EMRs are increasingly being integrated with practice management systems for optimal tracking of data between the clinical and administrative sides.

Adoption of EMRs goes hand-in-hand with improved practice management strategies, gained either through software programs or organizational initiatives.

With the passage of the American Recovery and Reinvestment Act last February, it’s become an issue of when, rather than if, physicians will ditch their paper charts in favor of EMRs. While many practices may not be ready for the transition to EMRs when the Medicare and Medicaid incentive program begins in 2011, expect a big push for adoption—not all at once, but stretching out over several years, right up until Medicare starts penalizing doctors for not using EMRs in 2015.

It’s probably a good idea not to rush because the Office of the National Coordinator for Health Information Technology (ONC) will not have a final definition of “meaningful use” of health IT—the standard by which physicians will qualify for the Medicare bonuses of up to $44,000 or Medicaid payments as high as $63,750—until the second quarter of 2010. However, ONC was to have published a proposed rule by the end of 2009 (as of publishing time, it did not). A draft circulated last summer provides some insight about what the final parameters will look like.

As proposed in July 2009 by the Health IT Policy Committee, an HHS advisory panel, physicians will have to:

• Use computerized physician order entry for all medication, laboratory, procedure, imaging, immunization and referral orders;
• Have electronic checks for drug interactions;
• Keep up-to-date patient problem lists;
• Incorporate test results into the EMR as machine-readable “structured” data;
• Report to CMS on ambulatory quality measures;
• Include at least one specialty-specific rule for clinical decision support; and
• Check insurance eligibility and submit claims electronically.

The Health IT Policy Committee hinted at offering some flexibility, proposing to give providers until 2014 to achieve meaningful use based on the 2011 criteria, which would cover the first year of participation. The 2013 standards correspond to a provider’s third year of meaningful use, and 2015 to the fifth year, regardless of what calendar year that happens to be. Latecomers may not be eligible for all possible funding, however, since the law requires physicians to start by 2012 in order to earn the full subsidy.

Timing is key
If the news that’s trickled down to the practice level is any indication, physicians will need as much time as they can get to comply.

Cindy Dunn, a senior consultant for the Medical Group Management Association (MGMA), reports hearing from numerous clients wondering when Uncle Sam was going to write them a check so they could purchase an EMR system. Well, it doesn’t quite work that way. Practices will have to buy and install the technology, and prove they are using it in a meaningful way before seeking Medicare and Medicaid reimbursement. “The stimulus isn’t there to help you purchase an EMR/EHR,” Dunn explains. “It’s there to help you provide better quality care.”

Practices must choose either the Medicare or Medicaid track; they cannot combine the bonus payments. However, they can piggyback incentives on top of an exemption to the Stark physician self-referral and Medicare anti-kickback rules that allow hospitals and health systems to cover up to 85 percent of the cost of EMR software and training.

It is a matter of due diligence whether to accept a hospital’s offer or whether to choose a system independently. Financial resources and payor mix should be important considerations in the decision, suggests Mary Pat Whaley, practice administrator at Halifax Regional Medical Center in Roanoke Rapids, N.C. “Each individual practice needs to measure where they are technologically and in the community,” Whaley says.

While it’s often unclear whether EMRs produce direct financial benefits, anecdotal evidence based on experience with the Medicare Physician Quality Reporting Initiative (PQRI) suggests that reporting on clinical quality measures is greatly simplified with an EMR, but it could depend on the particular system. Internist Jeffrey Hyman, MD, is firmly in this camp. Hyman, who is medical director of University Physicians Group, a 65-physician practice in New York City, says the group has been participating in PQRI since 2006, and about 35 clinicians in the group work in office-based settings and thus are eligible for PQRI bonuses. Some EMR systems have found PQRI “nearly impossible,” while others have found PQRI “seamlessly easy,” Hyman says.

Integrating practice management
A successful health IT project might require more than just an EMR. There could be widespread upgrading of practice management software for two reasons. First, the push to digitize records overlaps with the mandatory switch to HIPAA 5010 transactions and ICD-10 coding. Most healthcare organizations have until Jan. 1, 2012, to meet both the 5010 standards, while the ICD-10 compliance date is Oct. 1, 2013. Some with a system incapable of coding in ICD-10 or sending 5010 transactions may choose to work through a clearinghouse, but many practices will seize the opportunity to bring electronic data interchange in house.

Secondly, many vendors are touting the benefits of an integrated EMR/practice management suite that shares data between the clinical and administrative sides for streamlined business operations and more accurate coding.

Karen Ferguson, associate director of regulatory affairs for the American Medical Group Association (AMGA), says that its members, which tend to be large, multispecialty group practices, are looking at EMRs not for the payor bonuses but for some administrative efficiencies the technology can afford. “They want to get away from G-codes,” she notes.

To keep moving forward regarding adoption of EMR/practice management solutions, physicians and practice managers need to talk to their peers who have already adopted EMR solutions. They must understand their particular needs and research the systems. Most of all, they shouldn’t panic, but they should act vigilantly to meet the government’s mandates.