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Three states take lead in EHR Incentive Program

Medicaid programs in Oklahoma, Louisiana and Kentucky have issued the first EHR Incentive Program checks. Each state has important lessons to teach about boosting EHR adoption.

The federal funding tap is open, and Electronic Health Record Incentive Program dollars are flowing, at least to qualified participants on the state-administered Medicaid side. Oklahoma, Kentucky and Louisiana issued the first checks in January.

With all the discussion about the challenges of meeting requirements under the incentive program, it's not a surprise that the first checks written are being celebrated by officials as evidence of the early success of electronic health record (EHR) adoption.

Ironically, the first checks were written in states that had not been projected as early adopters of EHRs. According to 2010 preliminary estimates from the National Ambulatory Medical Care Survey, Oklahoma, Kentucky and Louisiana are near the bottom of the EHR adoption curve, ranking "significantly lower" than or "not significantly different" from the national averages when it comes to using EHR technology.

And while Oklahoma, Kentucky and Louisiana are busy processing registrations for their Medicaid incentive programs, many other states are still trying to launch theirs. According to the Medicaid State EHR Incentive Program website, managed by the Centers for Medicare & Medicaid Services (CMS), at least 23 more states plan to launch their programs in 2011. (Some states, such as Massachusetts, have started their programs but do not appear on the CMS list.)

As the first to issue payments from the Medicaid EHR Incentive Program, these states send a message that anyone can play this game. Kentucky has a large rural population, and some doctors don't even have broadband, yet the state was able to do it, said Dr. Carol Steltenkamp, chief medical information officer at the University of Kentucky's UK HealthCare hospital.

Regardless, even with about a dozen states being open for registration and even with these states' successes, it's hard to say where the next EHR incentive checks will be produced. Getting providers to put EHR adoption at the top of their priority list is a big challenge, but having the state's Medicaid incentive program to rely on could be a step in the right direction.

Regional extension center aided family practice with EHR adoption

Oklahoma was the first state to issue incentive checks, just two days after registration opened for the EHR Incentive Program. The Gastorf Family Clinic in Durant received two payments of $21,250, for two physicians who successfully implemented an EHR system, while the Norman Regional Health System received one payment.

The Gastorf Family Clinic signed up with Oklahoma's regional extension center, the Oklahoma Foundation for Medical Quality, or OFMQ, in August 2010, and worked closely with the REC throughout the application process.

Dr. Garth Splinter, the state Medicaid director, noted that this is a huge accomplishment for Oklahoma. "Oklahomans are fortunate to have medical professionals who care about improving patient care through available improvements in the usage of electronic health records," he said.

Meanwhile, two hospitals in Kentucky -- UK HealthCare and Central Baptist Hospital, both in Lexington -- were the first in the country to receive incentive checks.

UK HealthCare began switching to EHRs in 2000. For its work, the organization received $2.8 million.

"It's very exciting," UK HealthCare's Steltenkamp said, adding that it's hard to say just how much of the payment will cover the costs of implementing the EHR system. "I don't think it would be fair to draw that line."

The $2.8 million, then, is more like a bonus for being ahead of the game. "From our organization's standpoint -- because UK HealthCare has been dedicated to moving down this path -- this really is a pat on the back for having achieved the level that we're at," Steltenkamp said.

Being an early adopter of EHR technology certainly helped the hospital get its check so soon, but Steltenkamp credits the state's Cabinet for Health and Family Services with getting its Medicaid EHR Incentive Program up and running quickly. Kentucky was one of 11 states open for registration on Jan. 3.

It also helped that the process of applying for incentive funds was not terribly difficult, and took less than a day. Steltenkamp completed the first part of the application, which involved going to the CMS website and putting her organization's EHR applications into a basket. That process -- sort of like shopping, she said -- then generated a unique number to be used for the organization's application. Finally, a UK HealthCare employee familiar with the hospital's cost reporting filled out the rest.

EHR Incentive Program fever sweeps Kentucky

The University of Kentucky also houses the state's REC, of which Steltenkamp is the director. Getting incentive checks for UK HealthCare "has been a real shot in the arm for the regional extension center, in the sense that it made it real for the folks that are out there on the front line," she noted.

This really is a pat on the back for having achieved the level that we're at.

Dr. Carol Steltenkamp, CMIO, UK HealthCare

Providers who might have been skeptical of the EHR incentive program now can see progress being made in their own backyard, and may be more likely to begin taking steps toward meaningful use, Steltenkamp added. The potential for that reaction was a factor in UK HealthCare's decision to apply for incentive funds as quickly as possible. "We anticipated that that would be a plus," she said.

The Kentucky REC currently has 450 providers signed up for services, and 25 providers have registered for the state Medicaid EHR Incentive Program.

"Being among the first states to receive the Medicaid incentive payments is evidence that Kentucky has established a structure to move these efforts forward, and is truly leading the way in this nationwide effort." Gov. Steve Beshear said, adding that the incentive program has had a positive impact on Kentucky's ability to build a statewide health information exchange (HIE).

Overall, Kentucky expects to receive an additional $100 million in incentive payments over the next four years, Beshear said. "We've already made tremendous progress, but cost and technical support remain a barrier for offices and agencies seeking to upgrade to an electronic system. This program is a tremendous help in overcoming these obstacles."

Natural disasters lead Louisiana to take strides promoting EHR adoption

With many rural communities, Louisiana might not be considered a technology leader in many areas. Nevertheless, the state's patients, physicians, hospitals, clinics and Medicaid officials all inherently understand the value of EHR systems: They have learned firsthand what it's like to lose paper medical records.

"I think Louisiana has a little bit of a unique story," said Lisa Faust, director of media and communications for the state Department of Health & Hospitals. "I was here during hurricanes Katrina and Rita. My mom was evacuated, had none of her records with her and was unable to get her doctor on the phone to get a prescription that she needed. That happened to hundreds of thousands of people. We saw that over and over again."

Residents' memories of those problems will last a long time, and technology will play a larger role to protect against future disasters, Faust said. "People still have very sharp memories of those struggles, the … pharmacists trying to connect people at a time when no one could be connected. It's a really important part of the process, and one of the reasons you see us pushing so hard to be the first and to make this work."

Louisiana Medicaid issued the first-in-the-nation Federally Qualified Health Center (FQHC) incentive check Jan. 12 to Winn Community Health Center in Winnfield. The state is pushing EHR incentives through several promotions, including print ads and email campaigns, Faust said. Issuing that first FQHC check is a significant accomplishment in the eyes of the state, she added

Ultimately, about 100 Louisiana hospitals and 5,000 physicians and dentists could meet the Medicaid or Medicare criteria for receiving EHR incentives, said state health IT coordinator Zachary Jiwa. How many apply for the checks and ultimately meet the criteria, he said, is difficult to project at this early stage of the program.

Features writer Don Fluckinger contributed to this report. Let us know what you think about the story; email Anne Steciw, Assistant Editor.

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