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Striving to meet ‘meaningful use’ objectives

Les Bernstein
Tuesday, Apr 2, 2013

Les Bernstein | Chief Information Officer at Cookeville Regional Medical Center

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), which forever changed the landscape for how physicians and clinicians go about providing care. ARRA, which is a $789 billion stimulus bill, included $19.2B in incentives (funding) to accelerate adoption of Electronic Health Records (EHRs) under the Healthcare Information Technology for Economic and Clinical Health (HITECH) Act. All incentives are tied to “Meaningful Use of Certified EHRs.”

“Meaningful Use” sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs. Meeting these objectives comes at a cost, but what is not widely publicized and discussed is the fact that if a hospital or physician does not comply with “Meaningful Use” guidelines by 2015, they will be severely penalized for their inaction. Essentially hospitals and providers have no choice but to comply regardless of the cost.

The cost to implement the systems needed to meet the “Meaningful Use” objectives is very high. Many hospitals will spend millions of dollars and physicians can easily spend upwards of $50,000 per physician in software, hardware, services and resources to put the systems in place needed to meet the objectives. Incentive funds will only partially offset the significant investments being made for health information technology (IT).

According to Accenture, a global management consulting, technology services and outsourcing company, private practice doctors are saying that the cost of EHR systems is increasingly becoming a deciding factor in whether they continue to operate as an independent practice or close it down, typically to be hired as a hospital employee. Furthermore, the cost and hassle involved in installing and operating EHR systems is given by 53 percent of doctors surveyed as a main reason for giving up their private practice.

The government and academia believe that “Meaningful Use” of a certified electronic health record (EHR) technology improves quality, safety, efficiency, and reduces health disparities. It also engages patients and family, improves care coordination, and population and public health as well as maintains privacy and security of patient health information.

Ultimately, it is hoped that the “Meaningful Use” compliance will result in: better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals and more robust research data on health systems.

The reality is utilizing an electronic health record is a massive change and undertaking for hospitals, physicians and clinicians. Most people do not like change and healthcare professionals are no different than anyone else. If anything, the healthcare industry historically has lagged behind other industries in adopting information technology. Caregivers are concerned because tasks that used to take seconds, now could take minutes, thus slowing them down and creating more work for them. On the flipside, there are productivity improvements to be gained, especially on the back end, if used as intended.

Although adoption rates for use of an EHR are up significantly from 2009 – 2012, many hospitals and providers are utilizing the systems just well enough to qualify for the incentive money, or more importantly, they are doing what they need to do in order to avoid penalties. They are not necessarily taking advantage of the capabilities that are available.

For those that embrace the use of information technology and use it properly as a tool to assist them in their care for patients, the results are in line with the expected outcomes intended by the government. It is easy to see the benefits of how an EHR can improve outcomes as multiple caregivers now have instant access to a patient’s chart from multiple locations, providers are entering their own orders for medications and tests so there is no more transcribed errors or delays in having orders entered for a patient, and who can argue that stopping an adverse drug event through the use of intelligent software at the time the order is entered is a bad thing?

However, the downside is your caregiver is now spending more time in front of a computer screen and possibly less time interacting with you, the patient. Providers who are comfortable using their systems seem to have found a balance between utilizing the software and having a meaningful interaction with the patient. For providers who have not embraced the technology, the experience is not quite what you, as a patient, were probably expecting.

Whether health care professionals like or dislike the use of EHR technology, the fact remains, it is here to stay and the cost for implementing and maintaining these systems will only continue to rise. Government regulations continue to change and will dictate the landscape for how IT systems are utilized throughout the industry. Adapting to change and learning how to utilize the systems to take full advantage of their capabilities is critical to achieving “Meaningful Use”. Hopefully better outcomes will offset or reduce the overall cost of healthcare. Only time will tell.

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