Easing the Pain of EHR "Meaningful Use" Requirements

Modular EHRs Can Ease the Pain of “Meaningful Use” RequirementsIt sounded so simple: Buy an electronic health record (EHR) system and qualify for a portion of the billions of dollars in federal incentives promised under the 2009 American Recovery and Reinvestment Act. But unlike the government’s successful “Cash for Clunkers” program, physicians can’t just “sign-and-drive” to get their incentive check.

To qualify for federal EHR incentives, physicians have to meet 25 onerous “meaningful use” requirements -- a set of measures meant to ensure doctors use EHRs to lower costs, and improve the quality and efficiency of care. Some of the requirements include boosting the use electronic prescriptions and claim submissions, and using the technology to track and measure quality of care.

Doctors fear that meeting the requirements will cut into their productivity. A study by the Medical Group Management Association, Englewood, Colo., found that more than two-thirds (67.9 percent) of survey respondents indicated productivity would decrease if the requirements were implemented, while nearly a third (31 percent) said they would see productivity reduced by more than 10 percent.

Necessary adjustmentsThomas Stevenson, DO, chief medical officer for Covisint, and a practicing physician at the MetroHealth Breton Health Center in the Family Practice Clinic, Grand Rapids, Michigan, is now on his third EHR system. Echoing the findings of the MGMA survey, Stevenson said, “Production suffers significantly.”

One of the problems with traditional EMRs, aside from the significant expense, is that all the functionality is turned on at one time, Stevenson said. Once installed, doctors are left largely on their own to try to incorporate the technology into their workflow, Stevenson said.

“With this (third) install … we went to a 50 percent schedule for a month to get us up to speed on the product,” Stevenson said. Yet even after a month, when his practice went back to its regular schedule, the doctor found it very difficult to manage. “You’re still seeing the same number of patients, but you have to stay after work to be able to get all your documentation done,” he said. Previous EHR installations caused an even greater drag on productivity, Stevenson said.

Considering a “modular” approachStevenson suggests the new, modular approach, also known as EHR-M, can enable the incremental adoption of the system at a much lower price. It can increase the level of health-information technology adoption for meaningful use and allow doctors to achieve it at a much easier pace, with less disruption to office workflow.

In the EHR-M environment, Stephenson says, a physician can choose one tool (for example, e-prescriptions) and then spend a few days becoming comfortable with the technology without having to cut back on patient load. Once e-prescriptions are smoothly incorporated into the practice, the physician can then add on a second module, such as computerized physician order entry (CPOE) or disease management. In this way, doctors avoid the frustration of trying to adopt myriad technologies all at once.

Cost is another key factor. Instead of paying between $30,000 and $50,000 for a complete EHR system, physicians can access individual applications through a subscription service for as little as $5,000. And, because these applications are subscription-based, it’s easier to upgrade as newer, more efficient technologies are developed.