For cloud EHR users, meaningful use, data exchange low priorities

Health care providers adopting cloud-based EHR systems are doing so not to achieve meaningful use but, they say, because it makes clinical workflow and data management easier.

When forced to choose among hundreds of electronic health record software offerings, many providers are increasingly turning to cloud EHR systems. Doing so gives providers better clinical workflow and data management potential than paper-based records while simultaneously letting them ease their way into cloud adoption.

Qualifying for meaningful use, the federal incentive program for EHR adoption, is less of a motivator for these providers than one might expect.

ClearPractice LLC President Joel Andersen said that, while his company went through the process of getting Eden, its cloud EHR system, certified for meaningful use, it's hard to tell if the main driver of his company's business is meaningful use or the popularity of the iPhone and iPad among physicians.

For his part, Dallas-area internist Scott Yates M.D. isn't planning to apply for meaningful use incentives. (His practice doesn't see enough Medicare patients). He just feels that EHR workflows are more efficient and secure than paper. He also buys into the argument that electronic workflows lead to better patient care.

Northern Massachusetts physical therapist Kevin McGovern doesn't even qualify for meaningful use, but he, too, uses a cloud EHR -- in this case, from WebPT Inc. -- because it simplifies care coordination while minimizing IT support among his four clinic locations.

"I didn't do it to get a rebate," McGovern said. "I did it to make my staff happier, be safer, and speed production."

We had a central server and each office had a server. It just made things much more complicated if something went wrong.

Kevin McGovern, physical therapist

Like Yates, McGovern started out years ago with an EHR application he hosted in his office. He set up a wide area network and was the first of his vendor's customers to do so. At the time, McGovern said he was "kind of ahead of the curve with the technology." However, the server slowed down noticeably as more people logged in, and it was a kluge to manage from an IT standpoint.

"We had a central server and each office had a server. It just made things much more complicated if something went wrong," McGovern said. "It's archaic at this point. I wanted to make sure my practice was completely Web-based."

With that in mind, McGovern not only committed to a cloud EHR -- he also ported his billing and accounting system to Software as a Service vendors. He said the ease and speed of going paperless and Web-based has changed his practice for the better, with none of the performance issues of his old setup.

Cloud EHR not yet enabling health information exchange

Ironically, both Yates and McGovern -- two providers who aren't getting meaningful use incentives but went ahead with EHR implementation anyway -- are ready and waiting for health information exchange (HIE), another requirement tens of thousands of physicians will have to prove in the later stages of meaningful use.

They are finding it's not happening whatsoever. This is despite the convenience and interoperability benefits HIE would bring to a business that McGovern said is much more documentation-intensive than it was even a few years ago, thanks to demands of payers and regulatory compliance.

In fact, McGovern actively pursued point-to-point HIE with his top 100 referring physicians -- those responsible for 725 patient visits per week to his clinics. His "brilliant idea" was to acquire contact, prescription and insurance information for incoming patients from those referrers via email. He found that some of them run applications that theoretically could do it, as well as receive Continuity of Care Documents (CCDs) exported from WebPT. However, every single one chose to send patient information -- and receive reports -- via fax.

"It's very frustrating. The physicians are a little behind the curve, in my opinion," using their own EHR system to share data within their group practices, McGovern noted. "WebPT has the ability to communicate to the outside world. They don't seem to have that technology -- or they're not using that part of it."

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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