The passage of the HITECH Act in 2009 has lead to a rapid push to implement electronic health record (EHR) use in both the hospital setting and by outpatient providers. Unfortunately, it is not quite as simple as purchasing an EHR system from a vendor and flipping on the switch. Many organizations are now trying to understand and wade through all the government regulations, keeping within the specified timeline in order to reap the incentive payments for doing this.
First, with very limited data from scientific studies on the benefit of using an EHR, many physicians are hesitant to become early adopters for good reason. It is a very large financial investment and meaningful use a steep hill to climb for what many physicians are not convinced will significantly improve quality care.
As an emergency physician, I do not have to purchase an EHR system and am not qualified to receive an incentive payment as it is assumed a hospital based physician will use the hospital based EHR. I can tell you however this is a very important issue for your client hospital. The base incentive payment for a hospital is $2 million and will be higher based on a couple of factors. There is also an additional 10% for designated Health Professional Shortage Area.
Important goals for meaningful use are incorporating clinical decision support and error checking such as for medications and allergies, interoperability with other systems to share data, and required data reporting to CMS.
In order to meet meaningful use standards, you must use “certified EHR technology” that has been properly certified as meeting standards adopted under section 3004 of the Public Health Service Act (PHSA). Selecting a “certified” system means that the EHR has the proper components to achieve meaningful use but it would still need to be implemented in a fashion to meet the requirements.
There are 3 stages for meaningful use criteria and currently only clearly defined criteria for stage 1. The criteria for stages 2 and 3 will be forthcoming. The criteria are different for an eligible provider and hospitals but the concept is the same. For hospitals, there are 14 core criteria that must be met along with 5 out of 10 measures from a menu set of criteria. For each objective, there is a measure that must be met to count toward compliance with the objective. For example, for the objective to provide the patient with an electronic copy of their health information, more than 50% of inpatients and emergency patients who request it, must receive this within 3 business days.
Meaningful use of EHR systems will need to be interoperable, to be able to share important clinical data in a secure fashion to other providers that may be treating the patient. This would be enormously helpful for an emergency physician as it can be nearly impossible to get outpatient records, outlying hospital records, and results of outpatient imaging studies even on a good day with maximal effort. With the rapid expansion of Health Information Exchanges (HIE) in the coming years, this will be possible. It may reduce redundant testing and help the physician make a more informed clinical decision.
Another goal of meaningful use will be the required reporting of clinical and quality data. Like never before in history, researchers and public health experts will be able to study data from very large populations of Americans to further expand our knowledge of medicine. I predict an explosion of new ideas, as much as with any previous ground-breaking advance in medicine in the last century. The potential of healthcare information technology is certainly intriguing and may have significant benefit but this is yet to be proven. I believe the total cost is entirely unknown and I have my doubts that this will make a large dent in the increasing healthcare expenditures of the U.S. The practice of medicine will change rapidly in the next few years and many companies and organizations are racing into this field. This is the new frontier. It is an exciting time to be in healthcare.