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Adoption of electronic health records gaining ground
Adoption of electronic health records gaining ground Leslie Knudson Managing Editor lectronic health records (EHRs) are one of the key elements of health care reform aimed at improving the quality and delivery of U.S. health care. Supported by the Obama administration under the Health Information Technology for Economic and Clinical Health (HITECH) Act, the adoption of EHR systems has been spurred by the creation of incentivebased programs that reward eligible health care professionals and hospitals for demonstrating meaningful use of certified EHR technology.
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Led by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), the Medicare and Medicaid EHR Incentive Programs offer incentive payments to “eligible professionals, eligible hospitals, and critical access hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.”1 Since the programs launched in January 2011, more than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate and receive an incentive payment.2 Program timelines Designed with a phased approach, the EHR Incentive Programs consist of three stages: stage 1 sets the basic EHR functionalities required, such as capturing data electronically and providing electronic health information to patients; stage 2 increases health information exchange between providers and provides patients with secure online access to personal health information; and
Electronic health record adoption is being fueled by the Medicare and Medicaid EHR Incentive Programs.
stage 3 continues expansion of meaningful use objectives to improve health care outcomes.2 The first year reporting period to demonstrate EHR meaningful use is any consecutive 90day period during the calendar year, and then the entire calendar year for all subsequent years. Oct. 3, 2012, was the last day to begin the consecutive 90-day reporting period to demonstrate meaningful use for stage 1, and it was also the last day to begin participation in the program to be eligible to receive the maximum EHR incentive payment for the life of program.3 Health care providers can receive a maximum of $44,000 over five continuous years under the Medicare EHR Incentive Program, and a maximum of $63,750 under the Medicaid EHR Incentive Program.3 EHR Continued on C8
http://dx.doi.org/10.1016/S0001-2092(12)01044-7
© AORN, Inc, 2012
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The CMS and ONC released the final stage 2 meaningful use requirements in August 2012, which won’t go into effect until 2014. To qualify for stage 2 meaningful use, health care providers need to comply with and track 20 functional metrics and 12 clinical quality measures.4 Two new core objectives were added to the stage 2 reporting requirements: “physicians will be required to use secure electronic messaging to communicate relevant health information with patients, and hospitals will be required to automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record.”5 The last year to begin participation in the Medicare EHR Incentive Program is 2014, and incentive payments will continue through 2016. Medicare eligible professionals and hospitals must demonstrate meaningful use for each year in the program to qualify for incentive payments. Those that do not demonstrate meaningful use will incur reductions in Medicare reimbursements beginning in 2015; reductions will start at one percent and increase each year, up to a maximum of five percent.3 Challenges and benefits Adopting EHRs presents an array of challenges and benefits to health care providers. As with any new information technology, EHR technology is subject to limitations and system errors, including crashes that can disrupt health care services. Early adopters of EHR systems have already reported crashes, general usability issues, and problems with interoperability between multiple EHR systems.
Health care personnel have also voiced concerns regarding the time constraints associated with the new processes for entering information. Physicians who have used new EHR systems have reported that time spent on data entry is affecting their available time for seeing patients. For most health care providers, the cost of implementing EHR systems is a significant challenge as it requires substantial capital. The availability of electronic patient data also means that health care providers must ensure that privacy rules and security requirements are strictly upheld. Despite the challenges of EHR adoption, the EHR Incentive Programs have been designed and backed by the federal government with the belief that the long-term benefits of successful EHR implementation and use will far outweigh the challenges. The availability of patient data across multiple health care providers supports the new health care delivery models that are moving from fee-for-service to pay-for-performance. The shift from paper-based records to electronic-based records also allows for greater readability of physician notes and improved data organization. Patients will be able to access their medical records online to allow for a better understanding of their conditions and treatments. The new level of transparency and coordinated care made possible by EHR adoption has the potential for significant cost and efficiency gains across the entire U.S. health care system. Future outlook Industry analysts have reported a notable gap in adoption rates based on variables such as size and location, as smaller, rural hospitals have been slower to adopt EHRs in comparison with larger, more centrally located facilities. Under
Medicare EHR Incentive Program
Medicaid EHR Incentive Program
• Run by CMS
• Run by state Medicaid agency
• Maximum incentive amount is $44,000
• Maximum incentive amount is $63,750
• Payments over five consecutive years
• Payments over six years, does not have to be consecutive
• Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate
• No Medicaid payment adjustments
• Providers must demonstrate meaningful use ever year to receive incentive payments
• In the first year, providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.
*Taken from the Centers for Medicare & Medicaid Services website.1
C8 | AORN Connections
the Regional Extension Center program, the federal government is providing approximately $30 million to get 1,000 federally designated critical access hospitals (i.e., rural facilities with no more than 25 beds and a daily average of 10 or fewer patients) and other small, rural hospitals to demonstrate EHR meaningful use by 2014.6 Eligible professionals and hospitals will be required to update to 2014 EHR technology, regardless of their meaningful use stage, so health care providers should begin to implement a meaningful use strategy and account for technology costs in planning stages for 2013 and 2014. Providers are encouraged to participate in the widespread adoption of EHRs, which is viewed as a critical piece of the progression towards a new level of health care quality. References 1. EHR Incentive Programs. Centers for Medicare & Medicaid Services. https:// www.cms.gov/Regulations-and-Guidance/ Legislation/EHRIncentivePrograms/index. html. Accessed October 4, 2012. 2. HHS announces next steps to promote
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use of electronic health records and health information exchange. U.S. Department of Health & Human Services. http://www.hhs. gov/news/press/2012pres/08/20120823b.html. Accessed October 4, 2012. Providers: Start meaningful use reporting by Oct. 3 for most EHR incentives. Government Health IT. http://www.govhealthit.com/news/ providers-start-meaningful-use-reportingoct-3-most-ehr-incentives. Accessed October 4, 2012. Meaningful use of health IT stage 2: the broader meaning. Health Affairs Blog. http://healthaffairs.org/blog/2012/03/15/ meaningful-use-of-health-it-stage-2-thebroader-meaning/. Accessed October 4, 2012. Final rule on stage 2 of EHR incentive program issued. Modern Healthcare. http://www. modernhealthcare.com/article/20120823/ NEWS/308239960#. Accessed October 4, 2012. Feds want 1,000 rural hospitals on EHRs by 2014. InformationWeek. http://www. informationweek.com/healthcare/electronicmedical-records/feds-want-1000-ruralhospitals-on-ehrs-b/240008361. Accessed October 4, 2012.
November 2012 Vol 96 No 5 • AORN Connections | C9
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Led by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), the Medicare and Medicaid EHR Incentive Programs offer incentive payments to “eligible professionals, eligible hospitals, and critical access hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.”1 Since the programs launched in January 2011, more than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate and receive an incentive payment.2 Program timelines Designed with a phased approach, the EHR Incentive Programs consist of three stages: stage 1 sets the basic EHR functionalities required, such as capturing data electronically and providing electronic health information to patients; stage 2 increases health information exchange between providers and provides patients with secure online access to personal health information; and
Electronic health record adoption is being fueled by the Medicare and Medicaid EHR Incentive Programs.
stage 3 continues expansion of meaningful use objectives to improve health care outcomes.2 The first year reporting period to demonstrate EHR meaningful use is any consecutive 90day period during the calendar year, and then the entire calendar year for all subsequent years. Oct. 3, 2012, was the last day to begin the consecutive 90-day reporting period to demonstrate meaningful use for stage 1, and it was also the last day to begin participation in the program to be eligible to receive the maximum EHR incentive payment for the life of program.3 Health care providers can receive a maximum of $44,000 over five continuous years under the Medicare EHR Incentive Program, and a maximum of $63,750 under the Medicaid EHR Incentive Program.3 EHR Continued on C8
http://dx.doi.org/10.1016/S0001-2092(12)01044-7
© AORN, Inc, 2012
November 2012 Vol 96 No 5 • AORN Connections | C1
ehr Continued from C1
The CMS and ONC released the final stage 2 meaningful use requirements in August 2012, which won’t go into effect until 2014. To qualify for stage 2 meaningful use, health care providers need to comply with and track 20 functional metrics and 12 clinical quality measures.4 Two new core objectives were added to the stage 2 reporting requirements: “physicians will be required to use secure electronic messaging to communicate relevant health information with patients, and hospitals will be required to automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record.”5 The last year to begin participation in the Medicare EHR Incentive Program is 2014, and incentive payments will continue through 2016. Medicare eligible professionals and hospitals must demonstrate meaningful use for each year in the program to qualify for incentive payments. Those that do not demonstrate meaningful use will incur reductions in Medicare reimbursements beginning in 2015; reductions will start at one percent and increase each year, up to a maximum of five percent.3 Challenges and benefits Adopting EHRs presents an array of challenges and benefits to health care providers. As with any new information technology, EHR technology is subject to limitations and system errors, including crashes that can disrupt health care services. Early adopters of EHR systems have already reported crashes, general usability issues, and problems with interoperability between multiple EHR systems.
Health care personnel have also voiced concerns regarding the time constraints associated with the new processes for entering information. Physicians who have used new EHR systems have reported that time spent on data entry is affecting their available time for seeing patients. For most health care providers, the cost of implementing EHR systems is a significant challenge as it requires substantial capital. The availability of electronic patient data also means that health care providers must ensure that privacy rules and security requirements are strictly upheld. Despite the challenges of EHR adoption, the EHR Incentive Programs have been designed and backed by the federal government with the belief that the long-term benefits of successful EHR implementation and use will far outweigh the challenges. The availability of patient data across multiple health care providers supports the new health care delivery models that are moving from fee-for-service to pay-for-performance. The shift from paper-based records to electronic-based records also allows for greater readability of physician notes and improved data organization. Patients will be able to access their medical records online to allow for a better understanding of their conditions and treatments. The new level of transparency and coordinated care made possible by EHR adoption has the potential for significant cost and efficiency gains across the entire U.S. health care system. Future outlook Industry analysts have reported a notable gap in adoption rates based on variables such as size and location, as smaller, rural hospitals have been slower to adopt EHRs in comparison with larger, more centrally located facilities. Under
Medicare EHR Incentive Program
Medicaid EHR Incentive Program
• Run by CMS
• Run by state Medicaid agency
• Maximum incentive amount is $44,000
• Maximum incentive amount is $63,750
• Payments over five consecutive years
• Payments over six years, does not have to be consecutive
• Payment adjustments will begin in 2015 for providers who are eligible but decide not to participate
• No Medicaid payment adjustments
• Providers must demonstrate meaningful use ever year to receive incentive payments
• In the first year, providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate meaningful use in the remaining years to receive incentive payments.
*Taken from the Centers for Medicare & Medicaid Services website.1
C8 | AORN Connections
the Regional Extension Center program, the federal government is providing approximately $30 million to get 1,000 federally designated critical access hospitals (i.e., rural facilities with no more than 25 beds and a daily average of 10 or fewer patients) and other small, rural hospitals to demonstrate EHR meaningful use by 2014.6 Eligible professionals and hospitals will be required to update to 2014 EHR technology, regardless of their meaningful use stage, so health care providers should begin to implement a meaningful use strategy and account for technology costs in planning stages for 2013 and 2014. Providers are encouraged to participate in the widespread adoption of EHRs, which is viewed as a critical piece of the progression towards a new level of health care quality. References 1. EHR Incentive Programs. Centers for Medicare & Medicaid Services. https:// www.cms.gov/Regulations-and-Guidance/ Legislation/EHRIncentivePrograms/index. html. Accessed October 4, 2012. 2. HHS announces next steps to promote
3.
4.
5.
6.
use of electronic health records and health information exchange. U.S. Department of Health & Human Services. http://www.hhs. gov/news/press/2012pres/08/20120823b.html. Accessed October 4, 2012. Providers: Start meaningful use reporting by Oct. 3 for most EHR incentives. Government Health IT. http://www.govhealthit.com/news/ providers-start-meaningful-use-reportingoct-3-most-ehr-incentives. Accessed October 4, 2012. Meaningful use of health IT stage 2: the broader meaning. Health Affairs Blog. http://healthaffairs.org/blog/2012/03/15/ meaningful-use-of-health-it-stage-2-thebroader-meaning/. Accessed October 4, 2012. Final rule on stage 2 of EHR incentive program issued. Modern Healthcare. http://www. modernhealthcare.com/article/20120823/ NEWS/308239960#. Accessed October 4, 2012. Feds want 1,000 rural hospitals on EHRs by 2014. InformationWeek. http://www. informationweek.com/healthcare/electronicmedical-records/feds-want-1000-ruralhospitals-on-ehrs-b/240008361. Accessed October 4, 2012.
November 2012 Vol 96 No 5 • AORN Connections | C9