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To get meaningful use payments, urologists must address workflow

Urologists planning to attest for meaningful use must adapt to an electronic workflow. Choosing the right EHR system, and considering radiology, can make this transition seamless.

Meaningful use compliance among urologists is a difficult task, but it's one that can be achieved by carefully...

selecting the right electronic health record (EHR) system and mastering a new workflow. While other specialties struggle to receive meaningful use payments from the EHR Incentive Programs, there are a number of success stories from urology practices.

Urologic Specialists of Oklahoma Inc. is one case of successful meaningful use attestation. More than a dozen of its eligible providers (EPs) have received meaningful use payments.

One of the key factors in deciding to pursue meaningful use payments was when the practice's current EHR system was upgraded to a certified EHR system, Practice Administrator Sandra George said in an American Urological Association (AUA) report. That is a large tipping point, considering the Medicare and Medicaid EHR incentive programs require the use of certified EHR technology.

One of the practice’s doctors, Curtis R. Powell, M.D., F.A.C.S, spearheaded the attestation process and noted that challenges do persist. "Some of the data elements we were required to gather had not been part of our regular clinical inquiries," he said, noting that criteria for meaningful use have "more social history elements such as race and/or ethnicity."

Additionally, criteria for meaningful use require that a clinical summary be given to a patient within three business days. The practice wanted to save time and money on mailing the summary, Powell said, so they altered their process in order to give it to patients as they checked out.

The right urology EHR system a vital decision

Choosing an EHR system that best fits your practice's workflow is a top priority when planning to attest to meaningful use. "A lot of time was spent choosing the system that had a lot of functions, something that had both patient records and billing codes built in that could be used by urologists and radiation oncologists," said Robert Sunshine, M.D., F.A.C.S, chief of urology at St. Joseph Hospital in Bethpage, N.Y., and also a founding partner of Advanced Urology Centers of New York (AUCNY), a division of Integrated Medical Professionals PLLC, or IMP.

AUCNY's physicians attended classes hosted by their vendor in order to learn all the system’s features. While Sunshine said it was helpful, urology-based practices as a whole "need to find something that's user-friendly," he said based on the investment it takes for complete EHR implementation.

Receiving meaningful use payments possible by addressing urology-specific measures

Sunshine, who has been using an Allscripts Healthcare Solutions Inc.-based EHR system since 2007, expressed that urology, like other medical specialties, requires a specific approach to fulfilling meaningful use requirements.

One of the more frequent ailments in the field is urinary incontinence. Treating UI is a "huge cost to the health care system," he said. There are vital steps in approaching UI, all of which must be documented for Medicare patients, as mandated by the Centers for Medicare and Medicaid Services (CMS). "We have to characterize it, come up with a plan for how you deal with it and record the treatment to date," said Sunshine, who can record that information in his EHR system.

A lot of time was spent choosing the system that had a lot of functions, something that had both patient records and billing codes built in that could be used by urologists and radiation oncologists.

Robert Sunshine, M.D., F.A.C.S, chief of urology, St. Joseph Hospital

A second example is bladder cancer. Since working with labs is a necessity for bladder cancer treatment, a urology EHR system that's truly interoperable is crucial for the best treatment, Sunshine said. Specifically, AUCNY's EHR system exchanges data such as patient history, tests on urine culture, urine analysis and abnormal cell information. What’s more, AUCNY has connected with radiologists in the area, ensuring that digital images taken by those radiologists can then be opened and reviewed in its EHR system.

Common ailments notwithstanding, AUCNY fulfills all criteria for meaningful use -- for example, practitioners complete drug allergy and interaction checks, record medication lists, vital signs and demographic data and also provide a clinical summary for patients.

What's more, Sunshine said, ACUNY uses CMS-based tools designed to help with compliance -- such as the Physician Quality Reporting System (PQRS) -- "all the time."

EHR implementation, meaningful use attestation takes teamwork, patience

Although Powell led the meaningful use attestation movement for Urologic Specialists of Oklahoma, converting to an EHR workflow was a practice-wide initiative. The group figured out which criteria for meaningful use could be allocated to each member of the medical staff -- physicians, nurses and medical assistants.

Sunshine dealt with switching from paper to electronic processes by not tackling it all at once. When he saw four patients per hour, he would use the EHR system for one patient and paper workflows for the remaining three. He gradually increased EHR use to two, three and then all four patients -- but it was not easy.

"Learning this tool was the hardest thing I have done since my residency," he said. "It was a very steep learning curve because for years I was using a written chart." The patience required seems to have paid off, though, as Sunshine said he "could not imagine practicing without it today."

Let us know what you think about the story; email Craig Byer. Assistant Editor.

This was last published in December 2011

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