White House expert advises docs on meaningful use of EHRs

The term “meaningful use” has been a buzzword on the lips of primary care physicians for the past year, but many have been unsure whether they should be excited or scared about the upcoming electronic health record (EHR) incentive program from the Centers for Medicare and Medicaid Services (CMS).

The plan to pay bonuses to physicians who use EHRs was passed as part of stimulus legislation in 2009, but specifics on what physicians have to do to qualify for those payments—the definitions of meaningful use—were just released this summer.

More information on the incentive program and how it could affect internists was recently offered by David Blumenthal, FACP, the White House's national coordinator for health information technology. Dr. Blumenthal participated in a webinar on the AmericanEHR Partners site in August. The site is online.

AmericanEHR Partners is a new online community founded by ACP and Cientis Technologies as a national, credible transparent resource to support the selection, purchase, implementation and optimization of health information technology in practices of various sizes and in various specialties. The following is excerpted from the webinar.

Dr. Blumenthal on his own experience with EHRs

I'm not an informatician or a technology specialist. As a matter of fact, my introduction to technology came in my role as a primary care physician when the hospital I worked at put an EHR on my desk. It was not something I was looking for and not something I particularly welcomed, but I quickly found that my younger colleagues took to it like ducks to water and that to keep up with them and be part of my working member practice group, I really had to learn how to use electronic health records. I did that.

I needed some help to do it, but I got through it and I found that it was really improving my practice personally and my capacity to serve my patients in very important ways in terms of connecting me with the events of their medical lives, knowing what medicines they were on, knowing what the cardiologists, pulmonologists and neurologists were recommending, knowing what the surgeon had done at last visit, knowing what the biopsy result and what the mammogram results were.

On the barriers to widespread EHR implementation

We had to overcome three major barriers that physicians and hospitals and other providers were telling us got in the way of their use of electronic health systems. The first of those was financial, the cost of acquiring and maintaining electronic health records. The second was logistical and technological, the fear that the physicians, especially smaller groups, would purchase the wrong record or one that wasn't up to what they needed to do, that they wouldn't be able to implement it, that it might go down at critical times, and that they wouldn't be able to maintain it. The third was the lack of an infrastructure for exchange, and the lack of technical capability in communities around the country to move information up the street or across the street from one geographic location to another so that it could follow patients and connect physicians and other health professionals and hospitals to give a unified picture of patient care. A HITECH law, which was part of the stimulus legislation passed in 2009, systematically addressed each one of those barriers.

On the specifics of the incentive program

If you are a meaningful user of the electronic health record and sustain that status from 2011 to 2015, you can receive up to $44,000 in extra Medicare compensation or $63,750 in extra Medicaid compensation. If you are not a meaningful user in 2015, there may be Medicare penalties coming forward. That's not true, by the way, of folks who are qualifying as meaningful users under Medicaid.

On the timeline for implementation

You can begin to qualify as a meaningful user on Jan. 1, 2011, but it is not true that you have to be ready when the clock strikes midnight this coming January. In fact, you can start being a meaningful user on Oct. 1, 2012, and still qualify under Medicare for the full $44,000. In other words, you can become a meaningful user two years from this October [2010] and collect all the incentive monies that are made available under this law. You have two years to wait and see what records are on the market, two years to try them out, and two years to work with them before you announce to Medicare that you are ready to become a qualified, meaningful user and ready to try to meet the requirements under meaningful use.

On how to sign up

You will be able to register starting in January of 2011. … There will be a procedure to register on the CMS website as a qualifying meaningful user, that is a physician or practice that is in the process of meaningful use in electronic health records. The first payment … could occur as early as May. There will be lump sum payments. One could also register, as I said, as late as October of 2012.

On revisions to the original proposal

We noticed that the original regulation we published last December received an awful lot of comment. We were told by a lot of groups, including the ACP, that it was too demanding, too inflexible, too much an all-or-nothing kind of a rule, and we listened and we changed it. … I think it is fair to say that they think the rule has been modified sufficiently and that it is fair and achievable at the current time.

On where to get assistance

We have set up a system around the country of 60 regional extension centers. These are local support services. You can imagine them as kind of meaningful use HIE [health information exchange] geek squads. They are available specifically to help small practices in underserved areas and in primary care to obtain meaningful use. … Their goal is to help physicians decide which system to purchase, to help them install it, to help them run it, and to help them become meaningful users, and then to help them get value for their practice and their patients.

The different regional extension centers are taking different approaches. I do expect that some will engage physician opinion leaders and tutors. Some may actually get medical students working with them since a lot of medical students learn these records pretty fast. Others will make resources available through webinars like this, through materials online. There is going to be a variety of approaches. Some of them are quality improvement organizations. About a third of those 60 are already quality improvement organizations who applied for and got funding.

I think the way to start with the planning—planning is a critical part of this and it's a great thing to emphasize—is to go online and find out who is your regional extension center. Give them a little time to get set up, because they've just been funded and they're getting going.