Federal stimulus funds that soon will be available to help medical practices implement electronic medical records offer renewed incentive for making the switch to a "paperless" practice. But the change from traditional charting and record-keeping methods can be daunting for both doctors and office staff.

 

Through the American Recovery and Reinvestment Act, $44,000 in Medicare incentives will be paid over a five-year period to medical practices that adopt a qualifying electronic health record system. That amount can go up to $63,750 over six years for Medicaid providers. ARRA also provides for a variety of grants through federal and state agencies.

 

But Carmon Heilmann, president of PCS Medical Solutions LLC, a Memphis-based provider of practice management and electronic medical records systems, says only 20 percent to 25 percent of eligible practices in the Memphis area have made the transition.

 

"The rest are in various stages of evaluating systems or in denial," he said.

 

"Some practices are eager to move in this direction, some are absolutely against it, and everything in between," Heilmann said. "There are doctors and staff that are very technically savvy, and some doctors and staff who don't know how to turn on a computer."

 

Heilmann claims his company, formed more than 20 years ago, has never had an unsuccessful implementation. The firm now serves nearly 500 medical service providers in the mid-South.

 

"The doctors are the critical component," he said. "If they can't use the system, you can't call it successful."

 

The push to move forward now is enhanced by a looming penalty, Heilmann points out. Although the ARRA program is voluntary, providers will see their Medicare and Medicaid payments reduced beginning in 2015 if they haven't taken steps by then to establish a certified electronic health record system in their practice.

 

Certified EHR systems currently must meet standards set by the Certification Commission on Health Information Technology. These standards include proving "meaningful use," a term that has caused confusion and consternation among healthcare providers.

 

The federal funding isn't just paying doctors for adopting the electronic medical system, Heilmann said, but the practices also have to prove they're meeting the meaningful use requirements.

 

ARRA legislation includes 25 criteria for establishing meaningful use. These range from recording patient demographics and maintaining lists of patients' allergies and medications to checking insurance eligibility and filing claims, transmitting prescriptions electronically (e-prescribing), and sharing patient information with other care providers.

 

The complete list, along with the complete proposed role by the Centers for Medicare & Medicaid Services, can be viewed at edocket.access.gpo.gov/2010/pdf/E9-31217.pdf.

 

Shad Williams, chief executive officer of SergeMD, another Memphis-based provider of EHRs and electronic practice management systems, said that in order to comply with meaningful use, some practices are actively vetting EHR suppliers while those with existing systems are making upgrades.

 

Many practices are working with consultants at a Regional Extension Center, or REC, Williams said. In Tennessee, the REC is called TnREC. These centers are charged by the Office of the National Coordinator to drive EHR adoption and specifically meaningful use.

 

"There's a fee involved, but the unbiased advice and broad exposure to multiple EHRs and implementation methodologies are a good investment," Williams said. "The REC is like a personal trainer for EHR. They can provide the right guidance, diet and regimen, but you have to follow the plan in order to get the results you want."

 

A news release issued in March by the Medical Group Management Association, which represents 21,500 medical practice administrators nationwide, cited the group's research that suggests the changes in practice operations necessary to meet the 25 meaningful use criteria would lead to decreased provider productivity. The research – a questionnaire filled out by 445 respondents – also identified specific criteria that could prove particularly challenging to implement.

 

Also in March, MGMA's president and CEO, William F. Jessee, MD, sent a 43-page letter to Charlene Frizzera, acting administrator of the Centers for Medicare & Medicaid Services, outlining the criteria respondents objected to and recommended changes meant to make them more attainable.

 

Jessee's letter concludes: "We strongly support the overall objective of the ARRA incentive program to stimulate adoption of (health information technology) in ambulatory care settings. However, MGMA calls for substantive modification to the proposed rule, and urges CMS and ONC to request an extension of Stage 1 of the incentive program timeframe from Congress to enable eligible professionals to meet the goals of the program.

 

"In order to maximize the success of the program, we also believe that a workable and practical definition of meaningful use must be developed, reasonable and specialty-appropriate measures required, and program logistics created that reduce administrative burden on participating practices. Should the qualifications for participation in these incentive programs be overly stringent or the process too onerous, the government runs the risk of excluding a large percentage of physician practices from participation."

 

When a medical practice considers adopting EHRs, managers have to weigh the pros and cons involved. Stimulus funds can help defray the cost, but it is still an expensive process.

 

Robert M. Tennant, a senior policy adviser with the Medical Group Management Association, said significant upfront and ongoing costs definitely present a challenge for practices.

 

"The stimulus money does not flow until the EHR is purchased and meaningful use is achieved," said Tennant, who works in the association's government affairs office in Washington, D.C. So the practice has to figure out how it will finance the technology and supporting infrastructure.

 

Hardware, software and training are the three components of the transition, Heilmann said, and all can carry hefty price tags, depending on a practice's needs.

 

That's one reason most hospitals are already using EHRs, he said. They had much of the technological infrastructure in place to begin with.

 

"Hospitals typically have an IT staff, and health IT professionals and budgets for this, and have taken a more systematic approach to this," Heilmann said.

 

This has proven helpful for medical practices considering the change, he said, because most doctors spend a lot of time in hospitals doing rounds or checking up on their patients, so most have seen the EHRs in use there.

 

"So while hospitals and ambulatory care systems are very different, it does give the doctors some exposure to the EHR," he said. "Generally it's very helpful for them to see how the system works, to find information in the system and update it."

 

There is also a learning curve as doctors and staff learn how to use the new technology, which can potentially lower productivity in the short term.

 

On the other hand, once the technology becomes more familiar, proponents say practices are likely to see increased productivity and efficiency, as well as improved patient safety.

 

"There are lots of efficiencies that are not available otherwise," Heilmann said. For instance, communications can be much improved.

 

"There are many areas where they can save money. Transcription fees can be cut dramatically," he said. "I wouldn't characterize the system as a cost-savings measure, because there are costs in setting up and operating it, but these help offset those costs."

 

But for practices that have a successful installation, Tennant said the benefits can include increased productivity and streamlined administrative processes, remote access to medical records for on-call physicians, improved coordination of patient care and augmented patient safety.

 

In addition to these benefits, Williams, with SergeMD, expects to see increased patient satisfaction, especially among those with chronic illnesses who have to carry their medical records for a referral or specialist visit.

 

"We expect a certain level of technology – whether ordering at the drive-through or paying bills – and it's reasonable to think that your doctor is as automated as every other industry," he said.

 

"I expect ubiquitous use of EHRs, health information exchanges, online check-in, secure messaging for results, online prescription refills and virtual visits to be standards of care in the near future."

 

Administrators checking out various EHR providers will be under a lot of pressure to choose the most appropriate software for their practice, Tennant said. It must not only qualify the physicians for the incentives, but also meet the clinical and administrative needs of the organization.

 

Some of the factors to keep in mind, Tennant said, include a vendor's reputation, payment options, objective industry ratings, after-sale support and maintenance, integration with a practice's current practice management system software, applicability to the practice's size and specialty, and market longevity.

 

And of course, meaningful use requires that the software be certified. But because the certification requirements are still being worked out and getting certified is very expensive, Heilmann said practices should be wary of vendors that say they are "going to be" certified.

 

"The reason a lot of software writers and manufacturers haven't been certified yet is because they can't afford it," he said. "Research and development is very expensive, and it's going to increase to keep up with developments coming down the pike. The more reputable software vendors are better at keeping their product up to date."

 

Williams said choosing a local company also is a good idea, because the best training and support happens in person.

 

"As a practical matter, automating a practice will cause disruption, and access to local experts can make all the difference," he said.

 

Heilmann agrees. "Let's face it, it's a computer, they don't work 100 percent of the time. So ongoing support is an important part of decision making."