Timely Meaningful Use Adoption Could Reap Thousands of Dollars

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HealthEast Care System in St. Paul, Minn., will upgrade its McKesson EMR system to better accommodate meaningful use adoption. Brian Buchner, CNP, (seated) and Kim Basel, manager of clinical content, test out the CPOE with vendor support from Mark Pratt, MD.
The final meaningful use criteria for EHRs released in July by CMS and the Office of the National Coordinator for Health IT (ONC) scaled back the original interim final rule. The newer version with less stringent requirements gives cardiologists more of a chance to secure federal dollars for incentive payments to offset the cost of health IT adoption. But will current EMR technologies make the meaningful use cut?

Qualifying for money

Under the Health IT for Economic and Clinical Health (HITECH) Act, eligible healthcare professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR/EMR technologies to achieve specified objectives. As eligible professionals, cardiology practitioners stand poised to take advantage of up to $63,750 in the Medicaid EHR Incentive Program and up to $44,000 in the Medicare EHR Incentive Program.

To demonstrate meaningful use, the EHR reporting period is any continuous 90-day period within the calendar year. Thereafter, the EHR reporting period is the entire calendar year. Under the Medicaid program, there also is an incentive for the adoption, implementation or upgrade of certified EHR technology, which does not have a reporting period.

The meaningful use criteria are attainable in organizations across the U.S., says Brian D. Patty, MD, vice president and CMIO at HealthEast Care System, which includes three short-term, acute-care hospitals, one long-term, acute-care hospital and 14 primary care clinics based in St. Paul, Minn. “Certainly, if you’re shooting for 2011 or 2012, you should be well on your way to an EMR implementation. Even an organization that started its implementation when the initial rule came out a year and a half ago could easily hit it in the 2013 timeframe, and still qualify for the majority of the funding.”

Although for HealthEast most of the criteria are within easy reach, such as CPOE, Patty says that the healthcare system will have to adjust its timeline on certain initiatives including interoperability capabilities with surrounding organizations and the ability to capture and report data to CMS. It has scheduled a major EMR system upgrade to McKesson 10.3 from the 10.1 platform to enable reporting to CMS by October 2011.

For others, the incentive payment does not justify the accelerated means of adoption. “We would like to qualify for as much of the incentive funding as possible; however, we don’t want to completely tailor our implementation to the incentive schedule, because we need to ensure our EMR implementation is comprehensive, robust and fits the organization,” says Alan Katz, MD, director of cardiac imaging and informatics (CII) at St. Francis Hospital in Roslyn, N.Y. CII signed a contract in August to install an Epic EMR across six hospitals to handle the inpatient and outpatient functionalities. “We’re not going to capture every last dollar at the expense of having a less-than-ideal installation,” Katz adds.

One concern that Katz and others have is whether ONC-authorized testing certified bodies (ONC-ATCBs) will be able to produce enough certified EHR products in time for eligible providers and hospitals to meet Stage 1 meaningful use criteria. At the end of August, the Certification Commission for Health IT and the Drummond Group became the first ONC-ATCBs. While more organizations will become ONC-ATCBs, the question remains if these certified entities can review and certify all the available systems in time for facilities to make a wise purchase. At this point, investing in an uncertified system could result in zero incentive funding.

Meeting deadlines

Opinions differ among stakeholders as to whether or not the implementation of an EMR system will cause organizational stress or burden. “Whether an organization meets Stage 1 of meaningful use will depend on the adjustment to workflow and the vendor,” says Vance Chunn, CEO of Cardiology Associates in Mobile, Ala. “For our practice, meaningful use of EHR technology should be achievable because we’ll have the infrastructure in place.”

Cardiology Associates, a private practice with 28 cardiologists across five full-time and five outreach locations, expects to fully implement an EMR system from Allscripts within six to nine months. The goal is to get physicians onboard with the technology and reporting to CMS for 90 days in 2011.

Cardiology Associates began scanning patients’ records a year and a half ago under the notion that they would ultimately upload the records to an EMR system. All records of patients seen in the last three years have been scanned and the group is finishing up on older records that are onsite. The final step is to move to full EMR capabilities.

As with any new technology, efficiency is a concern. “The incentives definitely pushed us to move to an EMR sooner than we might have originally,” says Chunn. “With 25,000 new and 80,000 return patients annually, we worry a little about our productivity. We are concerned that having to click up to 60 times per patient might slow us down.” Further down the road, Stage 2 meaningful use criteria has the potential to reap savings from health information exchanges (HIEs) between entities, he says.

Meanwhile, Mid Carolina Cardiology (MCC), a 45-cardiologist practice based in Charlotte,  N.C., has been using Gateway Electronic Medical Management System (GEMMS) as an EMR across its eight sites since 1999, with no plans on changing. GEMMS offers a queriable database, along with e-prescribing and a secure health imaging exchange, which are functionalities related to meaningful use criteria, says Stephen McAdams, MD, a cardiologist at Mid Carolina. The system also is primed to handle Physician Quality Reporting Initiative (PQRI) data for meaningful use.

Using GEMMS version 7, McAdams says referring physicians can click an icon that opens a link to an encrypted tunnel. Within this portal, the primary care office can fill out patient information and upload files, such as ECG reports. The referrers send the record to the cardiologist’s office which opens the file to make an appointment for the patient. The cardiologist then routes the document internally, sees the patient for a consultation and sends the electronic document back through the encrypted portal to the referring physician’s desktop and medical record department. In addition, there is a proof of delivery log inherent in each step of the process.

Empowering users

Practices and hospitals would be wise to move steadily toward meaningful use adoption. They don’t want to move too fast and acquire programs that run the risk of not being certified or of not adequately addressing their particular needs. It’s best to determine if you will be ready to apply for incentive funding in 2011 or if you should wait until 2012 or 2013. But most of all, be sure to engage all the stakeholders in every step of the decision-making process.

“It’s more than supplying hardware and software solutions,” says Russell P. Branzell, vice president of information services and CIO of Poudre Valley Health System, based in Fort Collins, Colo. “It’s also about helping physicians and practices understand the rules of the game so they can make informed decisions. We don’t want them to invest in a system that will come up short for Stages 2 and 3 of meaningful use requirements.”

 Poudre Valley Health System has a single EMR system (Meditech) for its regional network of healthcare services that span northern Colorado, southern Wyoming and western Nebraska. The key to a smooth EMR adoption across the enterprise is empowering the stakeholders, Branzell says. “Once physicians and other staff are engaged in the technical solution, they need to be empowered by its clinical promise, that the initiative will lead to better patient care. Once that happens, the process will be manageable and the stakeholders will be accountable for its implementation.”