Many physicians continue to be frustrated and confused by the meaningful use criteria that spell out how they can receive incentive payments from Medicare and Medicaid for their use of electronic health records.
With that uncertainty, physicians are not jumping in with both feet to participate in the incentive program, even if they have purchased EHR systems. The Medical Group Management Association (MGMA) surveyed its members in April and found that 80% of those who already had adopted an EHR system said that they intended to participate. But at that time, only about 14% said that they were able to meet all of the criteria.
Physicians in smaller practices are especially challenged, Dr. Michael L. Hodgkins, a chief medical information officer at the American Medical Association, said at the AMA's House of Delegates meeting in June. He cited data that some 300,000 doctors are in practices of 10 or fewer physicians. Among those, fewer than 15% have implemented an EHR system, and most are not yet capable of meeting the meaningful use criteria.
According to Dr. Hodgkins, there are many obstacles to meeting meaningful use, including selecting from the more than 400 EHR products certified by the federal Office of the National Coordinator (ONC) for Health Information Technology, part of the Health and Human Services Department.
Another problem: “Aggressive” timelines set by the government, according to Dr. Steve Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP).
Dr. Waldren says it takes generally 6-18 months from purchase to active meaningful use of a system.
It's been a tough road, he said. Physicians who don't have EHRs or who have just gotten on board are struggling to get them operational and to achieve meaningful use. Those who have owned systems for awhile may face upgrades in order to meet the meaningful use criteria.
Meanwhile, there's the system's financial cost, training, and maintenance issues, and workflow changes once a system is in place.
The Long-Time User
Some physicians are not in a panic about the impending deadlines. Dr. Michael Mirro of Ft. Wayne (Ind.) Cardiology, a 24-physician group, said that his practice has been using health IT since 1996.
“We knew that we had to ultimately modernize our practice,” Dr. Mirro said in an interview. Their current system has improved efficiency and quality, and has “supported a higher level of coding and reimbursement.”
The system has “pretty much complete functionality,” said Dr. Mirro. It provides the EHR, offers e-prescribing and decision-support tools, and can be used for direct quality reporting to the American College of Cardiology's PINNACLE registry.
The system is web based, which reduces maintenance costs and IT headaches. The practice does not own the servers; it merely has local computers that interact with the vendor's servers and software. The system is certified by the Certification Commission for Health Information Technology and was updated to ensure that the practice would meet the meaningful use criteria. One helpful tool, according to Dr. Mirro: A meaningful use “meter” that tells the physicians how well they are meeting the goals.
Ft. Wayne Cardiology has already attested to the government that it was a meaningful user and has received the maximum $18,000 per physician incentive for 2011, Dr. Mirro said.
The annual cost is about $2,000 per physician per year. That's low, said Dr. Mirro, because his practice is owned by a hospital. The system is already somewhat ahead of the curve, as it already incorporates a patient web portal (a stage 2 goal).
Dr. Mirro said that physicians who are looking to buy or expand their health IT should talk with one of the 60 regional extension centers established by the ONC. These centers have been charged to help rural physicians and primary care physicians especially, and they offer vendor recommendations, practice audits, and other advice for free.
Dr. Mirro said that he believes most cardiologists will be forced to purchase an EHR sooner rather than later. With the decline in reimbursement (particularly for imaging services), cardiologists are increasingly being employed by hospitals. Those institutions – which themselves are facing a huge penalty if they don't comply with meaningful use by 2017 – will want to have a lot of connectivity with the physician practice.
A Model For Her Peers
In 2005, Dr. Jennifer Brull figured that she needed to get on board with health IT, even though it might be expensive and difficult for a family physician in a rural Kansas solo practice. A younger physician with whom she was collaborating suggested that having an EHR was the wave of the future, and would likely be a necessity going forward. She also had a practice-sharing arrangement with another physician, who was older. He wasn't as sure, said Dr. Brull in an interview.