Decision time

Trouble choosing an EHR? Extensions are ready to help you reach ‘meaningful use’

Government’s nationwide network helps physicians select and implement electronic health records and secure performance bonuses.

Getting electronic health records into your office may seem like a daunting task. There are a ton of EHR vendors to choose from, the systems cost thousands of dollars, and they require technically savvy folks to install them and keep them up and running. None of this is to mention the drain on a physician’s most precious resource: time.

But DOs shouldn’t wait. Putting off EHR implementation is tantamount to leaving cash on the table. The U.S. government is ponying up big bucks for physicians who achieve “meaningful use” of electronic records.

Physicians don’t have to wade into the deep waters of EHRs alone, though. As part of The Health Information Technology for Economic and Clinical Health Act of 2009, the U.S. government is paying out $677 million to support a nationwide network of 62 regional “extension centers” that help guide physicians through the process of selecting and implementing EHRs and reaching meaningful use.

“The U.S government recognized, and I think appropriately, that achieving meaningful use can be really challenging,” says Abel Kho, MD, co-executive director of the Chicago Health Information Technology Regional Extension Center (CHITREC). “As a practicing physician, I recognize we’re not necessarily trained to do this. We’re trained to treat patients.”

Of course, in the long run, there’s not much choice—DOs who don’t modernize could be penalized in the form of negative adjustments to their Medicare reimbursement beginning in 2015.

Find your regional extension center

The federal government has established regional extension centers to help health care professionals become meaningful users of health information technology.

Click on an icon below to get a regional extension center’s website link, mailing address and email contact.

View a larger map (Source: Office of the National Coordinator for Health Information Technology)

Conquering fear

“Many physicians are fearful of the change that’s going to happen in their practice, such as a reduction in the number of patients they’ll be able to see and an increase in cost,” says Dr. Kho, who is also an assistant professor of medicine and associate director of the Medical Informatics Program at the Northwestern University Feinberg School of Medicine in Chicago.

Besides the cost and disruption to a physician’s workflow, challenges to implementing an EHR include patient privacy concerns, vast selection of products, return on investment, apprehension about the technology and the potential need for an IT staff to support it. These are the hurdles regional extension centers strive to help physicians clear.

“Our biggest concerns were meeting meaningful use and how we would still be productive and efficient while producing quality care for our patients, as well as the cost and the amount of time we had to put into this type of project.” says Robert L. Hunter, DO, a family physician and osteopathic manipulative treatment specialist with Providence Medical Group in Dayton, Ohio.

Dr. Hunter worked with Dayton-West Central Ohio Regional Extension Center to implement his EHR. “This was a positive experience. Multiple physicians in the group have already received meaningful use money,” he says.

Typically, extension centers analyze a physician’s practice to understand his or her unique needs, help choose an EHR vendor, oversee the installation and support, and help ensure physicians receive their due in federal incentives.

“It’s important for people to recognize that they’re going to do OK. We’ve seen many of their colleagues succeed, and revenue has not dropped for many of them,” Dr. Kho says.

Using an extension center cost little or nothing for physicians, and Medicare and Medicaid providers stand to gain between $44,000 and $63,750 over the next five to six years.

Extension centers often help physicians do the following:

  • Select an EHR system.
  • Train and educate staff.
  • Optimize office procedures.
  • Convert data for paper records.
  • Begin e-prescribing.
  • Provide proof of meaningful use.

“The biggest challenges in the first several weeks were harnessing the inflow of information from hospitals and other outpatient sources, getting connected and ramping up volume,” Dr. Hunter recalls.

“My staff and colleagues felt that it was very helpful to have worked with the Michigan Center for Effective Information and Technology Adoption,” says Christopher T. Beal, DO, a general internist in St. Johns, Mich. “The center helped us in the critical decisions we had to make along the way.”

Following the money

“A lot of physicians are no long asking, ‘Why should I get an EHR?’ They’re asking, ‘How do I get an EHR?’ That’s a dramatic change from even one year ago,” Dr. Kho explains.

At CHITREC, the process goes like this: Physicians pay $850 up front, which guarantees them 10 hours of service from an implementation manager and access to educational tools and resources. Then, physicians begin to receive incentive money from CHITREC as they start to reach certain milestones: $1,000 when they go live with EHR and $1,200 when they achieve meaningful use.

Other cash incentives come from the federal government, which is paying out $27 billion over the next decade. Physicians must qualify for either a Medicare or Medicaid track. Medicaid providers are eligible for $63,750 over six years if they begin this year. Medicare providers are eligible for $44,000 over five years.

Physicians who don’t implement EHRs or don’t reach meaningful use could face government penalties in the form of reduced Medicare payments. In January 2015, the government will reduce Medicare payments for noncompliant physicians by 1%. In 2016 the penalty increases to 2%; in 2017, it’s 3%. After that, the penalties could keep climbing.

Modern thinking

DOs considering the switch to an EHR should act quickly. Extension centers in Michigan and Illinois, for example, are approaching the limit of how many physicians they can receive into the program (though they will still offer some resources to doctors after capacity is reached). Also, the transition isn’t exactly lightning-fast—it can take months to reach meaningful use.

“The regional extension center was difficult to start a relationship with in the beginning. It took several meetings to get started,” says Dr. Hunter. “The center helped us obtain a consultant to assist with implementation, though. All in all, it was a good relationship.”

Teaming up with an extension center may not be the best choice for all DOs, though. For example, physicians who plan on retiring in the next few years would see little benefit.

Some physicians aren’t letting old age or fear of a new technology stand in the way of reaching meaningful use.

“One of my physicians has been on paper for nearly 28 years and he successfully attested to meaningful use in August 2011,” says Dr. Beal. “He did not text or use email prior to attestation. He is now documenting his patient care in our EHR at a very high level.”

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