April 16, 2009
The recently passed HITECH Act (Health Information Technology for Economic and Clinical Health Act) provides funding for CMS (Medicare) to pay annual incentive payments to physicians for EHR adoption before 2015, once certain requirements (listed below) are met. As much as $44,000 per physician may be available.
- Demonstration by eligible professional to the satisfaction of the Secretary of HHS the use of a certified Electronic Health Records (EHR) system in a meaningful manner, which shall include ePrescribing.
- Demonstration by eligible professional the certified EHR is connected in a manner that provides the exchange of information to improve quality of health care.
- Submission of information to HHS on clinical quality measures.
There are some current EHR users that are very close to meeting these requirements; however, the vast majority are not. Studies estimate that less than 10 percent of all physicians utilize EHRs in a meaningful way for their workflow and documentation requirements.
It has been three decades since the Electronic Medical Record (EMR) was first conceived and more than fifteen years since the Institute of Medicine’s first report called for the implementation of computerized patient records. There is no doubt that EHRs can save countless lives and save millions if not billions of dollars. So why haven’t EHRs become the way most physicians practice medicine? There are many reasons–some are unique to each physician practice; however, here are four major reasons:
- High cost.
- Lack of understanding (by all parties) about workflow considerations.
- Lack of understanding that physician adoption is a change management process.
- Inability to establish and follow a timeline of reasonable goals, including a real Return on Effort (ROE)
for physicians.
For those practices that serve Medicare and Medicaid patients and have not yet purchased an EHR, the incentives included in the HITECH Act (both positive and negative) are now overwhelmingly compelling. Cost is always a consideration; however, this major issue has been greatly minimized. The process of purchasing a certified EHR should begin if not already started.
The greater challenge is for those that have purchased an EHR and are not close to full physician adoption and utilization. There are significant numbers of implementations that are not making significant progress or are failing.
What Steps Does Your Practice Need to Follow?
- Workflow Analysis and Assessment – The key to a successful implementation is the organization’s willingness to identify and fix outdated ways of accomplishing clinical work. It also requires flexibility within the certified EHR to adapt to these new, more efficient workflows. Even though medical care is incredibly complex, the process of providing ambulatory care can be broken down to a finite number of workflows.
- Physician Adoption and Utilization – An implementation plan needs to be developed based upon addressing the needs of physicians. It needs to include proven methods to gain their acceptance and adoption. Physician leaders need to be identified and developed. These leaders help redesign workflows and educate other physicians so the EHR makes sense to all clinicians. An EHR is not just another IT project. It truly becomes transformative when clinicians start to do things they never realized when they first started using it to replace paper-based documentation.
- Timetable for ROI and ROE – There are now major, measurable benefits in reducing unnecessary costs and increasing revenue through the use of EHRs. Common financial metrics for reducing costs include reductions in transcriptions, handling paper and personnel and overall efficiency. These should be identified, measured and reported to all shareholders. Even more important may be the non-financial metrics that greatly influence the physicians’ Return on Effort (ROE). These include improvements in patient safety and clinical care. Access to information, clinical alerts, efficient management of time and patient satisfaction should also be identified, measured and reported.
It is an exciting time to be in health care. Real improvement in the way our health care delivery system works is at hand. However, for many reasons the task is still daunting. It is critical to learn from previous mistakes and replicate the criterion for success. Take a consultative approach by developing a strategic, collaborative plan for your practice. Understand your current situation, identify what is required, identify a plan to reach your objectives and make sure your progress is reported and shared with all stakeholders in your practice.
The Somerset Health Care Team is ready to help you. For more information, please contact us.
My experience with EMRs as a physician is that no EMR fits the way physicians work and think. I have yet to encounter an EMR that actually speeded up my work flow. I am fairly computer savvy, and can type by touch, but still EMRS slow me down due to poor work flow. Secondly, EMRs are very expensive and cumbersome for a small practice to install and run.
I appreciate your comments. Some EHRs adapt better to each physician workflow than otthers, however there all require trade-offs and some stardization. For example, the eprescribing function takes longer than writing on a prescription pad, however it can automatically check the patients’ formulary and DURs which is better for the patient. The major benefits are patient safety and reporting. The cost to smaller practices has always been a major impediment to adoption, however there are EHR companies that focus on this large part of the physician market with more economical options.