The federal government has proposed the criteria that neurologists and other physicians must meet to qualify for financial incentives that reward the “meaningful use” of electronic health record (EHR) technology. And the practice of medicine will never be the same.
The Stage 1 criteria proposed by the Centers for Medicare & Medicaid Services (CMS) correspond to incentives of up to $44,000 for physicians who meet them by 2011 or 2012.
The proposed “meaningful use” criteria support the Health Information Technology for Economic and Clinical Health Act, a part of the American Recovery and Reinvestment Act of 2009, which was created to help physicians get beyond the cost barrier to EHR adoption. Although physicians are not required to participate in the program, those who demur will start being penalized by cuts in Medicare fees in five years. (For details on the criteria, see “Criteria: Meaningful Use for EHR Defined.”)
To qualify for the money, physicians must capture and use patient data electronically in ways that few of them currently do.
“The neurologists and administrators who understand what just came out...I think ‘daunted’ would be a good word to describe them,” said Gregory Esper, MD, MBA, director of General Neurology at Emory University School of Medicine.
He and other EHR-savvy neurologists support the government's ideal of improving the quality of health care through the use of electronic means. But they do not think it will be easy to achieve.
“This is a step that needs to be made, but it's going to be difficult and painful,” said Dr. Esper, a member of the AAN Practice Management and Technology Subcommittee. “We need to do this because health information, at this point in time, is not interchangeable in the way neurologists need it to be in order to enhance the quality and efficiency of care for our patients.”
WHAT TO DO NOW
Rather than mandate EHR use outright, the government's approach is to reward physicians financially for using certified EHR technology to perform specific functions. In the last days of 2009, it issued two documents: an interim final regulation (IFR) that broadly describes how EHR vendors will get their technology certified and the proposed rule for how the EHR incentive program will work.
While the interim regulation addresses EHR technology vendors rather than physicians, it is important to physicians because it authorizes the use of web-based EHR modules, providing them with an alternative to purchasing a comprehensive system.
Meanwhile, the proposed rule for the EHR incentive program is important because it defines what physicians must do in their practices to qualify for the financial incentives.
David C. Kibbe, MD, MBA, an advisor to the AAN Practice Management and Technology Subcommittee, said neurologists who are already using EHR technology should learn the proposed Stage 1 criteria for meaningful use and start thinking about workflow changes that would be needed to meet each step. The final criteria will not be published until later this year, but the proposal shows what the government is thinking. Even those physicians who have used EHR technology for many years will likely have to add new functions or upgrade their systems to comply.
In addition, Dr. Kibbe suggested that physicians contact their vendor to learn about its plan for getting the technology certified. The IFR identifies what products must do to achieve certification, but the organizations that will do the certification — and the process they must use — will not be known until later this year.
Of course, the majority of neurologists are not using EHR technology, and they have a different set of options. While it may seem counterintuitive, Steven J. Zuckerman, MD, another member of the Practice Management and Technology Subcommittee, advises them to sit tight for a while.
“Vendors want to give you the impression that you have to make a decision now,” he said. “But I think it would be more prudent to wait and see what the final regulations are and how the vendors are reacting to it.”
Courtesy of the IFR, vendors now know exactly what the government wants EHR technology to do and that both comprehensive systems and function-specific modules will be acceptable.
“This new approach in these regulations is likely to bring cheaper, better, and faster products to the marketplace within a year's time,” said Dr. Kibbe, founding director of the American Academy of Family Physicians Center for Health Information Technology.
He advises neurologists who have not yet purchased technology to proceed, but only with a written guarantee from their vendor that the technology will be certified to meet the government's standards. Those who have not made a purchase decision should determine whether a comprehensive EHR system or a small group of function-specific EHR modules will work best. This may not be possible until later in the year when the modular products have emerged on the market.
CRITERIA:MEANINGFUL USE FOR EHR DEFINED
In a carrot-and-stick approach, the federal government is offering financial incentives through 2016 to encourage physicians to use EHR technology. Those who are not enticed by the carrot will get the stick in 2015, when their Medicare fees are cut by 1 percent, followed by larger cuts in the next two years.
Beginning in 2011, neurologists who meet Stage 1 meaningful use criteria can receive EHR incentives of up to $44,000 over a five-year period. To receive the maximum amount, a physician must qualify for an initial incentive payment of $18,000 in either 2011 or 2012. The annual incentive payments decrease in each subsequent year, but to qualify for those payments, a physician must use the technology in increasingly sophisticated ways.
Physicians must qualify for an initial incentive payment by 2014 if they wish to participate in the program.
To qualify for a Stage 1 incentive, physicians must use certified EHR technology to capture health information in a coded format, track key clinical conditions, communicate information to help coordinate patient care, and report some clinical quality measures and public health information.
Among the 25 steps to quality for a Stage 1 incentive, neurologists must:
- Use computerized physician order entry for 80 percent of medications, laboratory, radiology/imaging, and referrals
- Maintain a problem list of current and active diagnoses, an active medication and allergy list for at least 80 percent of all patients
- Use electronic prescribing for at least 75 percent of permissible prescriptions
- Record demographics including preferred language, insurance type, gender, race, ethnicity and date of birth for 80 percent of patients.
- Record vital signs including height, weight, blood pressure and body mass index for 80 percent of patients.
- Send preventative care/follow-up reminders to at least 50 percent of all patients 50 years and over.
- Provide 80 percent of patients who request an electronic copy of their health information within 48 hours of their request.
- Provide 10 percent of patients with online access to their problem list, medication lists, allergies and lab results within 96 hours of the information being available to the physician.
- Report ambulatory quality measures to government agencies.
- Implement five clinical decision support rules relevant to the clinical quality measures
- The other criteria can be viewed at http://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf
- The government document that describes EHR technology eligible for certification can be viewed at http://edocket.access.gpo.gov/2010/pdf/E9-31216.pdf