Over the past 8 months, our office has successfully made the transition from paper to an electronic medical record (EMR). It has been exciting, but at times painful. All of us have had meltdowns, but we have also had a few delightful "ah-ha" moments. We are finally through the proverbial tunnel, almost into the light at the end of it, and that feels great.
One impetus that helped trigger our decision to take the electronic plunge, was the promise of reimbursement through the American Recovery and Reinvestment Act of 2009 (ARRA), otherwise known as the stimulus plan. Starting in less than one year, physicians who demonstrate meaningful use of an EMR and have a significant population on Medicaid or MediCare will be eligible for large reimbursements from the federal government.
If you are interested in taking advantage of this unique and generous program, I suggest getting started as soon as possible. Some of the criteria that constitute "meaningful use" are technologically quite sophisticated, and cannot be achieved overnight.
The criteria for "meaningful use" will be assessed in three stages. David Ford at CMA has put out a nice synopsis of the 556-page document that describes the components of stage 1, and I can't say how wonderful it is to have someone do the legwork on these types of federal programs so that we can just read his well-written summary. (Thanks again, CMA!):
http://www.calphys.org/assets/applets/meaningful_use_2010.pdf
Stage 1 starts in 2011-2013 (although you can start up 1- 4 years later if necessary)
Stage 2 runs through 2013-2015
Stage 3 starts after 2005
Stage 1 includes many fairly sophisticated expectations, the most challenging of which will be the requirement to include useful, point of care clinical prompts, and the ability to interface with other EMR's used by other health profesionals. Other requirements include the ability to generate lists of patients who need specific medical services, the generation of health reports, e-prescribing, timely access for patients to their own records, data exchange with public health agencies (i.e. immune registry) and privacy. Components of stage 2 and 3 are yet to be announced.
The amount of reimbursement is no small sum. Medicare providers will be eligible for direct bonus payments of up to $44,000 (plus additional amounts for physicians operating in designated health profession shortage areas such as ours) and this money will be paid out between the years of 2011 through 2015. Physicians who have at least 30% Medi-Cal patients in their practice will qualify for up to $65,000 in reimbursement money. Pediatricians who see at least 20% Medicaid and non-pediatric physicians practicing in federally qualified health centers or rural health centers where at least 30% of their practice is Medicaid, SCHIP, sliding scale, or uncompensated care will also qualify. There is a stick behind the carrot however, because starting in 2015 physicians who have not shown meaningful use of an EMR will be subject to decreased Medicare payments.
The California Medical Association has been working with the National Coalition for Health Integration (NCHI) to offer those of you who have not chosen an EMR an appealing option. The NCHI is the brainchild of Dr. Patrick Soon-Shiong, and it aims to provide a "robust, open source health information technology platform that supports the comprehensive management and exchange of biomedical data on a national scale." Check out their website at: http://www.nchiconnect.org. (I went to their website, but some of the pages do not scroll properly, so I was unable to read some of the information because it was hidden below where I could see)
The business partnership model being pursued by the CMA would go like this: If you are willing to allow NCHI to collect your stimulus money, they will to provide you with the electronic Health Record (EHR) of your choice, guarantee that it will meet the criteria for meaningful use, and underwrite the initial cost of purchase and implementation. If this works out, it could be a very advantageous arrangement, especially for smaller practices, or for physicians who do not have a lot of knowledge or expertise about the electronic world.
From my experience, I have been amazed at how much longer everything takes than one would anticipate. In the current economic climate, it took months just to find and secure a good business loan. Purchase and set up of new hardware takes weeks to months. Training new users took a long time, especially because some of the staff/physicians were new to computer use altogether. Working out the various bugs and glitches that crop up with implementation of a new system can be painstaking. We have had an excellent experience with Nylex, a local IT company who has helped us install, implement and maintain the sytem. Having good IT support is critical. Sometimes I think they double as counselors for those of us who have developed CFS (Computer Frustration Syndrome--it will be in the DMS-V) The frequency with which the internet goes down and the lack of any alternate internet back up line is a real problem for this area, but hopefully this will get better with time and infrastructure improvements.
In summary, the opportunity for federal reimbursement for an EMR is a valuable and time limited offer. Electronic medical records are coming whether we like it or not, so I suggest gettting on the bandwagon while the getting is good. For all those in primary care who are caring for significant numbers of Medical and Medicaid patients, now is the time to go electronic.
One impetus that helped trigger our decision to take the electronic plunge, was the promise of reimbursement through the American Recovery and Reinvestment Act of 2009 (ARRA), otherwise known as the stimulus plan. Starting in less than one year, physicians who demonstrate meaningful use of an EMR and have a significant population on Medicaid or MediCare will be eligible for large reimbursements from the federal government.
If you are interested in taking advantage of this unique and generous program, I suggest getting started as soon as possible. Some of the criteria that constitute "meaningful use" are technologically quite sophisticated, and cannot be achieved overnight.
The criteria for "meaningful use" will be assessed in three stages. David Ford at CMA has put out a nice synopsis of the 556-page document that describes the components of stage 1, and I can't say how wonderful it is to have someone do the legwork on these types of federal programs so that we can just read his well-written summary. (Thanks again, CMA!):
http://www.calphys.org/assets/applets/meaningful_use_2010.pdf
Stage 1 starts in 2011-2013 (although you can start up 1- 4 years later if necessary)
Stage 2 runs through 2013-2015
Stage 3 starts after 2005
Stage 1 includes many fairly sophisticated expectations, the most challenging of which will be the requirement to include useful, point of care clinical prompts, and the ability to interface with other EMR's used by other health profesionals. Other requirements include the ability to generate lists of patients who need specific medical services, the generation of health reports, e-prescribing, timely access for patients to their own records, data exchange with public health agencies (i.e. immune registry) and privacy. Components of stage 2 and 3 are yet to be announced.
The amount of reimbursement is no small sum. Medicare providers will be eligible for direct bonus payments of up to $44,000 (plus additional amounts for physicians operating in designated health profession shortage areas such as ours) and this money will be paid out between the years of 2011 through 2015. Physicians who have at least 30% Medi-Cal patients in their practice will qualify for up to $65,000 in reimbursement money. Pediatricians who see at least 20% Medicaid and non-pediatric physicians practicing in federally qualified health centers or rural health centers where at least 30% of their practice is Medicaid, SCHIP, sliding scale, or uncompensated care will also qualify. There is a stick behind the carrot however, because starting in 2015 physicians who have not shown meaningful use of an EMR will be subject to decreased Medicare payments.
The California Medical Association has been working with the National Coalition for Health Integration (NCHI) to offer those of you who have not chosen an EMR an appealing option. The NCHI is the brainchild of Dr. Patrick Soon-Shiong, and it aims to provide a "robust, open source health information technology platform that supports the comprehensive management and exchange of biomedical data on a national scale." Check out their website at: http://www.nchiconnect.org. (I went to their website, but some of the pages do not scroll properly, so I was unable to read some of the information because it was hidden below where I could see)
The business partnership model being pursued by the CMA would go like this: If you are willing to allow NCHI to collect your stimulus money, they will to provide you with the electronic Health Record (EHR) of your choice, guarantee that it will meet the criteria for meaningful use, and underwrite the initial cost of purchase and implementation. If this works out, it could be a very advantageous arrangement, especially for smaller practices, or for physicians who do not have a lot of knowledge or expertise about the electronic world.
From my experience, I have been amazed at how much longer everything takes than one would anticipate. In the current economic climate, it took months just to find and secure a good business loan. Purchase and set up of new hardware takes weeks to months. Training new users took a long time, especially because some of the staff/physicians were new to computer use altogether. Working out the various bugs and glitches that crop up with implementation of a new system can be painstaking. We have had an excellent experience with Nylex, a local IT company who has helped us install, implement and maintain the sytem. Having good IT support is critical. Sometimes I think they double as counselors for those of us who have developed CFS (Computer Frustration Syndrome--it will be in the DMS-V) The frequency with which the internet goes down and the lack of any alternate internet back up line is a real problem for this area, but hopefully this will get better with time and infrastructure improvements.
In summary, the opportunity for federal reimbursement for an EMR is a valuable and time limited offer. Electronic medical records are coming whether we like it or not, so I suggest gettting on the bandwagon while the getting is good. For all those in primary care who are caring for significant numbers of Medical and Medicaid patients, now is the time to go electronic.
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