The following article is written by Brad Melis, founder and executive vice president of ChartLogic.
April 18 was the first day for eligible providers (physicians) to "attest" or document their meaningful use of an EHR system and qualify for the federal HITECH act incentive payments. Most experts agree that the process is proving much harder than originally anticipated by health policy planners.
To find out what specific meaningful use requirements were the most difficult, our company, ChartLogic, surveyed 38 of our customers, all orthopedic practices, in early May (Note: Learn more about this survey and its results by clicking here). Our respondents reported the following top three challenges:
- Distributing clinical summaries (29 percent)
- Collecting vital signs (24 percent)
- Collecting patient demographics (5 percent)
Here are six steps to overcome these and other barriers presented by the meaningful use incentive program.
1. Incorporate a patient portal into your EHR system. Patient portals are online applications that enable physicians or hospitals to upload clinical or administrative (e.g., test results, appointment times) to secure websites accessible by patients. For example, many ambulatory EHR systems contain a module that can create sites for patients and upload needed information to them.
The meaningful use requirements state that the physician's office must provide clinical summaries to patients within three business days. Currently, few orthopedists can complete their patient documentation prior to the patient leaving the office. So, if you don't use a portal, you will need to mail the patient a printed summary. Many orthopedists see 40-60 patients per day. Printing and postage costs make mailing a costly, stop-gap solution.
When the practice has installed a patient portal, staff can quickly upload the clinical summary to the website. Note that it is not currently required that patients read or receive the clinical summary, just that it be "provided," which can be interpreted as sent electronically.
If you haven't yet made a decision on an EHR solution, or you have a choice of patient portal solutions that work with your EHR, it is a good idea to have the vendor demonstrate this process. If it takes six clicks of the mouse to send or upload the patient summary and you see 50 patients a day, that can add an extra 30 minutes of work each day for you or your staff. If you can find a more automated solution, allowing easy selection and quick uploading, you will find it easier to meet the meaningful use requirements.
2. Dictation and custom templates speed physician input. Practice efficiency will be significantly impaired if the physician must manually type in each patient's clinical information to a static EHR. Many EHRs incorporate voice recognition and custom templates enabling accurate summaries to be created in seconds with only a few clicks of a mouse. For example, some EHRs allow physicians to move from template to template (e.g., symptoms to medications) by voice command, without clicking on pull-down menus. Many physicians prefer voice commands because of their long experience with dictation.
3. Offload vital sign collection; consider digital monitors. The Stage 1 meaningful use requirements require eligible providers to collect vital signs on patient visits. Many orthopedic offices have not traditionally collected this information. It will be a huge waste of an orthopedist's time if he has to collect this information himself. The office workflow should be organized so that a nurse or medical assistant collects all the vital signs prior to rooming the patient.
The collection of vital signs data can be minimized with careful planning. In particular, you can reduce the time required to enter the data into the EHR. It may make sense to invest in a digital vital signs monitor. These machines can read weight, temperature and blood pressure and automatically upload it to your EHR system, eliminating the need to keyboard in the data. Be sure to check with your EHR vendor to see which devices it can interface with.
4. Have patients self-report demographic data. The meaningful use requirements state that practices must collect demographics as structured data, including preferred language, gender, race, ethnicity and date of birth. Again, this is likely to be a new data collection task for many orthopedic practices.
Patients are used to self-reporting this information in many business situations; it makes sense to have them do this in the waiting room. Many medical offices are finding it makes sense to provide check-in kiosks or tablets to patients. At least one company will provide customized "check-in" laptops free to most physicians (the devices display health product ads).
Some practices fear that their patients may not use an online or waiting room option if it is computerized. For example, many elderly patients may not be familiar with laptops. If you want to stay with a paper solution for this demographic and clinical intake data, you can provide "bubble-in" or Scantron forms that can be fed into optical mark readers which will feed the data to your EHR system. This is less efficient than collecting information digitally via tablet, but still an improvement over making staff keyboard in the data.
If you provide bubble sheet forms in addition to a patient portal or kiosk solution, you will be giving your patients several options. The key is to get the patients to enter the data in a usable form, so that your staff can reduce their data entry burden. Again, you should validate your options with your EHR vendor prior to implementing the new solution.
5. Boost meaningful use ROI. According to the current government schedule of meaningful use incentives, each eligible provider can earn up to $18,000 in the 2011 calendar year. However, an effective EHR system can return far more than this on an annual basis if it leads to increased practice efficiency and higher revenues.
A well-designed EHR can reduce or eliminate transcription costs and storage of paper records. In many cases, employees that were formerly assigned to paper document management can be reassigned.
In addition, billing productivity can improve by reducing eligibility problems and increasing the rate of level IV office visits with more thorough documentation.
6. Don't wait until 2012; get started now. While waiting until 2012 to begin meaningful use attestation process is an option currently allowed by the government, it makes little sense from either an economic or operational standpoint.
Medicare physician payments will be reduced by 1 percent for eligible professionals who are not successful e-prescribers during the reporting period of Jan. 1, 2011, through June 30, 2011. These penalties are scheduled to increase in 2012 and 2013. If you are going to the trouble of installing e-prescription software, you might as well make the investment in an EHR system that is certified for meaningful use.
Although government panels have discussed the possibility of temporarily delaying the Stage II meaningful use requirements (now scheduled for 2012), the Stage 1 incentives are in place now and the clock is ticking for practices that want to earn the maximum possible award.
It is obvious at this point that the era of HER has arrived. Any medical practice that hopes to prosper in the coming years must adopt an EHR system. An old business adage says that delay only compounds mistakes. By installing an EHR now, your practice will have time for effective training and implementation and be in a position to reap the very tangible rewards they offer.
Learn more about ChartLogic.
More Articles Featuring ChartLogic:
20 ChartLogic Orthopedic Practice Customers Eligible for HITECH Meaningful Use Payments
ChartLogic Launches Patient Portal for Orthopedic Medical Groups
ChartLogic Launches Voice Recognition EHR Data Capture Module