EHR: Facts beyond Fiction on East Tennessee Medical News

EHR: Facts beyond Fiction

By: VIVIAN MARSHALL

The $850 billion American Recovery and Reinvestment Act (ARRA) of 2009 allocates $51 billion to the health care industry and $19 billion earmarked to incentivize medical practices for the adoption and implementation of Electronic Health Records (EHRs,) also know as Electronic Medical Records (EMRs).

ARRA defines Electronic Health Records (EHR) as an electronic record of an individual's health-related information whichincludes patient demographic and clinical health information (i.e. medical history and problem lists) and, has the capacity to:

provide clinical decision support
support physician order entry
capture and query information relevant to healthcare quality
exchange electronic health information with, and integrate such information from other sources.

Qualified Providers/Meaningful Users

The government defines meaningful users, as eligible providers who demonstrate use of a qualified EHR in a "meaningful manner." The ARRA specifies e-prescribing, electronic exchange of medical records, and interoperability of systems as part of "meaningful use" criteria. The bill deferred to the Secretary of Health and Human Services (HSS) to establish more specific guidelines for determining what constitutes a "qualified EHR" by "meaningful users."

Beginning 2011, meaningful users of EHR systems will be eligible to receive incentive payments distributed over a five-year period. How does a physician receive incentive payments? Basically, medical practices may qualify in two ways: 1) if they bill a minimum of $24,000 to Medicare, or 2) if 20% of their patient base is Medicaid. If qualified, the practice may receive up to a 75% reimbursement of the year's Medicare and Medicaid charges, and practices with multiple physicians will be eligible to receive incentive payments for each provider.

Figure one illustrates the amounts paid to qualified medical practices based on the first year the provider becomes eligible:

Note the incentive payments decline for each subsequent year within the five year period, practices that become eligible after 2014 will not receive any payments, and after 2015, incentive monies cease.

Purchase Now or Later

Whether to purchase an EHR system in 2009 or wait until 2010 is a question many medical practices are struggling to answer. Many experts believe postponing an EHR purchase is a mistake because researching and selecting the right EHR system is a lengthy process, and many providers may find it difficult to have a system in place in time to quality for the incentives.

The Certification Commission for Health Information Technology (CCHIT) is a non-profit organization and the officially recognized certifying body for EHR systems. Its primary goal is accelerating the adoption of robust, interoperable health information technology within the health care industry (the term interoperable means software and IT products can share data compatibly).

The Certification Commission for Health Information Technology (CCHIT) provides a list of companies (such as Allscripts, LLC, Cerner Corporation, eClinicalWorks) whose products are fully certified during the past 12 months and those products which qualify for the exemptions. EHR software is "deemed to be interoperable" if a certifying body recognized by the Secretary of Health and Human Services certified the software no more than 12 months prior to the date a physician/recipient implements it within the practice. Any healthcare provider implementing an EHR within its practice should consider if it is CCHIT certified because without this certification, the practice cannot receive stimulus reimbursement.

The stimulus bill could be a double-edged sword for those practices that choose not to implement an EHR system. They face the potential loss of thousands of dollars of incentive payments and beginning 2015, they will be penalized by decreased Medicare and Medicaid payments. Practices not qualified as "meaningful users" will face decreases of 1% in 2015, 2% in 2016, and 3% in 2007, with a maximum reduction of 5% by 2020. Prudent healthcare professionals should begin the research process now, allowing ample time to create a short list of systems, meet vendors and see product demonstrations, check references, negotiate terms, and complete the implementation and training process.