For ambulatory physician practices that use electronic medical record (EMR) systems already, getting into meaningful...
use compliance does not involve bringing new systems online. Instead, it is a matter of tracking the differences between the proposed and final versions of federal rules and integrating those rules into their patient care workflow.
That might not be as big a job as migrating paper processes to EMR systems, but understanding how to integrate meaningful use tenets into real-world health care has its challenges. Atrius Health Inc., an 800-physician, Boston-based group, integrated Epic Systems Corp.'s EMR software across its system, starting 10 years ago. Last year, Quincy, Mass.-based Granite Medical Group switched over from Amicore Inc.'s PenChart, completing the transition system-wide.
Dr. Michael Lee, Atrius' director of clinical informatics, said the economics of EMR integration is one thing that drives docs to join Atrius, which formed when the ambulatory practices group of Harvard Vanguard Medical Associates banded together with four other large ambulatory groups, starting in 2004. Atrius continues to add practices to its group.
Long before federal lawmakers set down the financial incentives for this decade's health IT buildup, Atrius' network of primary care doctors and 35 types of specialists had decided to implement an EMR system. Banding together helped spread integration costs among hundreds of doctors. It became an attractive proposition for solo practitioners or small groups otherwise unable to finance a complex EMR integration on their own, and by its scale it allowed for a system that would be interoperable with local hospitals.
"We decided that it would be in good strategic interest for us, and better for patient care if we all shared the electronic records," Lee said in an interview at Atrius' headquarters in Newton, Mass.
At Atrius, the electronic record is a patient's definitive documentation, not an adjunct or backup to a paper process, nor a mix-and-match combination of paper and online files. As such, meaningful use compliance is not intimidating.
"We're waiting for the final regulations, so it's hard to fully comment without knowing exactly what they're expecting of us," Lee said. "When we looked at the [proposed meaningful use rules], we already met easily three-quarters of the criteria."
Lee's main concerns, as the Centers for Medicare & Medicaid Services make final meaningful use compliance rules, do not involve which data standards they eventually will require or which of the more than 100 quality indicators CMS will use to judge performance. Instead, Atrius is worried about how to apply the square pegs of some open-ended rules into the round holes of Atrius' workflow.
For example, by 2011, Atrius will need to provide the primary language for each patient in the electronic health record. Hospitals typically collect that information because they deal with interpreter services for non-English speakers, but Atrius and many ambulatory providers often do not. Collecting that data for every patient and getting it into Atrius' Epic system by 2011, for the sake of meaningful use compliance, presents a logistical problem, Lee said.
Meaningful use rules also require physicians to provide patients with an after-visit summary, which typically includes general information about a condition, as well as its treatment. It's a great idea for complex conditions such as asthma, Lee said. But, he wondered, is a summary really necessary for follow-up visits to a pediatrician for a teething baby? For checkups at a dermatologist? For an ear check with a specialist to make sure a previous issue has cleared up?
"In the meaningful use criteria, it says, 'all visits.' To engineer that for everyone is a bit of a trick," Lee said.
Watching for data exchange standards, too
Other meaningful use compliance issues that Atrius is watching closely -- and is preparing to work into its EMR system -- stem from data exchange standards, as state and federal leaders determine frameworks for providers to pass patient data back and forth.
Simple protocols become complex when providers across companies, states and regions need to get onto the same page. For example, one provider's EMR system might refer to one popular cholesterol-reducing drug as Simvastatin, while another uses its trade name, Lipitor. During information exchange, that issue can make one prescription multiply into many.
When we looked at the [proposed meaningful use rules], we already met easily three-quarters of the criteria.
Dr. Michael Lee, director of clinical informatics, Atrius Health Inc.
"When we talk about actual exchange of information at transitions of care, it's not clear how quickly we can get the systems to talk to each other directly so we don't create complex problems," Lee said.
Living on the cutting edge of health IT implementation has its costs. Because Atrius is striving to make all its patients' medical records completely electronic while regulators are still wrangling over standards, it sometimes has to deal with outside hospitals and providers who still use paper. In these cases, a central records facility scans documents, analyzes content and integrates the documents into a patient's Epic file.
"It comes to us [in] an enormous variety of ways," said Dan Moriarty, Atrius CIO. "That's the state of the art. You need to take it as it comes, and adjust accordingly."
At this point, Moriarty said, it does not matter to him which electronic data exchange standards authorities settle on, as long as they finish the decision making process: "I think a lot of people agree that when it comes to data exchange standards, any standard will do."
Let us know what you think about the story; email Don Fluckinger, Features Writer.