Health Information Technology Resources

Attention: Those Seeking Help with Electronic Health Record Questions

Every state has a Health Information Technology office which can provide state-specific resources for questions about eRx (electronic prescribing) and EMR (Electronic Health Records). These offices received grants to help practitioners in their respective state learn about and implement EMR's in their practices.

The web address for this information is:
http://statehieresources.org/contacts/

There is a significant amount of information about EMRs on the Internet. The official CMS website:
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204


The following article first appeared in the May/June 2010 Geriatric Psychiatry News and was updated by the author in October 2011.

Implementing an Electronic Health Record in the HITECH Era
By Maureen C. Nash, MD, MS, Co-Chair, AAGP Clinical Practice Committee

The buzz about how electronic medical records (EMR) and the expanded concept of electronic health records (EHR) will transform health care delivery in the United States keeps growing. The federal government and the Centers for Medicare and Medicaid Services (CMS) brought increasing attention and urgency to the issue with the HITECH Act (the Health Information Technology for Economic and Clinical Health Act). HITECH provides for federal stimulus money to be paid to hospitals and eligible health care professionals (including physicians) for implementing and using certified EHR products.

HITECH is ambitious and has a fast timeline. If you implement an approved EHR and use it "meaningfully" beginning in 2011, you are eligible for significant bonus payments from Medicare, up to $44,000 over 4 years if your EHR is implemented by January 2011. Medicaid providers have an even larger bonus available to them. The bonus amounts you are eligible for decrease each year but the sooner your system is implemented the more bonus money you are eligible for. This bonus structure becomes a three percent penalty on your Medicare billing beginning in 2015. One of the most likely reasons that physicians have been slow to embrace EHRs is that they bare the brunt of the risk and cost while most of the benefits accrue to health care insurance companies and larger entities such as hospitals. HITECH was enacted, at least partially, to equalize incentives for implementing an EHR.

If you are not already using an EHR/EMR in your practice, this may be a great time to look at the various products out there. If you are already using a product, it is important to talk with your vendor about whether they plan to certify their product to meet CMS criteria. For most physician practices it takes several months to choose an EHR and at least six months to implement one, therefore it behooves one to act now. Although no products are yet on the CMS list of approved products eligible for the HITECH bonus, there are a number of products that have met Certification Commission for Health Information Technology (CCHIT) certification and whose makers have promised that they will meet "meaningful use" HITECH criteria once these criteria are finalized.

Many resources are available to help you understand the options and choose the best product for your practice. The American Medical Association, American Psychiatric Association, American Academy of Family Physicians, and American College of Physicians are a few of the national health care organizations that have resources for selecting the right EMR/EHR for your practice. Physicians Practice, a magazine with an online presence at www.physicianspractice.com, has a number of articles on selecting the right EMR/EHR for your practice as well as periodic updates on the government stimulus funding and where that stands. Physicians Practice also has one of many online EHR resource centers: http://ehr.physicianspractice.com/home. Medscape is another website for physicians that has articles with physician surveys and background information on selecting the right EHR for your practice. One can also hire a consultant for more personalized expert advice. However, it is very important that the physicians and health care professionals who are going to be using the EHR be involved in trying out products. The most helpful advice is often from physicians who have previously implemented and/or used a particular EHR. The key is to talk with physicians who have practices that are similar to yours in size and workflow.

How you use your EHR system is as important as which system you choose. HITECH and related legislation specifies the following three components of "meaningful use": using a certified EHR in a meaningful manner (example: e-prescribing), using a certified EHR technology for electronic exchange of health information to improve quality of health care, and using certified EHR technology to submit clinical quality and other measures to CMS. Other rules will involve requirements for security, privacy, and interoperability. To demonstrate that you are using the EHR meaningfully in a particular year, you must employ your system to prescribe electronically and be able to exchange data with other providers, submit quality data to CMS or your state (if you are applying for Medicaid incentives), and make copies of your electronic records available to patients upon request.

Many experts recommend that physicians acquire an EHR to improve documentation and make their practice more efficient, not to earn a government subsidy. Because of the timeline for using an EHR and the fact that at the time of writing this article CMS has not finalized how one can earn the bonus funds, the most important thing is finding an EHR that will work for you. More than 30 percent of physicians would choose a different system after gaining experience with their current EHR system but cannot due to the expense and time required to change EHR systems according to a recent survey of practicing physicians published by Medscape. Remember, though, physicians need to buy an EHR as soon as possible if they want to receive the maximum funds available from the federal government. 

The expense of an EHR involves the cost of investigating which EHR to choose; the initial cost to implement a system, which can be a one-time cost for implementing a system on your computer system or an ongoing monthly fee for a web-based system; the cost of updates; and the cost of lost productivity during implementation. Some EHR systems are free or cost less than $1000, others as little as $150/month, while others cost tens or hundreds of thousands of dollars. Support and ongoing update costs must also be considered in any cost/benefit analysis.

Information from CMS about Electronic Health Records can be found at:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204

Resources

 American Psychiatric Association has a nice collection of references in their resources section entitled  EHR Educational Materials and Tools

http://www.psych.org/MainMenu/PsychiatricPractice/QualityImprovement/ElectronicHealthRecords/Resources_1.aspx

Carter, JH. Electronic Health Records: A Guide for Clinicians and Administrators, Second Edition. Philadelphia, PA: American College of Physicians; 2008.

Medscape: www.medscape.com

Phyisicans Practice Electronic Health Records: http://www.physicianspractice.com/ehr

Maureen C. Nash, MD, MS, FAPA is co-chair of AAGP's Clinical Practice Committee, and the Medical Director at the Tuality Center for Geriatric Psychiatry in Forest Grove, Oregon.