Prepare to meet "meaningful use" EMR requirement

True or false? The American Recovery and Reinvestment Act will provide physician practices incentives for the purchase of an electronic medical record system.

False. The ARRA is, indeed, meant to foster health IT adoption. But the incentive money will directly address the use of EMRs, not the purchase of the systems.

Secretary of the U.S. Dept. of Health and Human Services, Kathleen Sebelius, has until the end of the year to define "meaningful use," which physicians will have to meet by 2011, when the incentives kick in.

Without a definition, those in the market for an EMR are left wondering if waiting might be the best option, while early adopters wonder if their systems can meet future standards.

So what's a practice to do?

The experts' answer: Don't wait to buy or upgrade just for want of a definition. There are enough clues in the legislation to estimate the definition of "meaningful use."

Experts say it will be easier on you, and your practice, to buy now and tweak later. "Time is your enemy," said Mark Garsombke, an attorney with the Milwaukee law firm Whyte Hirschboeck Dudek. Waiting to buy could mean a delay in qualifying for incentives, he said.

Details included in the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, the provision of the ARRA that created the incentives, have hinted at what physicians can expect in the meaningful use definition:

• Qualifying EMR systems must be certified. Pat Wise, RN, vice president of health information services for the Healthcare Information and Management Systems Society, said because the Certification Commission for Health Information Technology is currently the only certifying body up and running, she expects early meaningful use requirements will include CCHIT certification.
• Systems must include electronic prescribing. According to Wise, the administration has made clear that e-prescribing will be one of the key components of meaningful use. The Centers for Medicare & Medicaid Services is already offering incentives to physicians who e-prescribe.
• Systems must be used for quality reporting. Incentive programs already exist under CMS's Physician Quality Reporting Initiative. The meaningful use guidelines are expected to include and build on those performance measures.
• Systems must be capable of exchanging information with other systems. The HITECH Act makes it clear the administration is still working toward a national health data exchange whose foundation will be EMRs.

Ben Quirk, senior partner of TempDev, a San Jose, Calif.-based EMR consultancy said practices that have bought or are buying systems from big-name vendors have a little less to worry about. He said these vendors have the resources to make the necessary upgrades to their products to meet meaningful use. Many of them are already assuring clients they will make any necessary changes or updates, and a few are even offering money-back guarantees if they don't.

And experts say there are steps practices can take to help them ensure their system is compatible with the future meaningful use definition:

• Talk to vendors. Grill them on what steps they are willing to take to ensure their clients will meet meaningful use. Ask them to put any promises in writing. Practices using small vendors should get contingency plans in writing in the event the vendor goes out of business or is bought out by another company.
• Focus attention on the practice holdouts if you're already using EMRs. Many practices that don't require EMR use have doctors still using paper. Now is a good time to get to the core of their concerns with using health IT, Quirk said. Incentives will be available on a per-physician basis, so physicians not using the systems will be leaving money -- up to $44,000 per doctor -- on the table, he said.
• Start e-prescribing. Incentive money is already available to physicians who prescribe electronically. This is sure to be part of the meaningful use requirements. The sooner you start, the quicker you'll be up and running by 2011, experts say.
• Begin participation in the Physician Quality Reporting Initiative. This is also something that is sure to be a requirement and something physicians can get paid to do now.
• Explore additional functionalities, such as clinical decision support tools. Wise said it's likely there will be some level of clinical decision support use required. Many systems don't have these functions. Computerized physician order entry is also likely to be required.

Wise said even if you want to wait until the definitions for meaningful use are released to make the purchase, doing your homework now can save time later. There are many systems out there as well as functions existing EMR users could add. It's always a good idea to compare prices and research vendors.

"That kind of preparatory work can be absolutely invaluable," Wise said. "And that kind of preparatory work can also make the difference between making a good, wise selection when you do decide to make the purchase as opposed to a selection that might come back and not give you the functionality that you desire."

Dolan is a business reporter. She can be reached at 312-464-5412 or by e-mail (pamela.dolan@ama-assn.org).

The print version of this content appeared in the June 22, 2009 issue of American Medical News.

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