Is Meaningful Use Doing What it is Supposed to?

Is the federal EHR Incentive Program (Meaningful Use) encouraging new adoption of Electronic Health Records (EHRs), or just rewarding those who already have one in place?

That is a question that has been raised recently, based on a survey done by iWatch News, which interviewed 62 doctors and hospitals who received the very first batch of payments from the Meaningful Use program in May. They found that about half of the earliest recipients of Meaningful Use money had already been using EHR systems for a couple of years or more.

But the goal of the EHR Incentive Program is to encourage new adoption – to get health care professionals to make the move from the paper-based legacy to an electronic platform. Is this occurring?

Hospitals vs. community physicians
First, it is important to distinguish between the experience of hospitals and that of Eligible Professionals (community physicians). Hospitals are complex ecosystems, with many different roles, departments, and internal legacy systems. The systems they adopt tend to be locally-installed enterprise systems (not web-based systems), very expensive, and difficult to implement. They also receive the lion’s share of Meaningful Use dollars – CMS payout data shows that those hospitals that are successful Meaningful Users get about $1 million from the program, whereas community physicians (Eligible Professionals, or EPs) get $18,000 (or $21,500 from Medicaid) their first year.

However, there are many more EPs than hospitals. There are also many more registrants in the Meaningful Use program (over 100,000 physicians and hospitals) than those who have received money so far (about 3,700 EPs).

For Medicare Meaningful Use, there are some hurdles to overcome – 20 of 25 criteria need to be demonstrated, and a Certified product needs to be used for 90 continuous days in 2011. That means that, even though the earliest payouts were to physicians who may have had a system in place already, as the year has progressed, more and more EPs came on board and demonstrated Meaningful Use.

Increasing adoption
The trend seen will likely continue. Our own experience has been that very large numbers of EPs (several thousand) have adopted our free, web-based EHR, and will be Attesting in December. Most all of these clinicians are first-time EHR users, and have worked actively with us to learn how to incorporate their EHR into the workflows of their clinical practice.

We have seen steady progress among our own EHR users in moving toward the performance thresholds needed for successful Meaningful Use, despite some of those measures requiring significant changes (positive changes, one could argue) in the ordinary workflows of clinical practice.

Our experience is that smaller practices typically have adopted our web-based EHR, for all the obvious reasons – free, no installation of equipment needed, quick self-service sign-up, vigorous help in adoption.

But is this typical for Meaningful Users generally? It seems to be. Again, reviewing CMS data of those who have been paid as of October, most of the EPs appear to be in solo practice. Even though CMS does not report by practice size (since Meaningful Use is a payout to each individual practitioner, not to each medical group), one can take the CMS payee-table, and aggregate around same-phone-numbers (a reasonable surrogate for clinicians in practice together), and see that most EPs are in solo and small practices:

Experience to date
The federal EHR Incentive Program has been an ambitious attempt to encourage the shift from paper to electronics in health care. The performance which must be demonstrated in order to receive incentive money can be a stretch for many, though we have seen many physicians reach for these goals.

In part because of the federal incentives, and in part because of a general “irresistible wind” from many parts of the healthcare delivery ecosystem (professional societies, licensing and accreditation boards, new forms of health care delivery, etc.), the move to EHRs is measurable increasing. Clinicians who never before have adopted such technology are entering this new era. And it’s not just hospitals and big medical groups –small practices are signing up, and receiving their incentive money in significant numbers. The availability of web-based (and free) EHR options has been particularly significant for the smaller-practice end of the healthcare delivery spectrum, which is (still) where the majority of practitioners reside.