EHR incentive payments: How to qualify -- and should you bother?

The proposed criteria for "meaningful use" of electronic health records (EHRs), which providers will need to meet to qualify for up to $44,000 in federal incentives, are "too high and too many," according to an executive at Catholic Healthcare West, the eighth largest hospital system in the nation, known as a leader in health care IT.

If that doesn't dissuade you from seeking the federal incentives, blogger Chris Thorman offers a helpful table that outlines the meaningful-use measures the government will use to decide whether you qualify for the incentives. Measures include "At least 50% of all clinical lab tests results are incorporated as structured data," "Implement five clinical decision support rules relevant to the clinical quality metrics the eligible provider is responsible for" and "Insurance eligibility checked electronically for at least 80% of all unique patients" -- and these are just year-one measures. They get tougher by year five.

Don't miss an upcoming editorial in FPM in which health IT guru David Kibbe explains why he thinks physicians should steer clear of the federal EHR incentive program.

Posted at 10:00AM Jan 21, 2010 by Brandi White  |  Comments[2]

Feds define ‘meaningful use' of health IT

Physicians hoping to qualify for up to $44,000 in federal funds for implementing an EHR should take note of the meaningful-use criteria approved July 16 by the Office of the National Coordinator for Health Information Technology's Health IT Policy Committee. The group's recommendations will be incorporated into a final rule from the Centers for Medicare & Medicaid Services due Jan. 1, 2010. Although not yet final, the recently released criteria give physicians a better sense of what their EHR systems will need to be able to do come 2011.

The year-one meaningful-use criteria for physicians (hospitals have separate criteria) fall under five areas and include the following:

Improving quality, safety and efficiency and reducing health disparities

• Use computerized entry for all orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) although electronic interfaces to receiving entities are not required in 2011
• Implement drug-drug, drug-allergy and drug-formulary checks
• Maintain an up-to-date problem list of current and active diagnoses based on ICD-9 or SNOMED
• Generate and transmit permissible prescriptions electronically
• Maintain active medication list and medication allergy list
• Record demographics (preferred language, insurance type, gender, race and ethnicity)
• Record advance directives
• Record vital signs (height, weight, blood pressure, BMI) and smoking status
• Incorporate lab-test results into EHR as structured data
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach
• Report ambulatory quality measures to CMS
• Send reminders to patients per patient preference for preventive/follow-up care
• Implement on decision rule relevant to specialty or high clinical priority
• Document a progress note for each encounter
• Check insurance eligibility electronically from public and private payers, where possible
• Submit claims electronically to public and private payers

Engaging patients and families

• Provide patients with an electronic copy of or electronic access to their health information (including lab results, problem list, medication lists, allergies) upon request
• Provide access to patient-specific educational resources
• Provide clinical summaries for patients for each encounter

Improving care coordination

• Electronically exchange key clinical information (e.g., problem list, medication list, allergies, test results) among providers of care and patient-authorized entities
• Perform medication reconciliation at relevant encounters and each transition of care (i.e., moving patients from one setting or provider to another)

Population and public health reporting

• Submit electronic data to immunization registries where required and accepted
• Provide electronic syndrome surveillance data to public health agencies according to applicable law and practice

Ensuring privacy and security

• Comply with federal and state HIPAA rules
• Comply with fair data sharing practices set forth in the Nationwide Privacy and Security Framework

Proving compliance
To prove compliance with these criteria in year one of EHR implementation in order to receive the federal incentives, physicians will have to report on roughly 30 measures, such as percentage of diabetics with A1C under control, percentage of smokers offered smoking-cessation counseling, percentage of all medications entered into EHR as generic when generic options exist and percentage of claims submitted electronically to all payers.

To view all of the measures, see the "Meaningful Use Matrix." This document also lists the criteria for 2013 and 2015 (or year three and year five of EHR implementation).

A major concern for physicians is whether the 2011 measures as a whole will be achievable. Additionally, there is concern that physicians won’t understand the details of what’s required to demonstrate meaningful use and will implement an EHR but fail to qualify for the stimulus payments.

Posted at 09:42AM Jul 21, 2009 by Brandi White  |  Comments[5]

The unsubstantiated benefits of EMRs

Electronic medical records are being touted as an essential ingredient in health care reform. Most recently, the Obama administration proposed the national adoption of EMRs on the grounds that it would save $80 billion a year and improve the quality of health care.

But not everyone is drinking the Kool-Aid.

Drs. Jerome Groopman and Pamela Hartzband, faculty of Harvard Medical School (and, notably, both Obama supporters), recently called EMR adoption “an overly simplistic and unsubstantiated part of the solution” and had this to say in The Wall Street Journal:

“The basis for the president’s proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.”

While there are real benefits of EMRs – such as medication alerts, reminders and increased legibility – it turns out that, despite all the hype, there’s no evidence that EMRs actually save the system money and improve outcomes. (They also can’t share data with one another and are cost prohibitive in many cases, but that’s another blog entry.)

Groopman and Hartzband cited several studies demonstrating the problems with EMRs:

“A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer – 48 compared to seven in the paper-based cohort. ... A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that ‘current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems.’ Similarly, researchers from the Brigham and Women’s Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, ‘As implemented, electronic health records were not associated with better quality ambulatory care.’ And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, ‘should be of concern to adopters, payers, and jurisdictions.’”

The bottom line: Once again, physicians are being told to invest their time and dollars in an unproven strategy on the hope that it will eventually pay off. An alternative approach, one advocated by the Network for Regional Healthcare Improvement, would be to create a system that rewards physicians and pays them fairly for achieving the desired outcomes regardless of the specific technology or tools they employ.

Posted at 11:26AM Mar 16, 2009 by Brandi White  |  Comments[5]

Spend $20 billion on health care IT? Yes, we can!

One of President Obama's first health-care-related moves in office is likely to be the approval of some $20 billion for health care information technology (IT) as part of the proposed $800 billion economic stimulus package. While IT alone is unlikely to transform health care (because "IT use in health care will reflect the system it's put into, rather than transform it," to quote Matthew Holt), this historic investment is sure to bring some benefit to physicians and their patients – if the money is spent right.

The leading idea for how to spend the $20 billion is to let every doctor in the country buy an electronic health record (EHR). But technology experts David Kibbe, MD, and Brian Klepper, PhD, say not so fast:

"The new Administration and Congress are about to throw a lot of money at the health IT problem, and the conventional thinking is to buy everyone an EHR of his/her choosing. While we enthusiastically applaud the vision that this represents, a more measured approach would create a smoother and more productive transition. At the same time, it would signal the EHR industry that, for national deployment, they need to come to terms with issues they have avoided so far."

The issues they cite are:

1. EHRs are too expensive, upwards of $40,000 per physician in a medium-sized practice. Of course, the stimulus package would help everyone forget about the costs for now, much to the delight of EHR vendors.

2. EHR implementation can be difficult, disrupting practice operations and revenue for months.

3. There is no conclusive evidence that using EHRs actually improves quality of care.

4. EHRs are still not interoperable, which means providers cannot easily exchange data with one another if they use different systems, which they surely will.

So what's a better way to spend the $20 billion? According to Kibbe and Klepper, the IT solutions that have "more bang, with less turmoil, for the buck" are e-prescribing, e-referring, patient communication technologies (e.g., secure e-mail and Web applications that allow patients to schedule appointments online, pay bills online and view lab results online) and broadband access to the Internet for every medical practice and every home in America.

Posted at 10:38AM Jan 23, 2009 by Brandi White  |  Comments[1]