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CMS Proposes Adjusting Meaningful Use Timeline

Posted by Matthew Smith on Dec 10, 2013 11:48:00 AM

Meaningful Use, CMS, Meaningful Use DeadlineOn Friday afternoon, federal officials announced that CMS has proposed delaying the start of Stage 3 of the meaningful use program, while the Office of the National Coordinator for Health IT has proposed adjustments to its certification process.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments.

Revised Meaningful Use Timeline

Under CMS' revised meaningful use timeline:

  • Stage 2 would be extended through 2016; and
  • Stage 3 would begin in 2017 for health care providers who have completed at least two years in Stage 2 of the program.

According to a blog post by Robert Tagalicod -- director of CMS' Office of E-Health Standards and Services -- and acting National Coordinator for Health IT Jacob Reider, the revised timeline would offer a variety of benefits, such as:

  • Allowing for more analysis of stakeholder feedback on Stage 2 progress and outcomes;
  • The availability of more data on Stage 2 adoption and measure calculations;
  • Allowing for more consideration of possible Stage 3 requirements;
  • Providing additional time for preparation for Stage 3 requirements; and
  • Giving vendors adequate time to develop and distribute certified EHR technology ahead of Stage 3 and to incorporate usability and customization lessons.

In the fall of 2014, CMS is expected to release a notice of proposed rulemaking for Stage 3 and ONC will release the corresponding NPRM for the 2017 Edition of ONC Standards and Certification Criteria, according to the blog post.

The NPRMs will offer additional details on the new proposed timeline.

The final rule on Stage 3 of the meaningful use program is expected to be released in the first half of 2015.

Changes to Certification Process

Meanwhile, ONC has proposed a new regulatory approach that would allow certification criteria to be updated more frequently.

According to officials, the change is designed to:

  • Provide public input on policy proposals;
  • Allow the certification processes to more quickly adapt to include newer industry standards; and
  • Provide more predictability for EHR developers.

As part of the new approach to certification, CMS will propose a rule to create a voluntary 2015 edition of certification criteria.

According to the blog post, the voluntary 2015 edition would:

  • Be responsive to stakeholder feedback;
  • Address issues identified in the 2014 certification edition; and
  • Reference updated standards and implementation guides designed to advance interoperability.

Because the 2015 edition would be voluntary, providers participating in the meaningful use incentive program would not be required to upgrade to 2015 edition EHR technology and vendors would not be required to recertify their products (Tagalicod/Reider, CMS blog post, 11/27).

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, Meaningful Use Deadline, EHR Adoption, MU

6 Things to Know about Meaningful Use and EHR Certification in 2014

Posted by Matthew Smith on Sep 20, 2013 3:50:00 PM

Meaningful Use, EHR, SixWith the 2014 EHR reporting period for meaningful use right around the corner, here are 6 key pieces of information you need to know:

#1. Does Meaningful Use (MU) Stage 1 Change in 2014?

Yes, the 2014 reporting period marks the beginning of a restructured meaningful use Stage 1.

Certain “core” and “menu” objectives have been removed/combined and eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) can no longer count measure exclusions toward meeting menu objectives. Equally important is that all Stage 1 EPs, EHs, and CAHs now need to provide more than 50% of unique patients with the ability to access their health information online (to meet the new Stage 1 core measure as part of the “View, Download, Transmit to 3rd Party” objective).

Graph 1

#2. Do All EPs, EHs, and CAHs Need to Upgrade to 2014 Edition Certified EHR Technology in 2014?

Yes, starting with the 2014 meaningful use reporting period all EPs, EHs, and CAHs need to upgrade to 2014 Edition EHR technology only – regardless of the meaningful use stage they need to meet.

The 2014 Edition EHR certification criteria support both revised MU Stage 1 and new Stage 2 requirements. They also include important updates that set new baselines for better interoperability, electronic health information exchange, and patient engagement. EHR technology certified to the 2011 Edition will no longer be acceptable for the purposes of meeting the “Certified EHR Technology” definition and from a regulatory perspective 2011 Edition certifications will “expire” come the 2014 MU reporting period.

#3. What is the Meaningful Use Reporting Period Length in 2014?

2014 has a special MU reporting period length for all non-first time EPs, EHs, and CAHs.

As a result, no EP, EH, or CAH (that previously demonstrated MU before 2014) has to start MU at the beginning of the Federal Fiscal Year (FY) [October 1, 2013] or Calendar Year (CY) [January 1, 2014].

The 2014 MU reporting period for both Stage 1 and Stage 2 performance is set to one calendar quarter during a Medicare EP, EH, and CAH’s reporting year (e.g., April 1, 2014 through June 30, 2014 would be a Medicare EP’s 2nd quarter and an EH/CAH’s 3rd quarter). All Medicaid EPs, EHs, and CAHs (as determined by their state) will have an “any continuous 90-day” or 3-month reporting period during 2014. Last, all new EPs, EHs, and CAHs continue to have an “any continuous 90-day” reporting period.

#4. What Happens if a Medicare EP, EH, or CAH Skips Meaningful Use in 2014 or Applies for a Hardship Exception in 2014 (to Avoid the 2016 Payment Adjustment)?

Once a Medicare EP, EH, or CAH starts meaningful use, it is required to continue to meet highermeaningful use stages according to the regulatory schedule set by the Centers for Medicare & Medicaid Services.

This policy applies even if the Medicare EP, EH, or CAH is granted a “hardship exception” for a given reporting year, it skips, or it fails. For example, regardless of whether an EP “passes,” “hardships,” “skips,” or “fails” their “Stage 1, Year 2” performance during 2014 they will be required to move up to “Stage 2, Year 1” in 2015 (with a full year reporting period) and will not get to repeat Stage 1 for a third year.

Medicaid EHR Incentive Program policy is different in two respects. First, the Medicaid program does not have payment adjustments, so hardship exceptions are unnecessary. Second, Medicaid providers are not required to participate in consecutive years of the Medicaid EHR Incentive Program (see Medicaid FAQ). Thus, unlike Medicare providers, Medicaid providers who skip years of participation will resume their meaningful use progression where they left off.  For example, if a Medicaid EP skips 2014 (which would otherwise be their “Stage 1, Year 2”) and also skips 2015 but comes back to the Medicaid program in 2016, they would be required to demonstrate “Stage 1, Year 2” in 2016 as if they never left the Medicaid program for those two years.

#5. When is the Last Year Medicare EPs Can Start Meaningful Use to Get Incentive Payments?

2014 is the last year in which an EP can begin to get incentive payments.

As stated in the Health Information Technology for Economic and Clinical Health (HITECH) Act, no incentives can be paid to Medicare EPs that begin MU after 2014.  EPs that start MU in 2014 could still earn as much as $24,000 in incentives if they demonstrate MU from 2014 through 2016.

#6. How Does 2014 Meaningful Use Performance Relate to Medicare Payment Adjustments?

2014 meaningful use performance is the basis for 2016 Medicare payment adjustments.

For EPs this potentially means a -2% reduction to the Medicare physician fee schedule (PFS) amount for covered professional services furnished by the EP during 2016 (EP tip sheet). The payment adjustment calculation for EHs and CAHs is a little more complicated and different for each. Here’s a link to CMS’ EH/CAH tip sheet.

 

Electronic Health Records EHR Assessment

 

Article courtesty of ONC's Health IT Buzz.

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, EHR Adoption

MGMA Urges Hold on Meaningful Use Penalties

Posted by Matthew Smith on Aug 26, 2013 10:53:00 AM
Meaningful UseCiting concern about vendor readiness and that "significant investments" in EHR technology could go for naught, MGMA leadership is calling on HHS for an indefinite moratorium on meaningful use penalties for physicians who have completed Stage 1 meaningful use requirements.

The association of physician practice administrators is one of several that has recently called on federal officials to adjust parts of the meaningful use program.

In an Aug. 21 letter to HHS Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney wrote about physician concerns over the diminished opportunity for physician practices to meet the requirements of Stage 2.

MGMA represents 22,500 members who lead 13,200 organizations nationwide. Those physician practices include about 280,000 physicians that provide more than 40 percent of the healthcare services delivered in the United States.

In the letter, Turney notes: "Currently, there are more than 2,200 products and almost 1,400 'complete EHRs' certified under the 2011 criteria for ambulatory EPs. As of this writing, there are only 75 products and 21 complete EHRs certified for the Stage 2 (2014) criteria. This lack of vendor readiness has significant implications for EPs." 

"Without the appropriate software upgrades and timely vendor support," Turney continued, “EPs will be unable to meet the Stage 2 requirements and thus will be unfairly penalized starting in 2015.

Turney stressed the MGMA’s long-term support of federal efforts on meaningful use as a way to improve clinical performance and derive efficiencies.

"However, it has become clear that the alignment between the more rigorous Stage 2 requirements and the ability of the vendor community to produce and deploy Stage 2," she wrote.

In the letter, Turney details concern over marketplace readiness, citing lengthy wait times for installations and training.

"We are also concerned that the current 'all or nothing' approach to achieving meaningful use may prove to be problematic for EPs attempting to meet the more stringent Stage 2 requirements," she stated.

MGMA also put forth four additional recommendations:

  • Extend the reporting period for Stage 2 incentives by a minimum of one year.
  • Extend the reporting period for Stage 1 incentives for EPs whose EHRs have not been recertified by January 2015
  • Conduct a comprehensive vendor survey related to certification and readiness
  • Build additional flexibility in the Stage 2 reporting requirements. MGMA raises concerns over Stage 2 requirements related to patient actions, such as the requirement to provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP and that a secure message was sent using the electronic messaging function of the certified EHR by more than 5 percent of unique patients.

MGMA joins several other groups, who have recently asked for adjustments to the meaningful use program.

In an Aug. 15 letter, HIMSS called on federal officials to keep Stage 2 of the program on schedule, while extending the attestation period for the first year. The organization also recommended extending the attestation period through April 2015 for eligible hospitals and through June 2015 for eligible providers.

CHIME has asked for a one-year delay of Stage 2, saying vendors need time to prepare and policymakers need more time to prepare for Stage 3.

The American Academy of Family Physicians asked CMS to delay Stage 2 by a year, asserting the program could "outstrip the capacity of many certified electronic health record technology vendors and ambulatory family medicine practices."

The timeline for physician compliance was too tight, wrote AAFP Board Chair Glen Stream, MD, in an Aug. 7 letter to Sebelius and other federal officials.

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, EHR Adoption

Important Deadlines Approaching for Meaningful Use Program

Posted by Matthew Smith on Jul 17, 2013 12:14:00 PM

Meaningful Use, Stage 2, EHR, EMRMeaningful use, the government program of financial rewards and penalties for encouraging doctors to use electronic health records (EHRs), has several important deadlines approaching.

October 3, 2013, is the last day doctors and other eligible professionals (EPs) can begin the attestation process to qualify for the first stage of meaningful use (MU1) in 2013.  (The reporting period for MU1 attestation is 90 days.)

February 28, 2014, is the final deadline for reporting attestation results for 2013 and qualifying for the Medicare MU financial bonus. The final 2013 deadline for Medicaid attestation varies from state to state, so EPs need to check with their state Medicaid agency to learn their state’s deadline. EPs qualifying for the first time in 2013 under the Medicare program will receive $15,000, and those qualifying under Medicaid will receive $21,250.

In addition, EPs will be able to begin attesting to the second stage of meaningful use (MU2) on January 1, 2014. The MU2 attestation period for 2014 will be 90 days, but in 2015 and beyond will be for a full calendar year. That’s because the MU certification requirements for EHR systems will change in 2014, says Robert Anthony, deputy director of the health information technology initiatives group in the Centers for Medicare and Medicaid Services. The briefer reporting period will give EPs additional time to acquire or upgrade to MU2-certified technology.

Medicaid EPs can choose any 90-day period in 2014 in which to attest, but Medicare EP attestation periods will start on January 1, April 1, July 1, or October 1.

Like MU1, qualifying for MU 2 requires meeting a series of core (required) and menu (optional) objectives. A complete list of MU2 objectives is available on the CMS Web site at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Do....

A self-directed timeline showing the length of time required to demonstrate meaningful use at each stage and the maximum incentive payment for each year of participation is available at www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html#.UcoEHOvgKS4.

 EHR, Meaningful Use, Stage 2

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, EHR Adoption

EHR Meaningful Use Dropout Rate Among Family Docs Hit 21% in 2012

Posted by Matthew Smith on Jul 8, 2013 4:30:00 PM

EHR, Meaningful UseAs US physicians continue to embrace electronic health records (EHRs), data on CMS' EHR incentive program holds both positive and troubling news regarding family physicians' participation and success in achieving meaningful use of their EHRs. 

According to CMS' recently published EHR meaningful use attestation data(healthdata.gov), 23,636 family physicians became first-time meaningful users in 2012. The number represents a 180% increase compared to 2011 EHR statistics.

In an interview with AAFP News Now, Jason Mitchell, MD, director of the AAFP's Center for Health IT, said the latest report confirms family medicine "still has the greatest participation both by percentage and by the numbers."

However, the report also revealed a drop in the retention rate of attesting physicians. In fact, of the 11,578 family physicians who attested to meaningful use in 2011, only 9,188 did so in 2012, a 21% drop in participation.

Mitchell and Steven Waldren, MD, the center's senior strategist for health care IT, crunched the raw numbers -- buried deep in the April attestation data -- and determined that the overall meaningful use dropout rate among all physician specialties was 20%.

Why the Tumbling Numbers?

The new data raise a key question: Why were a good number of physicians unable to maintain meaningful user status, especially since no changes were made in the meaningful use stage one requirements from 2011 to 2012?

Although there's no way to know for sure, Mitchell and Waldren cited some possible reasons for the decline.

Looming large on their list is the length of the reporting period. In 2011, physicians only had to report on measures for 90 consecutive days and could start, stop and shift dates to make that happen. However, during year two, the reporting period stretched to a full year. The extra reporting burden may have discouraged physicians. Others simply may have lost track of their progress during the year.

"For some physicians, the issue likely was a lack of ongoing monitoring of their meaningful use numbers throughout that entire year," said Mitchell.

And unfortunately, some physicians simply missed the two-month attestation window for 2012 reporting that ran from Jan. 1 to Feb. 28, 2013. "A physician could have been a meaningful user the whole year and then missed the attestation deadline," said Mitchell.

"Don't be that guy in the next round," said Waldren. "It's very important to check the timeline for 2013(www.cms.gov) and understand the deadlines for meaningful use."

In addition, 2012 saw a decrease in function of the federally funded regional extension center (REC) programs. According to Mitchell, the state-based organizations were designed to sign physicians on with a REC, assist physicians with EHR implementation, and then help them become meaningful users and successfully attest to MU.

The first year, the RECs were offered incentives to get physicians on board, but there was no built-in incentive for RECs to maintain physicians through the second year, and many of the RECs already were running out of funding to sustain their work, said Mitchell.

AAFP Working to Resolve Issues

To help ensure family physicians' future success with the meaningful use program, the AAFP already is working with CMS and the Office of the National Coordinator for Health IT to investigate, find answers and fix problems.

"Is there one particular measure that is tripping up physicians? If so, let's look at changing that," said Waldren. "Is the 12-month reporting period an obstacle? Do physicians need software that provides a 'dashboard' to enable them to track their progress?

"Let's work on identifying the problems and see what corrections can be made, because we want to be sure that 20% of our 2012 meaningful users don't drop off in 2013," said Waldren.

Mitchell and Waldren said physicians could ease the meaningful use burden by taking a few steps. For example, they encouraged members to

  • plan ahead by checking requirements and deadlines and then stay on top of those obligations,
  • crank out electronic meaningful use reports on a continuous basis to show progress toward meeting standards, and
  • ensure that an EHR's internal tracking mechanism for certain measures, such as the drug formulary and interaction features, are turned on for the entire reporting period.

"Such features could inadvertently be turned off by the vendor during a routine system update," said Waldren.

Mitchell expressed concern about physicians' desire to stay in the game when meaningful use two rules are applied in 2014. "The rules do change significantly, and technology has to be more sophisticated," said Mitchell.

And although the reporting period window collapses back down to three months for the first year of meaningful use two, the reporting must be done quarterly, so there can be no "shifting and shuffling" of dates to attain a consecutive 90-day reporting period. In 2015, meaningful use stage two will once again shift users to that full year of reporting, said Mitchell. 

Meaningful Use, Meaningful Use Incentives

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, EHR Adoption

Study Cites EHR Meaningful Use Challenges; Praises Adoption Progress

Posted by Matthew Smith on Jun 10, 2013 1:24:00 PM

EHR, EMR, Meaningful Use, Annals of Internal MedicineThe task of automating America's health care system via physicians' use of electronic health record (EHR) technology is progressing but far from finished. That's the conclusion offered by authors of a new study in the June 4 issue of Annals of Internal Medicine.

According to the article, "Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians," U.S. physicians are embracing EHRs in increasingly high numbers, but as recently as 2012, few physicians could meet the objectives set forth in stage one of the federal government's EHR meaningful use (MU) program. 

In fact, of 1,820 primary care and subspecialty physicians in office-based practices who responded to the survey, 43.5 percent reported having a basic EHR, but only 9.8 percent said they had achieved MU. Fewer than half of the respondents said their EHR systems were capable of performing any of the patient population management tasks included in the survey. 

The results didn't surprise study co-author Michael Painter, M.D., J.D., a family physician and senior program officer at the Robert Wood Johnson Foundation, which partnered with the Commonwealth Fund to fund the independent assessment of the nation's progress in adopting EHR technology. "Transformation is incredibly hard, but our family docs -- and everybody else -- are doing a heroic job at adopting and then learning to use this new technology," said Painter. 

EHRs are a tool that can be used to automate America's health care system -- an absolutely necessary process, according to Painter. Pulling an EHR out of a box is just the first step, said Painter. The real magic is in learning to use EHRs to perform key tasks, such as managing patient populations and generating quality metrics. 

"Yes, we're having steady sustained increases in adoption, and that's exactly what we wanted to see," said Painter. "But what we really want is the transformation process."

Study Highlights

In addition to answering questions about national trends in EHR adoption and determining how many physicians were able to meet MU criteria, researchers also wanted to know which MU measures were most difficult for physicians to meet and whether physicians were able to use their EHRs to manage the health of their patient populations. 

According to survey results, physicians most commonly used their EHRs to

  • view lab results,
  • order prescriptions electronically,
  • view radiology and imaging results, and
  • record clinical notes.

On the other hand, physicians were least likely to use an EHR to

  • exchange patient clinical summaries and lab and diagnostic test results with clinicians outside the office,
  • generate quality metrics, and
  • provide patients with post-visit summaries and copies of their personal health information.

As for meeting MU criteria, 11.2 percent of primary care physicians had done so compared with just 7.6 percent of subspecialists. 

Among primary care physicians, 40.5 percent had between eight and 10 MU functions available via their EHRs compared with 36.5 percent of subspecialists. Nearly equal proportions of primary care physicians and subspecialists reported having no MU functions (14.6 percent and 12 percent, respectively). 

The authors noted that "computerized systems for patient panel management and quality reporting do not seem widespread, and, where they are implemented, physicians reported that they are not always easy to use." For example, fewer than half of physicians could generate lists of patients by diagnosis. Furthermore, only about one-third of physicians could

  • track referral completion,
  • generate reports on quality of care,
  • send patient reminders for preventive or follow-up care,
  • pull names of patients who missed appointments or were overdue for care,
  • create patient lists by lab results, and
  • provide patients with after-visit summaries.

Physician responses regarding ease of use of patient-management functions varied, but nearly half of physicians said they could not, or found it very or somewhat difficult to, perform many of the above functions.

Moving Forward

Researchers concluded that the study results held implications for federal policy, particularly in light of MU bonus payments doled out to more than 145,000 health care professionals and totaling more than $3.9 billion through September 2012. 

"The pace of adoption of basic EHRs seems to be increasing, and findings around availability and perceived ease of use of systems that can help to manage patient populations should be of concern to policymakers," said the authors. "Using EHRs as simple replacements for the paper record will not result in the gains in quality and efficiency or the reduction in cost that EHRs have the potential to achieve." 

However, Painter focused on the positive. He pointed out that although just 10 percent of physicians in the study had met MU criteria, "the number who are really close is really big -- almost 40 percent. It's 40 percent for primary care physicians and almost 40 percent of (sub)specialists, and that's a big deal."

In addition, Painter said he would expect that a good number of physicians would have "tipped over" into actually meeting the criteria if they were surveyed now. He predicted that when the already written and approved MU stage two rules take effect in mid-2014, physicians would "blow right past those because they're going to need -- and want -- to use those population tools and quality metric tools." 

Painter, who saw patients in private practice from 1995 to 2003, urged his family physician colleagues to beat back discouragement. "It's really hard to practice primary care right now. It's slow going, but we are making progress," he said. "The best developers are going to try to develop things that physicians just love to use, but we're not there yet. We can't go back, because we can't get to where we need to be with health transformation without automating all these information processes." 

However, physicians can help move things along by being very vocal with health information technology developers about what they need in EHR systems to get the greatest results possible, he added.

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

New Studies Explore How EHR Use Influences Physician Behavior

Posted by Matthew Smith on May 30, 2013 3:02:00 PM

NewStudyJPG resized 600Two separate studies published this week examined the effect of electronic health record systems use on physician behaviors.

EHR Alert Fatigue Study

Clinicians might ignore positive alerts from EHR systems because of a deluge of repetitive, inappropriate alerts, according to a case report published this week in PediatricsMedscape reports.

Researchers from Stanford University Department of Biomedical Informatics and Harvard Medical School examined the case of a two-year-old boy who died after clinical staff overrode EHR alerts about potential drug allergy cross-reactivity. Prior to inappropriately administering a diuretic to the patient, the clinical staff overrode more than 100 alerts over the course of one month.

"Excessive electronic alerts warning clinicians of potential but rare adverse drug cross-reactions result in increased patient safety risks by rendering these alerts meaningless," the authors wrote, adding, "The threat of missing a rare event must be balanced with the dangers of burdening clinicians with unnecessary and interruptive electronic alerts."

In an accompanying editorial, Stephen Lawless -- with the Nemours/Alfred I. duPont Hospital for Children -- wrote EHR alerts "should neither replace nor minimize accountability that occurs through daily physical examination and reassessments."

Lawless concluded, "If the reliance on alerts results in either the purposeful or fatigue-induced deterioration of clinical assessment and decision-making skills, then alternative messaging techniques should be sought and studied" (Brown, Medscape, 5/28).

Provider Reliance on EHRs Study

Physicians might rely less on EHRs because they accept medical uncertainty as part of their practice, according to a separate study published in the Journal of the American Medical Informatics AssociationInformationWeek reports.

Based on interviews and observations of 28 doctors at a Texas multispecialty group, researchers organized physicians into three categories:

  • Reductionists: Clinicians who believed that the more information they put into an EHR the less uncertainty felt by physicians and the better care outcomes are;
  • Absorbers: Clinicians who spent less time documenting information and more time talking to patients; and
  • Hybrids: Clinicians who had characteristics of both reductionists and absorbers.

Reductionists used EHR systems the most, while absorbers used EHRs the least, the study found.

Those seeking to reduce uncertainty believed documentation through the EHR could help other providers who might care for the same patient.

In comparison, absorbers believed their conversations with patients were the most important tool for diagnosis and treatment.

Whether a physician was tech savvy did not necessarily predict his or her use of EHRs, study authors noted.

Lead author Holly Lanham--assistant professor of medicine at the University of Texas Health Science Center at San Antonio--said, "Uncertainty reduction is helpful, and IT is already designed to help us with that. What I'm hoping is that the finding of this paper will encourage EHR developers and policy makers to recognize that uncertainty is inevitable and figure out how to help doctors and nurses cope with that uncertainty" (Terry, InformationWeek, 5/28).

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

New Study Suggests EHR Use Among Docs 60 and Older Below 30%

Posted by Matthew Smith on May 16, 2013 3:44:00 PM

EHR, Meaningful UseEHR use is much lower among older and independently practicing physicians, according to a new survey by the Deloitte Center for Health Solutions, with 30% fewer independent physicians using a meaningful use-capable EHR than their larger practice peers. 

Only half of physicians over the age of 60 use a full EHR, compared to approximately 70% of younger practitioners. With only 30% of solo practitioners using an EHR, and 81% believing that the promise of reduced costs after adoption is false, the EHR Incentive Program has some work to do among the smallest practices to convince them that EHRs are truly in their best interest.

It may be little surprise that EHR adoption is higher among younger age brackets, but coupled with recent research that shows older physicians would rather retire* than go through the bother and expense of an implementation – and the willingness of a quarter of physicians who might stop seeing Medicare and Medicaid patients to avoid the paperwork – it calls into question the effectiveness of the upcoming payment penalties associated with meaningful use.

According to the survey, 71% of solo physicians have no intention of implementing an EHR at the moment.  Already unable to afford the initial outlay costs, this leaves the most vulnerable segment of providers open to being hit hard by the 2015 payment adjustments.  Sixty-seven percent of physicians who do use an EHR say that the software interrupts their face-to-face patient interactions during an exam, something that solo practitioners and their patients tend to value highly.

Among physicians whose practices do have an EHR that meets meaningful use guidelines, overall satisfaction rated a middling 63%.  Faster billing, e-prescribing, and improved communication and care coordination were among the top benefits of using the system, with physicians involved in accountable care organizations significantly more likely to believe that communication and coordination were important highlights of EHR use.

“Skeptical physicians are likely to be more readily influenced by peers with credible firsthand clinical experience using HIT,” the report says, suggesting that providers talk to their neighbors about their trials and successes during adoption to gauge their own risks and rewards.  “Health IT underpins the future health care system and is a required tool for physicians. While apprehension may be understandable, inaction is not an option.”

Nearly half of medical professionals eligible for the meaningful use program have received an incentive check, according to the latest numbers released by the Centers for Medicare & Medicaid Services.

CMS said 255,772 out of an estimated 527,000 health care professionals got a total of $5.2 billion in incentive payments as of March. Of those, 160,890 received payment through Medicare; 83,765 were paid from Medicaid; and 11,117 received payment through the Medicare Advantage program. There are 386,024 physicians and other eligible professionals in the program (link).

CMS said 3,858 eligible hospitals have gotten a total of nearly $8.6 billion in incentive payments.

*Despite high satisfaction with EHR software and continued interest in tools like clinical decision support and e-prescribing, physicians are generally pessimistic about the future of medicine, with half believing that incomes will take a nosedive in the next one to three years, and 60% believing that many physicians will retire earlier than planned due to the frustrations of dealing with Medicare, Medicaid, the loss of independence, and the burdens of malpractice suits and liability laws.

Electronic Health Records EHR Assessment

Topics: Meaningful Use, Ambulatory EHR, EHR Adoption Rate, EHR Implementation, Small Practice EHR Adoption, EHR Adoption

Two New Rules Provide Momentum for Electronic Medical Records

Posted by Matthew Smith on Apr 10, 2013 5:28:00 PM

EHR, Electronic Health RecordsThe Obama administration has proposed two rules to extend protections that allow hospitals to donate electronic health record technology to physicians who refer patients to their facility, The Hill's "RegWatch" reports.

Background

The Stark Law bans payments that are aimed at encouraging referrals to hospitals. In addition, the federal anti-kickback law prohibits payments that are designed to influence care for Medicare beneficiaries.

However, in an effort to encourage physicians to adopt costly EHR systems:

  • CMS established an exception to the Stark Law allowing hospitals to donate EHR software to physicians; and
  • HHS' Office of Inspector General established a "safe harbor" provision to protect such EHR donations from anti-kickback enforcement, provided that the physicians cover 15% of the cost of the EHR technology.

The exceptions to the Stark and anti-kickback laws are scheduled to expire at the end of 2013.

Details of Proposed Rules

The Obama administration's proposal includes:

In addition to extending the EHR donation protections, the new proposed rules would remove an electronic prescribing requirement from the original rules and adjust language regarding the types of EHR systems that qualify for exceptions (Conn, Modern Healthcare, 4/9).

OIG in its proposed rule said, "We expect these proposed changes to continue to facilitate the adoption of electronic health recor[d] technology" ("RegWatch," The Hill, 4/8).

CMS in its proposed rule said that it is considering extending protections for EHR donations to Dec. 31, 2021, to align with the end of the Medicaid portion of the meaningful use program.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

Publication, Public Comments

The two proposed rules are scheduled to be published in the Federal Register on Wednesday.

Federal officials will accept public comment on the proposed rules for 60 days after their publication (Murphy, EHR Intelligence, 4/9).

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Records, Electronic Medical Records, CMS, Health IT, Family Physicians, EHR Adoption

Avoid Physician Backlash: 7 Tips for a Successful EHR Rollout

Posted by Matthew Smith on Mar 25, 2013 3:11:00 PM

EHR Launch, Physicians, Nationwide, hospitals are aggresively acquiring physicians and creating tighter affiliations with physician groups. Building a strong physician network is always difficult, but the challenge is even greater when it is combined with an electronic health record rollout — a necessary move that will allow the partners to share information and take advantage of new payment initiatives.

Implementing a new ambulatory EHR system often will disrupt practice workflow, impair physician productivity and affect physician income. But when a hospital is providing the system, cultural and political issues come into play that can damage or kill relationships. For many hospitals, the EHR rollout creates a physician backlash just when the integration strategy is getting off the ground.How can a hospital mitigate the risks of implementing an ambulatory EHR system? The following seven steps will help minimize conflict, contain costs and increase your chance of a successful rollout.

1. Form a Multi-stakeholder Governance Team

Some hospitals treat an EHR implementation as just another information technology project. Information technology staff members lead the system selection and installation process, executives take a hands-off approach, and physicians are relegated to the role of "receivers." This approach does not work well with electronic health records.

EHR use has a huge impact on physician practice as well as hospital strategy and finance. For that reason, a governance team that includes hospital executives and physician leaders must direct the EHR implementation. Multidisciplinary governance is key to helping physicians transition from independence to collaboration. 

2. Get Agreement on Objectives and Be Honest About Differences

Conflicts arise during an EHR implementation that easily can derail the project. For instance, physicians often request electronic connections to independent labs. But this undercuts the goal of clinical integration. To avoid such distractions, the governance body needs to establish agreements on the strategy and core objectives.

Hospital culture tends to be methodical and risk-averse, while physicians are used to making quick decisions, with little need to consider the impact on others. Agreeing on the basics will help smooth out these cultural differences. A common understanding of strategy and core objectives can help:

  • physicians focus on the needs of the system and the importance of careful planning;

  • hospital administrators make faster decisions and allow stakeholders to proceed more independently;

  • both parties understand how to pick their battles by delineating what is open to debate and what is not, what is a critical concern and what is a side issue.

3. Hire Medical Practice Expertise

Hospital administrators who have not worked in a medical practice usually do not understand medical office processes and needs. This is true in every hospital department, and IT is no exception. The problem: EHR implementation teams that do not grasp ambulatory workflows often create needless disruptions.

The solution is to hire an expert who understands medical practice workflows, management processes and culture. The ideal expert is someone with direct experience working in a small practice setting — for example, a former practice manager who has been through an EHR implementation.

An implementer with medical practice expertise will understand how to interact with physicians and office staff. He or she will be able to foresee implementation problems and configure the EHR system to meet individual practice needs.

4. Form Collaborative Task Forces

Even with medical practice experts on the implementation team, hospitals need a way to learn from medical practice staff members about what will — and will not — work in their office. The solution is to create implementation task forces that include key individuals.

Nurses, practice administrators, medical records staff, billers, even receptionists all should be represented. Establish an overall task force to plan EHR configuration and processes, and break out smaller groups to tackle specific issues like template design and process metrics.

Collaborative task forces can anticipate user problems that hospital IT staff would never see coming. They also build a sense of shared ownership for the EHR system. In addition, task force members are able to support their coworkers after implementation, reducing the practice's reliance on hospital IT.

5. Build a System, Not an Assembly Line

Implementing an EHR system for a physician network will require medical practices to adopt some standard workflows and clinical protocols. While standardization is necessary, it can create problems in individual situations and for certain medical specialties. A rigid approach to workflow design will breed resentment and result in a poorly functioning system.

Here's a rule of thumb for EHR implementation decisions: Don't force any changes that won't improve care quality or bottom-line results.

Say a group of family physicians wants to use voice recognition software to create referral notes. Some hospital-led implementation teams oppose voice recognition technology on the grounds that it does not generate discrete data within the EHR system. But meaningful use regulations and quality initiatives do not require all documentation to be formatted as discrete data. Since voice recognition technology may improve quality of care and make life easier for physicians, the best decision is to allow its use in the proper place within an EHR environment.

6. Rip Off the Band-Aid®

Even with good planning and risk mitigation, an EHR implementation is expensive and resource-intensive. The issue before hospitals and physicians is this: Do you want it to be quick and expensive or slow and expensive?

Both parties must devote resources up front to ensure a prompt and efficient EHR rollout. Physicians need to set aside time to learn the system, which means temporarily cutting back their schedules. Hospitals need to provide additional support to soften the impact on physician productivity. Some hospitals provide physicians with medical scribes to assist with the transition to electronic charting, while other hospitals supply temporary nursing support to help practices maintain patient flow.

These moves add expense to an implementation project, but they are a small investment when weighed against the risks of a failed rollout.

Here again, agreement on core objectives (see Step 2) is important. Both hospital administrators and physicians must be able to understand why they are making the change if they are to maintain commitment to the implementation and make needed investments.

7. Share Accountability

While the system rollout requires a big push, the work does not end there. All stakeholders must have ongoing accountability for creating high-performance electronic health records.

The hospital, of course, is responsible for maintaining the system and providing training. Physicians are responsible for using the system well. Ultimately, successful EHR adoption and meaningful use depend on what happens at the practice level.

While physicians need to make time to learn the new system, they also need to attend training sessions (you might be surprised by how many do not). Medical practice staff should participate in planning and implementation. Practice representatives also should take part in EHR user groups — collaborative learning groups that allow staff to share best practices and solve system problems, ultimately reducing their long-term reliance on hospital support.

Hospital administrators and physicians need to work together on continuous improvement. This is where the governance structure is still important, because there needs to be a body that identifies improvement goals and enforces behavior change for the sake of the entire system.

Best Chance for Success

Each of these steps will minimize the problems that can arise during a hospital-led EHR implementation. Together they allow hospital leaders to ensure the best chance of success for an electronically connected physician network.

 

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Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians

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