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Radiologists: Meaningful use payments only part of EHR motivation

Don Fluckinger, News Director

Meaningful use was already a hot topic at the Radiological Society of North America Inc.'s 2010 annual meeting, as electronic health record (EHR) systems were seen as a means to drive clinical data analytics adoption.

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At RSNA 2011, with radiologists now chasing meaningful use payments, the topic was on fire. Two key themes repeated themselves:

  • Eventually, meaningful use certified radiology information systems (RISes) will become a new category of health IT software best described as "the radiology EHR."
  • Meaningful use is not all about the Benjamins, necessarily, but instead about ensuring radiologists aren't left behind and putting them on par with medical specialties, such as cardiology and nephrology, that are receiving meaningful use payments.

A few radiology practices have completed meaningful use attestation, and some of them shared their experiences in two RSNA 2011 sessions -- one aimed at helping RIS vendors and their picture archive and communications systems (PACS) cousins plot the future, and one for radiologists themselves.

In both sessions, speakers analyzed the results from a KLAS/RSNA online survey of more than 200 radiologists' perceptions of meaningful use.

The overriding consensus among radiologists, KLAS found, was that some meaningful use criteria will benefit the specialty -- especially clinical decision support, with which radiologists could provide evidence-based measures to referring physicians for conducting the most appropriate imaging tests. This is a common sticking point right now.

According to the survey results, many radiologists are still just learning what the attestation process entails. Many aren’t interested in finding out, either. Only 6% of responding radiologists indicated they were very familiar with meaningful use requirements. Some 28% said they would tackle meaningful use attestation; 27% more are at least considering it; and 35% said they didn't know if they would. Ten percent of radiologists said "no" altogether.

"This field is changing dramatically every three months. The targets are moving, the technology's changing…and we're in the midst of a merger of two clinical entities -- and now we have more PACS than we thought we did before," said James Whitfill, M.D., chief medical informatics officer of Phoenix-based Southwest Diagnostic Imaging, whose radiologists practice in several area hospitals as well as 22 imaging centers. Southwest delayed its start of meaningful use, letting the early adopters figure out how to best fit the regulation into their workflows before radiologists begin their own compliance and IT investment program.

Moving past meaningful use stage 1

For the radiologists receiving meaningful use payments in the program's first year, it's been a bit confusing to adapt requirements to the radiology specialty. After all, the criteria were designed with primary care physicians in mind -- although, according to Centers for Medicare and Medicaid Services (CMS) data, more than half of EHR incentive payments so far have gone to specialists.

For the radiologists receiving meaningful use payments in the program's first year, it's been a bit confusing to adapt requirements to the radiology specialty.

One example is the lack of clarity from CMS as to what amounts to a "patient encounter" from which the meaningful use clinical quality measures are computed. This can be frustrating to radiologists; many times, they report findings to referring physicians after viewing images of patients instead of seeing the patients themselves. Does CMS define such a "read" as a "patient encounter," therefore tripping requirements to collect data on smoking status, immunizations and so on?

The key to navigating that issue, said Keith Dreyer, D.O., vice chairman of radiology computing and information sciences at Massachusetts General Hospital, is consistency -- as in, either count them as patient encounters or exclude them, every time. Don't pick and choose inconsistently to comply with different quality measures.

Dreyer, who represented radiologists at a meaningful use workgroup session held by the Health IT Policy Committee and Office of the National Coordinator for Health IT (ONC), said from the RSNA lectern that stage 1 of meaningful use lacked directly applicable mandates for many practicing radiologists -- because of that aforementioned common scenario where radiologists mostly read images and don't see patients.

Future stages, he imagines, will have many more compliance mandates for radiologists, because they will likely involve more image sharing and clinical decision support. He told SearchHealthIT.com he can only make educated guesses about the upcoming stages, however, even though he's been in recent contact with ONC leaders -- including a face-to-face meeting with ONC head Farzad Mostashari, M.D., to discuss the next stages. He said ONC continues play its hand close to the vest about what radiologists will have to do to comply with stages 2 and 3 of meaningful use.

"I honestly don't know, they haven't even released preliminary information, so I'd hate to even speculate [on what stages 2 and 3 will look like to radiology]," Dreyer said. "There are discussions going on, I know, next month, but they won't say if those discussions will result in stage 2 or stage 3 CQMs [clinical quality measures].”

Regardless, specialties are increasingly participating in meaningful use, Dreyer added. “There is discussion around imaging, how to set the standards for imaging, as well as specialists in general. What to do with the specialists in general, because there's a lot of complaining coming in."

Vendors aren't up to speed on EHR meaningful use

The KLAS survey also delved into radiologists’ perspective on vendor preparation. Only 8% of respondents thought their RIS vendors were well prepared for meaningful use, while 39% said they felt their RIS vendor was not prepared, with the balance of respondents indicating various levels of confidence in between. The breakdown for PACS vendors among respondents was similar, Dreyer said.

He added from his own data collected for the RadiologyMU.org site that 35% of RIS products are completely ONC certified for meaningful use, another 35% have modular certification, and another 18% are in the certification process. This takes from four months to a year and a half, depending on the vendor.

The disparity between the 8% of radiologists being confident in their software vendors' meaningful use prep and the one-third of RIS vendors that are certified is because the KLAS conducted its survey late last summer, while the RadiologyMU.org data was current to the RSNA show. Five vendors received full certification between the two surveys, Dreyer told SearchHealthIT.com.

Another factor fueling radiologist uncertainty about meaningful use is the lack of specific information geared toward their specialty.

"We need to collectively find a better way to have a forum where people can see who's certified and who's not," Dreyer said. "The ONC site has the billions of products out there, and all I want to see are the eight that I care about. I think that's where the disconnect is."

Certified RIS as "radiology EHR" key to getting meaningful use payments?

Dreyer and his peers floated the notion of the ONC-certified RIS becoming "the radiology EHR." That could happen, he said, because of the complexity of meaningful use compliance for radiologists. Many practice in several facilities. In many cases, either the EHR systems at those hospitals don't talk to each other to give the radiologist a full picture of the radiologist's patient base, or those systems have a radiology-specific software module that isn't ONC-certified.

Many large EHR vendors have not yet begun the certification process for their radiology modules, and some have indicated to Dreyer that it may not happen at all. This is giving rise to the standalone RIS applications that do achieve ONC certification becoming de facto certified EHRs. Radiologists can collect patient quality metrics data for meaningful use reporting, piped in from the various EHRs of referring physicians and hospitals with whom the radiologists work. Once the radiologist fills in what's left with his own data when needed, he would be ready for meaningful use attestation.

"[Meaningful use] fits right in to a RIS nicely," Dreyer said. If this new "radiology EHR" doesn't emerge in the market, he added, radiologists could in theory qualify for EHR incentive payments by using free, Web-based EHR systems that are ONC certified, such as those from Practice Fusion Inc. and OpenEMR. But that’s not a complete solution either, since those systems aren’t built for radiology. "That's a lot of double-work or interfacing. I don't think all that's necessary."

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


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