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For radiology, meaningful use means workflow, system tune-up

In specialties such as radiology, meaningful use incentives are reached not by implementing EHR systems but by getting Web portals, data exchanges and quality reports in order.

While they might not create many electronic health record files and they might not even own an EHR application, radiologists are big players in health IT. They generate a lot of the patient care data found on hospital networks, and they will have to share it with the physicians who refer their patients. As a result, it is possible for radiology to get meaningful use incentives as spelled out in the federal government's EHR Incentive Program.

Radiologists' need for connectivity to and interoperability with EHR systems make them important enough, in the grand scheme of health care technology, to earn those incentive payments, said Dr. Keith Dreyer last Wednesday in a presentation for radiology site He is vice chairman of radiology informatics at Massachusetts General Hospital in Boston and a Harvard Medical School professor.

According to Dreyer's calculations after the Centers for Medicare & Medicaid Services (CMS) issued its meaningful use final rule last July, about 90% of radiologists are eligible for Medicare incentive payments -- as well as penalties for not conforming to meaningful use regulations. Radiologists tend to perform enough diagnostics outside of hospitals to meet eligibility criteria for meaningful use. Most will easily meet the requirement of seeing Medicare patients, too, because that age group overlaps with their typical patient.

"When you look at the 35,000 or so radiologists in the United States practicing -- and you multiply this out -- it's an over $1 billion dollar-incentive opportunity for U.S. radiologists, collectively," Dreyer said.

For IT leaders at hospitals or standalone clinics interested in securing meaningful use funds for radiology, Dreyer outlined how the game plans might differ from the typical physician's:

  • It's not (necessarily) about the EHR. Since many radiologists are not creating medical records but, rather, are adding data to patient records other providers create, the main goals for radiology in enabling meaningful use include processes such as image sharing, health information exchange (HIE) and clinical decision support -- and not necessarily EHR adoption.
  • Some of the meaningful use objectives don't apply to all radiologists, or at least a good share of them. Two obvious examples are e-prescribing, since few radiologists prescribe medications, and computerized physician order entry, or CPOE, since they typically are reading studies, not ordering treatments. The Office of the National Coordinator for Health IT within CMS listened to comments from several professional groups that banded together to submit a single radiology meaningful use comment letter earlier this year. The upshot? As of this writing, radiologists are exempt from five of the "core set" and six of the "menu item" meaningful use requirements. All of these are detailed (and updated as regulations evolve) at
  • Some technology in many radiology offices can fulfill meaningful use requirements -- recording smoking status of patients, for example, as well as providing personal health record files and Web portals for image sharing or maintaining a list of a patient's active diagnoses. Dreyer said to check with vendors to confirm that these systems are meaningful use-certified and to encourage them to certify if they aren't already.
  • However, other technologies required for meaningful use aren’t typically in radiology. IT staff will likely have to purchase and implement them to accomplish compliance goals. These might include applications enabling clinical decision support, HIE and ambulatory clinical quality measures reporting.
  • Once a radiologist has settled on which meaningful use requirements to pursue -- and in what order -- implementation steps include training the eligible practitioners who will be meaningfully using the EHR systems, confirming that the software in use is all certified for radiology meaningful use, and developing the data analytics and reporting mechanisms the regulations require.

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

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