long before anyone was ready to sit at the computer and follow the CMS’ instructions for meaningful use attestation, MedCentral Health System in Mansfield, Ohio, was integrating its health IT and assessing what was needed to improve the health system and care delivery.
That included having doctors sit down with one another, determining access points for data and remaining patient-focused, according to Pam Crawford, a registered nurse who is vice president of nursing and social services for the health system. "There was a lot of tweaking that we had to do."
MedCentral -- a health system with a community hospital, critical-access hospital and a network of 200 affiliated physicians -- developed an action plan based on the core measures they had to meet and the optional criteria they selected. The team that would lead the project included physician champions, the IT department, clinical analysts, a project manager and its EHR vendor, Siemens Healthcare. The health system decided it would start its 90-day reporting period on Dec. 7, 2010.
When meaningful use attestation opened on April 18, MedCentral CIO Mike Mistretta spent about 30 minutes at the computer, entering the health system's data in the CMS database. Having screen shots of the CMS system, not to mention having all of the information organized ahead of time, allowed the process to go smoothly, he said. "We were pretty prepared."
We're constantly looking at how we can make improvements.
Pam Crawford, vice president of nursing, MedCentral Health System
Just as much preparation was needed at a practice that includes six cardio physicians and six nurse practitioners. The Heart & Vascular Center of Arizona (HVCA), based in Phoenix, was also ready to begin meaningful use attestation on the earliest day it was available, but not before it had converted all its paper documents to digital records.
That itself required Herculean effort. For the physicians who had been practicing 30 years, "some patients had 11 volumes of charts," said HVCA Administrator Barbara Watkins, a registered nurse. The practice worked with a scanning company to create digital records.
In 2007 the organization began using GE Centricity practice management software; the next year, it went live with General Electric Co,'s EHR software. That vendor partnership was key as the planning process for meaningful use started, Watkins said. "Your vendor has to be your best friend."
Doctors must individually complete meaningful use attestation for the EHR Incentive Programs. The first physician was ready on April 18; HVCA is helping its others now. Having all the information at their fingertips makes attestation easier, Watkins said.
Both MedCentral and HVCA found difficulties in meeting some of the requirements; one of the biggest is the core criterion to provide patients, per their request, with an electronic copy of their record. While helping patients become more informed about their care is important, it's a challenge to make that requirement work in reality, according to MedCentral’s Crawford.
The challenge for HVCA is that it offers a patient portal -- Watkins said doctors don't often have requests for records, since patients can already see the information. But, for the EHR Incentive Programs, "we have to have metrics for all that."
Meanwhile, information exchange helped to meet other criteria. For example, MedCentral integrates medication information from local pharmacies; this way, admitted patients continue to receive the most accurate drugs possible. The more information available creates a better care experience and can lead to improved outcomes, Crawford said. "We're constantly looking at how we can make improvements."
As the health system turns its attention to meaningful use Stage 2 criteria, those types of tweaks become even more crucial, she added. "That’s going to be here before we know it."
Health information exchange is a bigger component of Stage 2 -- and practices will have to work harder to achieve this, according to Watkins. "Everyone is at the beginning of finding their ways through this process."
For its part, HVCA has already achieved information exchange with another practice -- and, in doing so, the practice is going above and beyond the meaningful use requirements. CMS merely requires a Continuity of Care Document, while HVCA is accustomed to sharing a more detailed physician’s note, Watkins said. "We want to meet meaningful use, but we also want to make sure they get all the information they want."
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