An extensive campaign by the federal government to encourage medical professionals to make their office records electronic has many rheumatologists wondering if now is the time to make significant investments in computer equipment and software.
Providers can apply for federal incentive money beginning this year to buy or upgrade certified electronic health record (EHR) systems meant to replace paper documentation in hospitals and medical offices nationwide. The government hopes digital conversion will encourage efficiency, reduce errors, and ultimately improve the U.S. healthcare system, in part, through computer-assisted analysis of shared data related to medical conditions and diseases.
Rheumatologists considering the program’s merits say investment in technology isn’t cheap. They therefore want a records system that their staff will use and can integrate with their current practice management software as well as meet mandates for financial incentives. Chief among their concerns are labor-intensive documentation and expenses for training, hardware, software, and services.
To be eligible for the incentives, a provider must register and show “meaningful use” of its EHR system for 90 consecutive days during the first reporting year and the entire calendar year thereafter. The term “meaningful” is key to the program, which federal authorities emphasize rewards the effective use of EHRs, and not just adoption of an electronic system.
To receive the full amount of available incentives, a physician must attest to meaningful use of an EHR system by October 1, 2012—although ACR experts recommend starting the transition to meaningful use much earlier, and doing a “dry run” to make sure that your system works effectively and all reporting requirements are met. The Centers for Medicare and Medicaid Services recommends that eligible providers register for the meaningful use program as soon as possible; registered practices don’t need to begin reporting until they are ready.
At the onset, the definition of “meaningful” mostly addresses electronic collection and reporting of patient data. Providers must comply with a list of 20 objectives, including the creation of electronic patient summaries and drug allergy lists. The objectives and measures increase in three stages and apply to the eligible provider’s entire patient population, not just Medicare or Medicaid recipients.
I’ve been using a computer for 15 years to write my notes, so to me the good side of this is that they are going to force some of this stuff to happen. There will be some unhappy parts of it as well. There will be some parts that will be difficult for us.
—Thomas D. Geppert, MD
“Meaningful” Confusion
Exactly what qualifies as “meaningful use” hasn’t been easy to understand for rheumatologists and their administrative staff, who jokingly rename the term “meaningless.” Craig W. Carson, MD, an Oklahoma-based rheumatologist, says even though his practice is already a paperless operation, he hesitates to implement meaningful use until the kinks are worked out of the government program.
“I can tell you that despite being totally and 100% electronic for several years, we are not, according to government definitions, meaningful users, which is quite distressing,” says Dr. Carson. “The problem is our government thinks we need to record not just age and gender but we need to record preferred language, race, and ethnicity. So we’re not compliant.”
Carson’s office recently started collecting expanded patient demographic information for meaningful use. However, the three-physician practice may wait until 2012 to seek incentive payments in order to collect federal funds for e-prescribing in 2011, since both are not allowed in the same year, says Karen Hansen, Dr. Carson’s practice manager.
The complexity for interpreting and implementing the rules goes hand in hand with adapting the best computer system to do the heavy lifting of data collection and measurements. Both are key building blocks to success. Some rheumatologists have just begun their search for a suitable records system while others already have EHR systems and are researching upgrades or added services that will be needed to qualify for incentives.
It is essential to verify that not only the system but also the particular software version is certified, says Itara Barnes, Senior Specialist of Registries and Healthcare Informatics at the ACR. The Office of the National Coordinator for Health Information Technology (ONC) provides a listed of certified EHR vendors on its website http://onc-chpl.force.com/ehrcert.
Choosing the right system on a limited budget takes time and can be frustrating and stressful, says Deborah Wasser, wife of Kenneth B. Wasser, MD, and administrator of his solo rheumatology practice in New Jersey. “I’ve been investigating a lot of different EHR programs and talking with vendors,” she says. “You feel like you’re dealing with a used car salesman. They try to sell you stuff you don’t need.”
Wasser initially conducted a three-month trial program of an EHR system offered by the company that already provides the practice’s e-prescribing software. The system proved to be cumbersome and too generic to allow for enough customization.
“I would say after the first month I knew that we wouldn’t go with this program and that we would have to actually put out a lot more money and go with something else,” Wasser says.
She ultimately chose an Internet-based “cloud” service that maintains records on a remote server offsite. Assured by the vendor that it meets meaningful use standards, she expects to pay about $15,000 up front and a monthly maintenance fee thereafter.
Customization Options Lacking
Dallas-based rheumatologist Thomas D. Geppert, MD, wanted to upgrade his EHR system to a level that could improve accuracy and efficiency for the 10 physicians in his Texas practice while meeting meaningful use guidelines.
“I’ve always thought that the real advantage to computer programs is that it would help me avoid making a mistake, that I could write rules that would say that if this happens and this happens, I should be reminded about this,” says Dr. Geppert. “Well, my program is not that good about that kind of stuff.”
Wasser and Dr. Geppert complain of a lack of customizable software to help rheumatology practices gather meaningful use data. Typical programs that require doctors to click a series of boxes to generate notes may work for primary care physicians, but this method falls short of the needs of rheumatologists. It simply takes too long to find the proper symptoms for rheumatology patients with complex conditions, and to sift through numerous medical terms and conditions that don’t apply to their specialty.
The requirement to provide patients an electronic summary of each visit poses another challenge for rheumatologists attempting to meet the first of three stages for meaningful use objectives. To generate a document of helpful guidance without extraneous information, Dr. Geppert says that physicians in his practice will have to adapt how they write patient notes to the nuance of the computer software.
Despite being totally and 100% electronic for several years, we are not … meaningful users, which is quite distressing.
—Craig W. Carson, MD
While Dr. Carson is confident his EHR system can handle the electronic patient summary, he doesn’t know what method he would use to deliver it to the patient. “If it means that I’m going to print out a piece of paper with the summary, why do I have an electronic chart now?” asks Dr. Carson.
On the other hand, giving patients some form of an electronic summary assumes everyone has a computer and knows how to use one, says Dr. Carson who also worries about the security of patient information traveling through the Internet’s digital highway.
Despite some philosophical differences with the government’s digital efforts, Dr. Carson seems better poised than many to participate. His office converted to electronic records years ago, instituted a task force dedicated to “meaningful use” issues, and has a well-trained staff familiar with the required data collection and reporting.
“We’re going through the core objectives one at a time and seeing where we are compliant and where we’re not compliant,” says Dr. Carson.
Dr. Geppert’s practice is in the process of upgrading computer software to get it certified for meaningful use. He also expects to spend between $10,000 to $15,000—a cost shared among the 10 physicians in his practice—to upgrade the computer server.
Despite the frustrations, Dr. Geppert views the federal program as beneficial and believes that software companies who want to stay competitive will do more in the future to help meet meaningful use requirements.
“I’ve been using a computer for 15 years to write my notes, so to me the good side of this is that they are going to force some of this stuff to happen,” says Dr. Geppert. “There will be some unhappy parts of it as well. There will be some parts that will be difficult for us.”
Catherine Kolonko is a medical writer based in California.