Meaningful use drives physician EHR boom

Physicians are responding to the promise of bonuses for electronic health records adoption — and the threat of penalties if they don’t.

By — Posted Dec. 24, 2012

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When the medical practice of Howard Axe, MD, found itself in need of a new electronic prescribing system two years ago, implementing a full electronic health record system with an e-prescribing component was never seriously considered.

But a year and a half later, the 20-physician internal medicine and pediatrics practice in Arlington Heights, Ill., found itself shopping for an EHR vendor. Once that ball started rolling, things progressed quickly. The practice’s six locations went live in June.

The motivating factor this time? A program called meaningful use.

Meaningful use, which went into effect in 2011, involves Medicare and Medicaid financial incentives. Practices can earn bonuses of up to $44,000 per physician over five consecutive years from Medicare, or up to $63,750 per physician over six years from Medicaid, for installing a certified EHR system and meeting several criteria for the use of it.

Although meaningful use had been introduced when Dr. Axe and his colleagues starting shopping for their replacement e-prescribing system, not enough was known about the program for it to factor in to any of the practice’s decisions, he said. They realized they probably would be implementing an EHR at some point, but thought it would be several years.

Once he and his colleagues realized the money was available, Dr. Axe said, “you don’t necessarily want to leave it on the table.” He said they certainly didn’t want their current revenue to drop when Medicare penalties for not adopting an EHR, which start at 1%, take effect in 2015 based on 2013 or 2014 usage.

A December report from the Centers for Disease Control and Prevention’s National Center for Health Statistics show that Dr. Axe and his colleagues weren’t the only ones feeling the pressure to adopt since the program was introduced. The proportion of office-based physicians using an EHR rose from 48% in 2009 to 72% in 2012.

“This increase shows that the use of EHRs to deliver better care is becoming the norm across the country,” said Farzad Mostashari, MD, national coordinator for health information technology, in a statement sent to American Medical News.

Despite the positive aspects of the report, it is causing concern among some organized medicine groups, including the American Medical Association, because it found that of the 72% of office-based physicians using EHR systems, only 27% had systems capable of supporting at least 13 meaningful use core objectives. The report estimates that even fewer have the ability to meet all 15 core objectives, all of which must be met for compliance.

“We are pleased that CDC’s recent data show that more physicians are adopting and using EHRs and that there is a high interest among physicians to take advantage of the available incentive payments through the government’s EHR meaningful use incentive program,” said AMA Board of Trustees Chair Steven J. Stack, MD. “However, we remain concerned that the vast majority of those using EHRs are still using systems that do not meet the criteria for meaningful use.”

Dr. Stack said the AMA would like to see more flexibility built into the program so more physicians can participate.

Compliance may be undercounted

The CDC says 40% of EHR-using doctors use a system that would not qualify completely for meaningful use incentives.

The federal office that oversees the incentive program, however, says trends are moving in the right direction despite the low numbers in the CDC report.

In a Dec. 12 data brief, the Dept. of Health and Human Services Office of the National Coordinator for Health Information Technology analyzed the CDC data and found that physicians have been busy adding capabilities to these basic systems to prepare for meaningful use.

The data brief showed that physicians’ capability to meet four meaningful use objectives related to improving quality, safety and efficiency grew by 66% to 90% from 2011 to 2012. At least two-thirds of physicians had computerized capabilities to meet nine core objectives in 2012, according to the ONC. One of the greatest gains was made in e-prescribing. The proportion of physicians who had that capability jumped from 55% to 73%.

Others, particularly those working with small practices, say the trends probably are even more promising than the data show. Since the February-July time period that data were collected for the CDC report, the landscape has changed quickly because so many physicians, like Dr. Axe and his practice, are on the EHR fast track.

“My first impressions were that [the CDC report] just didn’t make sense because of what we have seen with the clients who are working with us,” said Paul Kleeberg, MD, clinical director for the Regional Extension Assistance Center for HIT, the regional extension center for North Dakota and Minnesota. RECs are funded under the Health Information Technology for Economic and Clinical Health Act of 2009 to help small practices adopt EHRs and meet meaningful use.

Dr. Kleeberg said 42% of the practices that signed on to his REC for help already have attested to the first of five stages of meaningful use. Those numbers were similar to national data the Centers for Medicare & Medicaid Services reported at the end of October, which showed that 42.3% of physicians eligible for the Medicare meaningful use program and 57.7% of those eligible for the Medicaid program already have attested and received payments.

Although EHR adoption rates seemed to have exploded in the past year, much of that came from practices that upgraded basic systems for meaningful use, said Paul Wilder, vice president of product management for the New York eHealth Collaborative, the REC for New York state. CDC data show that of the 72% of doctors using an EHR, about 40% were using a basic system that would not qualify for meaningful use incentives.

Dr. Axe called the EHR implementation a “painful,” time-consuming process. Not only is the practice learning a new work flow, it is transferring all of the paper data to the new EHR and re-creating data lists that were stored in its old stand-alone e-prescribing system. As painful as the process has been, the practice is forging ahead with its plans to send in its attestation documents to apply for the incentive money before Dec. 31.

Wilder said many practices are rushing to meet the year-end deadline to attest so they do not lose out on $5,000, which will happen if they wait until after Jan. 1, 2013. He said CDC data won’t reflect the rapid activity until late 2013.

“We don’t fine-tooth-comb the data anymore, because we know what’s really happening on the street,” he said. And what’s really happening, he said, is that meaningful use is having its intended impact.

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Physicians doing more with EHRs

A new government analysis of physician use of electronic health record systems found that the percentage of doctors using computerized systems capable of meeting select core meaningful use objectives had risen for each area.

Computerized capability Physicians in 2011 Physicians in 2012
Computerized provider order entry for medication orders 65% 80%
Demographics recording 72% 79%
E-prescribing 55% 73%
Medication allergy list 57% 68%
Active medication list 57% 68%
Drug interaction checks 51% 67%
Problem list maintenance 54% 66%
Clinical summaries to patients 38% 56%
Clinical decision support rule 40% 50%
Clinical quality measures 30% 43%

Source: “Physician Adoption of Electronic Health Record Technology to Meet Meaningful Use Objectives: 2009-2012,” Health and Human Services Dept. Office of the National Coordinator for Health Information Technology, Dec. 12 (link)

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External links

“Physician Adoption of Electronic Health Record Technology to Meet Meaningful Use Objectives: 2009-2012,” Health and Human Services Dept. Office of the National Coordinator for Health Information Technology, Dec. 12 (link)

“Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001-2012,” Centers for Disease Control and Prevention National Center for Health Statistics, Dec. 12 (link)

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