The electronic revolution has slowly but surely begun to filter down to the physician level in Louisiana. As with most technological advances, there are early adopters and late adopters. That there will be implementation of Electronic Health Records (EHRs) is inevitable.
The American Recovery and Reinvestment Act (ARRA) of 2009 contained significant health information technology grants designed to increase the use of EHRs and achieve “meaningful use.” The five priorities of “meaningful use” are: 1. Improving safety, quality and efficiency while reducing health disparities, 2. Engaging patients and families in their own care, 3. Improving care coordination, 4. Improving population and public health and 5. Ensuring privacy and security of personal health information (PHI).
Significant financial incentives are in place for practitioners in Medicaid (practices with over 30% Medicaid patients) and non-hospital based Medicare. The former can receive up to $63,750 in incentives and the latter can receive up to $44,000 over five years. The plan for implantation is staged, and the first incentives can be received for just buying an EHR system. Progressively, however, the practitioner must demonstrate that they are achieving “meaningful use” to obtain subsequent incentives, which phase out entirely in 2016 for Medicare.
“Meaningful use” entails achieving objectives in a series of “core requirements” (15) and “menu set” objectives (5). The former include such standard information as allergies, demographic information, problem and medication lists, vital signs, smoking status and other objectives. While the “menu set” includes such objectives as drug formulary checks, patient education resources, immunization records, patient reminders and others.
There are also “Clinical Quality Measures” currently relating to hypertension, tobacco use and weight that must be incorporated in 2011 and 2012. These will be followed by measures of breast and colo-rectal cancer screening, monitoring of glycosylated hemoglobin values (for diabetics) and tobacco cessation.
The AARA legislation contains both the carrots of paid incentives and the sticks of reduced reimbursements and incentives over time to encourage physicians to get on the EHR bandwagon. The Louisiana Health Information Technology (LHIT) Resource Center was established to assist 1,400 priority primary care providers to achieve meaningful use criteria. It is hoped that all Americans will have access to EHRs by 2014, although this may be an unrealistic expectation.
Ultimately, it is hoped that all providers will also be hooked up to Health Information Exchanges, which will allow transmission of health information between various providers (including hospitals and outpatient clinicians.) The hope is to achieve coordination of care and reduce some of the horrendous waste in duplication of services and fragmented care.
Implementation of EHRs has been spotty for a number of reasons. Inertia tends to block some innovation, while expense and drops of productivity among providers are other problems. Even though EHRs are supposed to achieve cost savings for both the provider and patients, they are sometimes difficult to substantiate in the painful initial period of implementation. To add to the confusion, there are multiple vendors of multiple systems and providers are hesitant to make the considerable investment of time and resources without substantial reassurances of success. That, in fact, is the point of the current financial incentives.
So prepare for your provider to have a tablet or a laptop, with or without a stethoscope, when you see them next time. For some patients, this has already occurred. For others it will be a disconcerting shock. Whatever your reaction, this “Brave New World” of Electronic Health Records is here to stay.