Spurring Health IT Adoption

The Obama administration really, really wants doctors to start using electronic health records (EHRs). For the past few years, they have been out urging physicians to invest in the systems and offering a pretty big carrot for adoption. Under the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, physicians who meet certain quality metrics through the use of certified health IT systems can qualify for incentive payments from Medicare and Medicaid. Under the Medicare program, the maximum incentive is $44,000 over 5 years. Under Medicaid, it’s nearly 64,000 over 6.

HHS officials want to make paper medical records a thing of the past. Courtesy Wikimedia Commons/U.S. Navy Photo by Rod Duren/ Public Domain.

Now officials at the Health and Human Services department are trying to drive up adoption by removing a potential barrier to early participation in the program. HHS recently announced that physicians can begin participating in the incentive program this year and not have to meet quality standards until 2014. Previously, if a provider reported to HHS that he or she was using health IT as part of the incentive program in 2011, they would have to meet the quality standards starting in 2013. But those that started sometime in 2012 wouldn’t have to meet the standards until 2014 and would still qualify for the maximum incentive payments. It can get a little complicated, but essentially HHS is trying to take away reasons for people to hold off on adopting EHRs.

It’s hard to tell if this latest policy change will make a big difference to physicians considering an EHR. But the incentive program as a whole does seem to have physicians interested. A new survey from the Centers for Disease Control and Prevention found that 52% of office-based physicians report that they plan to take advantage of the new incentive payments. As for doctors who have already adopted some type of “basic” EHR, that number has climbed from 17% in 2008 to 34% this year.

Tell us what’s driving your decision to adopt an EHR in your practice? Take our poll:

— Mary Ellen Schneider

Will Electronic Health Records Kill Private Medical Practice?

Last January marked the official start of America’s ambitious program to turn its health records electronic, spearheaded by a federal incentive program that will award some U.S. physician up to $44,000 to help pay for their electronic system. The first payments from the government’s $27 billion piggy bank earmarked for electronic health record (EHR) funding began flowing on Jan. 5, including a $42,500 initial payment to two practitioners from the Gastof Family Clinic in Durant, Okla., who had the distinction of being the first individual docs to receive incentive payments.

Gastof Family Clinic staff receives the first EHR incentive check last January. courtesy EMR Daily News

But what fraction of the EHR cost will $44,000/physician actually cover? Can every U.S. doc, especially those in private practice, afford to pay whatever the cost balance will be to make their system work, and more importantly to keep their system in compliance with the data-reporting demands of the Center for Medicare and Medicaid Services (CMS)?

Some serious questions about the cost and feasibility of compliance came up in a session I covered last week in Las Vegas at the annual meeting of the National Association of Medical Directors of Respiratory Care, when the president of the group, Dr. Steve G. Peters, a Mayo Clinic pulmonologist, talked about what he’s seen as Mayo’s massive resources mobilized in an effort to comply with the demands of the 2009 law that set up the EHR system for Medicare and Medicaid.

The problem is that CMS demands automatic feedback from each physician’s or hospital’s EHR system on several patient-assessment measures and management decisions. “It sounds easy, but it’s not,” Dr. Peters said. “It’s very tricky, and it differs from measure to measure,” leading to a big IT challenge. Even though the Mayo Clinic already had a system-wide EHR in place, tweaking it so that it reports the data that CMS wants remains a work in progress. “We have 85% of it there, but the last 15%is hard.”

What will this mean for the private practitioner with shallow pockets? After Dr. Peters spoke, a comment came from audience member Dr. Theodore S. Ingrassia III, a pulmonologist from Rockford, Ill. He said that he had checked into the costs, and the $44,000 incentive likely will cover just a fraction, perhaps less than 25%, of the eventual cost for IT support to refine a system so that it can do and report everything that the regulations require. And, Dr. Ingrassia added, he can’t foresee himself being in a position to spend that much.

The major hospitals in his area, recognizing his dilemma and those of his fellow private docs, have offered them a deal: the hospital will fund their future IT needs if they forsake their independence and join the hospital’s staff, an option that Dr. Ingrassia didn’t like much either. His current solution? Stall, and hope the 2015 deadline, when CMS penalties are scheduled to start for physicians who have not yet installed an EHR system, will eventually get pushed back or that another, more palatable option emerges.

“Many predicted what you’re experiencing, that this incentive will not buy much,” Dr. Peters said in reply to Dr. Ingrassia. And, Dr. Peters added, “no one will admit it, but there is de facto pressure that there won’t be private practice in the future. Everyone will need to report measures on hundreds of patients,” and to afford to do that they “will need to be part of an organization.”

In short, the U.S. mandate for an EHR that can report back to the government a specified list of patient measures and treatment decisions may become a big, and possibly the final nail in the coffin of private U.S. medical practice.

—Mitchel Zoler (on Twitter @mitchelzoler)

Protecting Patients in the HIT World

Image via Flickr user southerntabitha by Creative Commons License.

Many electronic health records are equipped with alerts and other safety features, designed specifically to prevent the type of human errors that too often put patients at risk for injury. But the reality is that health information technology (HIT) has its own problems when it comes to patient safety. The Health Information Technology Policy Committee, which advises the federal government’s health IT czar, met earlier today to talk about some of the unique safety risks presented by HIT.

It turns out that only a small part of the problem is caused by faulty technology, said Paul Egerman, who co-chairs the Certification/ Adoption Workgroup for the HIT Policy Committee. While some problems do occur because of software bugs, those are generally easily fixed, provided they are discovered. Instead, the bulk of the problem comes from the complex interactions between people and technology, known as issues of usability. In other words, the technology can be working fine, but if the staff isn’t trained to use it or if using it makes their lives so miserable that they develop workarounds, bad things can happen.

This problem could become magnified as more physicians and hospitals adopt electronic health records with an eye on cashing in on government incentives for the use of the technology. These incentives begin in 2011. Mr. Egerman and his group put out preliminary recommendations for how to solve some of these potential patient safety issues. For starters, they suggest that all training and implementation for HIT devote some time to patient safety as well as how to report patient safety risks. They also want to focus on the near misses and potential hazards to try to prevent unsafe conditions before an error is made. They also called for establishing a national database where providers could report problems and the information could be rapidly disseminated to other institutions that might be doing something similarly risky.

Has health IT helped or hurt patient safety efforts in your institution? Let us know.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

ICD-10 Sneaks Up

From the American Health Information Management Association’s ICD-10 meeting in Washington:

Like any profession, medical billers have their own “in” jokes, as was evident at today’s conference on the ICD-10 (which the attendees called the “I-10”), the newest incarnation of the diagnosis code set. “What does I-10 mean to me? Hypertension,” said Dave Hochheiser, vice president of data analytic solutions for Ingenix Consulting, in Eden Prairie, Minn. Why is that funny? Because under the new ICD-10 codes, “I10” is the code for hypertension.

OK, maybe that’s a bit obscure. But the discussion during the rest of the meeting was all brass tacks, and the message was: Start thinking about ICD-10 now, even though it won’t be sneaking into a computer near you until 2013.

Image courtesy Flickr Creative Commons user mlsj

At first glance, ICD-10 might not seem that big a deal – after all, you’re just replacing one diagnosis code with another. Well, not exactly.

Since one purpose of ICD-10 is to get more specific, the new codes have a lot of permutations. For example, the current version of the codes, known as ICD-9, includes exactly one code for a simple laceration of the finger, 883.0. ICD-10, on the other hand, offers 270 choices for the same diagnosis, depending on which hand was involved, which segment of which finger, whether it involved a foreign body, and so forth, noted Robert Burleigh, past president of the Healthcare Billing & Management Association. All that precision will be great for future health care researchers to mine data from, but for physicians and hospitals who are just trying to get paid, it can be a real nightmare to implement.

Every commercial insurer out there will be trying to figure out how to apply the new codes. Then there’s Medicare, which will have to rewrite all its local and national coverage decisions since they are all written using ICD-9 terminology, Mr. Burleigh said. And Medicare Advantage providers also will be affected, because reimbursement rates to providers are increased based on the patient’s severity of illness as determined by diagnosis code. Not to mention the problem of fitting all the new diagnosis codes onto a superbill.

Of course, getting paid in the ICD-10 era will depend on having a computer system that knows how to deal with ICD-10 codes. Providers need to make sure that ICD-10 capability is specified in their contracts with vendors, and include penalties if deadlines are missed, said Mr. Burleigh. Let the buyer beware.

–Joyce Frieden