Summary:Public and private financial incentives are aligning like never before to encourage physicians to adopt electronic health records. To support the transition, the government has also invested billions in training health informatics specialists and creating regional advice centers to provide technical and other advice. Despite this, progress is slow and obstacles remain. The most significant of these obstacles may be the amount of time required to transition to an electronic system.
Von Brian Schilling
In 2009, under the Health Information Technology for Economic and Clinical Health (HITECH) Act, the federal government allocated $27 billion to an incentive program that encourages hospitals and providers to adopt health record systems electronics (EHR). Billions more were allocated to train health information technology (HIT) staff and to help hospitals and providers set up EHRs, which would allow health data that was previously in paper records to be shared between providers and improve the quality of health care use. 🇧🇷
Hundreds of studies of EHRs and decision support systems across the country have demonstrated the benefits of such tools. EHRs can reduce drug interaction rates, reduce death rates in the chronically ill, reduce nursing staffing requirements, andlower costs🇧🇷 A 2011 meta-analysis of HIT implementation studies found that 92% of reports published to date were overwhelmingly affectedpositive result🇧🇷 However, the adoption of HIT in the US was slow. Only about 10% of physicians use what could accurately be described as a complete electronic medical record system, while just over 50% use at least part of it.sistemas EHRin the place. Instead, 90% of doctors in the Netherlands, Great Britain and New Zealand use itEPA.
Implementing an EHR is not cheap. Cost is often cited as the main barrier to wider adoption of such systems, but it's not necessarily the cost of an EHR system itself that offers many benefits.the doctors stop🇧🇷 Rather, the significant costs involved could be the loss of revenue incurred during the months of preparation, planning, training, and workflow redesign that typically accompany the switch to an EHR.
The Rewards of EHR Implementation
For physicians willing to adopt EHRs, the financial incentives offered by the federal government are significant. The average physician with at least 30 percent of their patients covered by Medicare is eligible to receive up to $44,000 in total incentives. A doctor who has at least 30 percent of his or her patients covered by Medicaid is eligible to receive even more, up to $63,750. However, to earn that money, doctors must do more than buy an EHR system. They must demonstrate that they have used this system "wisely" in terms of quality improvement. At a minimum, this means having systems capable of prescribing and prescribing, reporting quality data, and sharing data between providers.
As of May 19, 320 healthcare professionals (including 283 physicians and 37 hospitals) have received incentive payments totaling $75 million from Medicare for demonstrating the wise use of electronic health records. The relatively slow start was perhaps to be expected: To qualify for this first round of incentives, clinics had to not only meet certain EHR requirements, but also accept payments within the first two weeks they became available. Many practices were simply not that far along in the process.
The number of physicians and hospitals enrolled in the incentive program is probably more important to HIT's future: 42,600. This much higher number suggests that many more practices are currently in the process of implementing an EHR and hope to qualify for incentives soon. CMS estimates that a total of approximately 485,000 physicians may be eligible to participate.
The discrepancy between the number of doctors eligible to participate and the number of doctors who actually participated is probably a matter of time (the program is relatively new) and time. That being said, the transition to EHR requires a significant time investment, and many physicians remain unable or unwilling to make this investment, regardless of other associated advantages and disadvantages.
"I forgot for a moment that the initial financial investment is not negligible," said Amanda Parsons, M.D., M.B.A., deputy director of the New York City Department of Health and Mental Hygiene Primary Care Information Project, which covers the city of New York until regional expansion oversees the center (see below). “The truth is that going from paper to EHR takes months. And for most doctors, at least initially, it's easier to document things in their own shorthand. I tell them that transitioning to an EHR is like agreeing to become a triathlete: It's great for you, but you have to commit to serious and consistent training. It is not something that will end in 2 or 3 weeks. It's an ongoing process to keep up with technology as new versions and new features come out."
In fact, even staunch EHR advocates admit that transitioning roles isn't easy. Some of the most difficult aspects of demonstrating meaningful use include the ease of using the EHR to collect and report patient demographics, vital signs, and smoking status. This requirement has forced some practices to re-request this information if it has not been recorded or dated correctly. And the standards are getting stricter: The US Department of Health and Human Services (HHS) is developing "Tier 2" and "Tier 3" criteria for fair use, which must include requirements related to population health management and quality improvement. HHS has yet to say publicly when the practices will meet these more stringent standards.
On-site support: Regional advice centers
To help physicians overcome these obstacles, the HITECH Act established a network of 62 Regional Consultation Centers (RECs). Relying more on experience and energy than on staff, RECs have a specific role in helping primary care providers become experienced and significant users of electronic health records. To do this, they offer seminars, advisory services and even direct technical support for practices. Each REC office is assigned a specific goal for the number of physicians it hopes to enroll in the EHR effort.
"Our goal was to have 1,000 physicians sign a pledge to implement the EHR by the end of the year," said Todd Thornburg, Ph.D., director of the South Carolina Technology Implementation Assistance Center, the regional advisory center for the state . "We just announced that we've reached our goal, which means we've hired about 20% of all primary care physicians in the state since June 2010. That's pretty good market penetration."
It was not easy to get to this point. Thornburg's first presentation to South Carolina doctors fell on deaf ears. "We were trying to get the message across that the introduction of an EHR would help them get all these really significant incentive payments," she said. "But it seemed like we were telling them what to do, which doctors don't like."
Thornburg pushed back on the original message, instead focusing on how HIT could help physicians improve their care and allow them to practice medicine in the way they choose. "There was an immediate difference in susceptibility," she said. "It changed the tone of our conversations with the doctors and brought some fervor back to the exchange."
The 1,000 physicians committed to implementing the EHR in North Carolina represent a wide range of practice sizes and types. "We have small practices and large practices, practices in rural areas and practices in larger metropolitan markets; there is no particular characteristic that sets them apart," he said. However, the largest and most e-savvy practices could meet all the “good use” criteria by the end of this year, while rural practices could take four years to reach that milestone because in many cases they are starting from scratch. Thornburg said. .
In New York City, Parsons reports that the local REC just finished its 2,500. doctor has hired, which is a long way from their goal of 4,543 for 2014, to help them get up and walking," Parsons said to introduce and take advantage of that quality of care is improved.
Parsons said that part of the problem is that EHR providers, of which there are several hundred, simply don't have the customer volume and experience needed to make EHRs easier to use and trouble-free. "There is still work to be done to deliver a product that is ready to use out of the box and easily configurable for single vendor workflows," she said. "If you saw a drill, you saw a drill."
To help medical practices choose among EHR providers, the ONC has established an EHR software certification program and now posts the names of all certified software products online in a searchable database. To receive meaningful usage incentives, practices must use one of the certified providers. This doesn't limit your options too much: 525 EHR products are listed for outpatient practices and 263 for hospital practices. However, potential customers can narrow their search for a provider by specifying what features they want in an EHR.
arouse the interest of physicians
To encourage clinicians to invest the time and manpower needed to implement it, EHR proponents often point to the operational benefits of such systems. Daniel Saylak, D.O., chair of the American Osteopathic Association Board of Trustees for Medical Informatics, a specialty affiliate of the American Osteopathic Association (AOA), notes that EHRs help keep practices running smoothly and, as As a result, they potentially earn more money. They also improve quality and safety. Electronic medical records have built-in checks to ensure there are no drug interactions and can eliminate problems associated with poor writing. "There were a number of prescription issues that don't exist for us anymore," Saylak said of his own practice. "No doctor going to e-prescribing will ever feel comfortable again, it's just not as safe or efficient a process."
Other quality gains that often follow EHR adoption are attributable to system capabilities that help physicians keep pace with medical advances, match patients to the right therapies, coordinate prescriptions, and communicate with diverse healthcare teams. geographically diverse care.
patient commitment
The benefits of transitioning to an EHR system are not just for physicians. Many EHR systems on the market today have a "patient portal" that allows individuals instant access to their own lab results, X-ray reports, medication lists, and other information. These portals also allow patients to securely communicate with their doctors and other medical personnel via email. As far back as the 1970s, it was suggested that giving patients access to their own medical records would help engage them in their own care. The same has already been said about the expansion of the use of email between doctors and patients. None of the claims have been fully investigated, but anecdotal evidence suggests that patients appreciate easy access to their records.
security concerns
With reports of large-scale data leaks, security breaches, and targeted database hacks of various kinds regularly making national headlines, concerns about EHR security are extremely high. To address related concerns, the Office of the National Coordinator is currently working for 18 months to develop standards and guidelines to improve the state of cybersecurity across the HIT spectrum. Key initiatives will focus on helping practices securely install HIT systems, educate the healthcare IT community on security issues, and even create support resources to help with security emergencies.
HIT Employee Training
Securing provider interest in HIT is just as important to the success of the program as having a sufficient skilled workforce to ease the transition. There is currently a large gap to fill: In May 2010, the Office of the National Health Information Technology Coordinator (ONC) estimated that hospitals and medical practices would need an additional 50,000 HIT employees within five years to meet HIT requirements.significant use criteria🇧🇷 That number wouldn't be surprising for group practice CIOs, of whom 54% in a recent survey said they had difficulty recruiting or retaining enough skilled IT staff to create, implement and implement support.maintain systems.
Recently introduced educational programs may eventually fill the gap. In April, the first 1,274 students graduated and 8,741 enrolled in 82 community college HIT programs funded with $36 million in ONC scholarships. Graduates of these six-month, non-degree programs are qualified to help implement, update, test, maintain, and support the implementation of HIT programs. ONC expects these programs to graduate more than 10,000 new HIT professionals by the end of 2012, and that number each year thereafter. Otherwise, the skills gap may pose a serious obstacle to meaningful use on a large scale.
Perhaps unsurprisingly, recent research found that HIT offers the best career prospects for recent graduates of all majors. Increase interest. William Hersh, MD, professor and chair of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University, said his university program "had three to four times as many applicants as he could handle." .
Private insurers/private incentives
Private insurers and large employers are also promoting the introduction of HIT. Nearly all major health insurers have some type of incentive program for physicians and medical groups to adopt electronic health records and/or meet significant usage requirements. Incentive programs differ significantly from one insurer to another. At CIGNA, for example, physicians certified by the National Committee for Quality Assurance (NCQA) Physician Practice Connections (PPC) program (a program that requires the use of EHRs to write electronic prescriptions, track the results of testing and providing email communication with patients) are listed in the CIGNA Physician Directory, which helps patients navigate.
At Highmark, a $29 million health information technology grant program is encouraging primary care physicians to adopt EHRs and electronic prescribing. To date, Highmark has donated more than $5.3 million to approximately 650 practices in support of HIT initiatives. And Kaiser Permanente created a system that links members' electronic medical records with their appointments, records and billing information. The system gives doctors instant access to patients' medical records and provides online decision support tools to help doctors determine which treatments are most effective. The system can also submit prescriptions electronically and request lab tests online.
Employers are also putting money on the table to persuade doctors to introduce HIT. More than a dozen major employers, including General Electric Co., IBM, United Parcel Service, Procter & Gamble and Verizon Wireless, are now coordinating their performance-based pay-for-performance efforts through the Bridges to Excellence program, which is "Practices that systematically use, recognize processes and information technology to improve the quality of patient care." Incentives under this program can run into five figures for group practices, but incentives vary from employer to employer.
Will the sides be comfortable?
While EHRs promise to improve quality of care and practice efficiency, adoption of such systems poses a challenge for physicians who must invest in expensive hardware and software and spend extensive time training themselves and their staff to use them. practice medicine. The efficiency of electronic medical records, while important, is not always immediately apparent as new workflows and new processes must be learned. Furthermore, simply choosing a system can also be difficult. That leaves some doctors content to wait on the sidelines for now.
But medical leaders believe this ambivalence is temporary. As word spreads about the quality and financial benefits of electronic health records, it is likely that more physicians will become involved in the process. For example, at the last AOA annual meeting, a survey of attendees found that 53% of attending physicians had already adopted EPA. "I was expecting to see 20 percent," Saylak said. "Having more than half of our members involved in EHR adoption is great news."
references
1 Healthcare IT News Team, "Doctors find it hard to upgrade to new EHR despite Rx benefits,"health IT news, May 26, 2011.
2R Hillestad, J Bigelow, A Bower et al., “Can electronic medical record systems transform healthcare? Potential Health Benefits, Economics, and Costs.”health matters, 2005 Sep 24(5): 1103-17.
3PL Dolan, "Electronic Medical Records: How Implementation Affects Staff"american medical news, October 5, 2009.
4D. L. Greiger, S. H. Cohen, and D. A. Krusch, "A pilot study to document the return on investment for implementing an ambulatory electronic health record at an academic medical center,"Journal of the American College of Surgeons2007 Jul 205(1): 89-96.
5M.B. Buntin, M.F. Burke, M.C. Hoaglin et al., "The benefits of information technology in health: a review of recent literature reveals mostly positive results."health matters, 2011 Mar 30(3):464-71.
6C. Hsiao, E. Hing, TC Sosey et al., "Electronic Medical Record/Physician Office Electronic Health Record Systems: United States, 2009 and 2010 Preliminary State Estimates," December 2009. 2010.
7AK Jha, D. Doolan, D. Grandt et al. "The Use of Health Information Technology in Seven Nations",International Journal of Medical Informatics, Dez. 2008 77(12):848–54.
8Des Roches, E.G. Campbell, S. R. Rao, et al., "Electronic medical records in ambulatory care, a national survey of physicians,"Das New England Journal of Medicine, 2008 Jul 359(1): 50-60.
9J. Conn, "Working on IT",modern health, May 24, 2010.
10HIMSS 22nd Annual Leadership Survey, available online athttp://www.himss.org/2011Survey/healthcareCIO_final.asp