Technology  June 18, 2010

Rules for electronic medical records on tap

Medical practices that haven’t yet ditched their paper records will need to do so soon. The federal government’s rules for “meaningful use” of electronic medical records are set to be released this month. That’s also when health-care providers will find out how to qualify for their share of the $20 billion in reimbursement grants to be paid out starting next.

The sooner practices start converting, the more grant money they’ll have an opportunity to qualify for; if they delay, they could face financial penalties. And government-funded consultants are ready to help Colorado primary care providers determine what an EMR conversion will cost, and just how much they can expect to get back from Uncle Sam.

The $787 billion American Recovery and Reinvestment Act of 2009 included about $20 billion for health-care IT, including Medicare and Medicaid incentives for physicians to implement EMRs. The maximum incentive is $44,000 per physician over five years for those applying through Medicare, with up to $18,000 the first year, followed by $12,000, $8,000, $4,000 and $2,000.

Providers with more than 30 percent of their patients on Medicaid can apply instead for the Medicaid incentive, which can be up to $63,500 over a five-year period.

In Colorado, about 32 percent of practices have already adopted EMRs, and that percent goes down as practice size goes down, explained Robin Leone, director of the Colorado Regional Extension Center.

Regional extension centers were funded under the recovery act to improve health information exchange. “We’re delivering services to help providers get to meaningful use – specifically small practices with 10 providers or less,” Leone said. “We’ll look at your existing system, if you’re ready to implement, and what system would be a good fit.”

Leone’s program launched June 14, with a goal to get 2,300 providers in the state to meaningful use by 2011. She said if the incentives aren’t a driver to make physicians want to convert to electronic records, the penalties may be.

Penalties, costs loom

“They’re using blunt trauma at the end,” explained Loveland CPA Paul F. Mueller. “They’re saying, ‘If you’re not going to get on the program, we’re not going to subsidize your inefficiency.’ It’s the carrot and the stick. If you don’t want the carrot we’re going to use the stick on you. In 2015, physicians who do not implement the technology will see a 1 percent reduction in Medicare payouts, and that cut will go up another 1 percent every year.”

Ellen Batchelor, project manager with the Colorado Foundation for Medical Care, the state’s health-care quality improvement organization, works with practices that are in the process of selecting and implementing EMR systems. Recently, her organization recognized Fort Collins practices Rocky Mountain Family Physicians, Internal Medicine Clinic and Miramont Family Medicine for “Excellence in Prevention through Health Information Technology.”

All three demonstrated improvement in numbers of patients screened for breast or colorectal cancer or number of immunizations given to patients aged 65 or older, and quality improvement through best practices.

“Prior to the advent of the EHR (Electronic Health Record), the only way practices could gather such lists was to either hand-count the information in each patient’s paper chart or double-enter the data into both the paper chart and a standalone patient registry,” Batchelor said. “EHRs have made it much easier for practices to take a more coordinated approach to caring for their patients.”

Asked about the cost of implementing electronic records, Batchelor said the initial software alone can cost anywhere from $15,000 to over $100,000.

“That’s just the software,” she said. “Then you have to have hardware, computers, probably networks, storage capacities, fax servers. Hearing dollar signs yet?

“There’s also maintenance, training, time off when you close a practice to implement,” she continued. “If they want to get a lab interface, there’s an additional charge to develop that. There are continually additional charges. We work with 10 different vendors, so we’ve seen all scenarios.”

Asked about reimbursements, Batchelor says a lot is still to be determined. “The proposed rule is the only guidance we have on that – and it’s 600 pages long,” she joked.

How will “meaningful use” be defined? That’s the million-dollar question, she said.

Entire system electronic

Judy Van Norman, Banner Health’s senior director of clinical informatics, agreed. Banner has spent in excess of $200 million over seven years rolling out EMRs across the entire organization. By next year, Banner will have completed the rollout to all 22 facilities, and Van Norman expects the hospital will qualify for some of the recovery act payments.

She’s participated in an oversight committee looking at what it will take to qualify for meaningful use at each stage of the five-year period. The calculation for hospital payments is more complex than physician payments, but she estimates Banner could receive reimbursements for half the cost of the system.

“But the legislation’s not final, so you don’t know how much additional work there will be,” she added.

Though some may argue the requirements are too stringent, Van Norman is optimistic about the results. “We believe the government incentivizing health-care providers to more rapidly adopt electronic medical records is a good thing,” she said.

Banner did not begin its conversion with incentive payments in mind in 2003 – since they didn’t exist then.

“The reason we made the investment was to have better information to make the right decisions and coordinate care,” Van Norman said. “Having patient records in a computerized format will give us a lot more data to fully understand what works and what doesn’t, and I think that’s going to more rapidly increase our ability to treat patients in an effective manner.”

Cultural transformation

Starting in 2006, Loveland’s McKee Medical Center implemented 14 EHR applications, completing their system with clinical documentation and physician order entry last year.

Pat Duncan, a registered nurse and McKee’s clinical informatics facility director, said in addition to the technological changes it’s been a profound cultural transformation.

“Electronic records isn’t just pushing a bunch of buttons,” she said. “It transforms the way we approach care across disciplines. It makes things very immediate and requires us to change our approach, how we provide and document care. That is not without struggle. It is the soft stuff, the cultural stuff that is the hard stuff. We have habits, and those take time to adjust.”

The clearest example of the benefit in electronic records is simply the elimination of handing off handwritten physician orders through multiple people, which left lag time and chance for error if an order was read wrong, Duncan said. Now transmission is instantaneous.

“For clinicians such as myself – I’m a nurse by trade – to be able to reinvent themselves in these new and meaningful ways to move health care to a different level is absolutely a gift,” she said. “Way before there were governmental organizations waving money, Banner was out doing this years ago. We are well ahead of the curve for meaningful use and that is something I am very proud to be involved in.”

Medical practices that haven’t yet ditched their paper records will need to do so soon. The federal government’s rules for “meaningful use” of electronic medical records are set to be released this month. That’s also when health-care providers will find out how to qualify for their share of the $20 billion in reimbursement grants to be paid out starting next.

The sooner practices start converting, the more grant money they’ll have an opportunity to qualify for; if they delay, they could face financial penalties. And government-funded consultants are ready to help Colorado primary care providers determine what an…

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