Is It Time to Start Shopping for an EHR?

The Doctor's Office , June 18, 2009

The Health Information Technology for Economic and Clinical Health (HITECH) Act, a portion of the American Recovery and Reinvestment Act (ARRA) passed in February, is creating a lot of buzz in the healthcare industry. Approximately $20 billion will be appropriated through the act to help physicians, medical practices, hospitals, states, and some healthcare vendors adopt information technology that will be used meaningfully. What does this mean for you and your practice?

What makes understanding and moving forward with the act difficult is that there are no directives for how all the changes are going to happen. What we do know is that the law states that this money will be available to physicians who can demonstrate "meaningful" use.

So, what does that specifically mean? Money will only be available if physicians can show meaningful use. "That's a big deal, and I think approximately 80% of the people that you talk to in the real world don't get that," says Kibbe. "What they are likely to say is, ‘If I buy an EHR, I'll get this money.' Wrong. That's not what the law says. It doesn't mention specific standards. It's very unclear how the certification will be done and by whom."

With those considerations in mind, it's a good time to formulate an information technology and business plan for your practice. "What we're telling people is that if you have a business plan for the adoption of a comprehensive EHR from company A, B, or C; if you have been working on the plan for a while; and if you can afford it, there's probably no reason to delay that purchase right now," says Kibbe. "On the other hand, though, these monies do not get paid until 2011, and we don't have clear guidelines or specifications with respect to the minimum [technological] requirements, in terms of the tech they need to have to qualify under the meaningful use clause."

That means there is a risk you could be investing in a system that is more expensive and complicated than you need. Once the terms of the bill are laid out, your system might not have the technological requirements needed for you to meet the bill's standards, and you might need to purchase expensive extras, updates, or even an entirely new system.

Physicians will also need to track disclosures from EMRs to a greater extent than is currently required to comply with the HIPAA privacy rule, meaning that whatever vendor you select will need to add the ability to track and report this in- formation, says Chris Apgar, CISSP, president of Apgar & Associates, LLC, in Portland, OR.

Consider accreditation
It's also important to see whether the EHR is accredited. The most well-known accrediting body is the Certification Commission for Healthcare Information Technology (CCHIT). "They have worked with a number of organizations; they accredit EHRs. It's a key in the stimulus package," Apgar says.

Medical professionals should begin looking at the way things are going to roll out. Some money will come to each state, but it's important to know how it's going to happen. "What I would anticipate seeing is that there is going to be a differentiation between rural versus urban," says Apgar. "The infrastructure for an urban [health information technology (HIT)] is usually well established, while it may not exist in some rural areas of states."

But what if you've already purchased a system? Or what if you've had one for some time? The first thing to do is to make sure your EHR follows the currently known guidelines of the act and has the aforementioned attributes. Is it able to e-prescribe? Does it follow the three guidelines defining meaningful use? If not, you will need to discuss upgrades and interoperability work with your vendor. In some cases, the way a practice customizes a system can compromise its interoperability, so upgrades need to be planned carefully, Apgar says.

"Another key thing the system should be able to do is to export quality reports in standardized formats in ways that are likely to be chosen by the Secretary of Health and Human Services," says Kibbe. If it can't, Kibbe suggests looking into an upgrade because it's a technological capability you will need to report and apply for the incentive when the time comes.

What should you be doing now?
Even though you may want to consider waiting to purchase a system, it's always a good time to be thinking about acquiring the healthcare application you need and to be educated and prepared for what you need to know and do in the future.

For example, few people realize that $2 billion has been set aside as discretionary funds for HIT exchange stations at the state and regional level. Why is it important? HIT extension offices will act as help desks and training facilitators for those in healthcare adopting and using EHR technologies.

This resource will help new users avoid the usual pitfalls that come from adopting EHRs, such as stress, decreased productivity, paper chart conversion costs, and a decreased number of patients that can be seen per day.

Although almost every state will have HIT exchange programs or projects, many are still in the planning phase. "Therefore, it would be wise for physicians to contact their local state and government offices to try to learn who will be responsible for receiving federal money that will provide resources to help them in the implementation of the HIT and EHR systems and to learn how to do that in a way that is very effective," says Kibbe.

This article was adapted from one that originally ran in the June 2009 issue of The Doctor's Office, a HealthLeaders Media publication.

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