Achieving Meaningful Use of EHRs – what do I need to do?

How will my Electronic Health Record (EHR) help me get to EHR Incentive (“Meaningful Use”) money? This question has been asked repeatedly by physicians who are in the process of deciding upon, or implementing an EHR in their practice.

The first step , of course, is signing up for the incentive via the CMS web site. This can be done now – actually having a Certified EHR product is not necessary to register.

The second step is to make sure that the EHR product being used is Certified by an Authorized Certification and Testing Body (ONC-ACTB). A list of such products is maintained by the ONC, called the Certified Health IT Products List (CHPL), and is updated as new products become Certified. It is important to ensure that the version of the product you are installing (or have already installed) is the actual Certified version that appears on the CHPL list – locally-installed products will generally need to be upgraded to the version that allows access to Meaningful Use money.

One can use a combination of Certified Modules in order to cover all 25 items on the Meaningful Use list, which is an approach that hospitals and others who have already invested in legacy systems that don’t quite deliver on all the requirements will most likely take on – but most clinicians in ambulatory practice will likely want to choose a Complete EHR as a one-stop product. The product needs to be Certified by the time of Attestation.

The third step is to review the Meaningful Use criteria – there are 15 core (mandatory) elements, and 10 menu items (which a provider only needs to pick 5 to report). Achievement of each of these elements needs to be completed, and then Meaningful Use reporting will be done by Attestation. The CMS web site (the same one used to register in the first place) will have the Attestation section available on April 1 (the earliest date to apply).

Not all products will offer simple dashboards for Meaningful Use to the user. When we were at the HIMSS conference last week, and looked at a number of other EHR vendors, asking them how they were going to assist their users so that they would know how they were doing with each of the criteria, the response was quite varied. Some had not given it much development time. Others were proceeding via an array of reports that could be generated by the user (or a technical assistance person – some of the reports were challenging to access). No one really had a quick at-a-glance dashboard built yet.

Is the money all mine?
Once Meaningful Use is achieved, and Attestation has occurred, and money is received, will the EHR vendor try to take a piece of it? An interesting and provocative response to that question came from one particular vendor – AthenaHealth – in comments during its Q4 2010 quarterly earnings report (as a publicly held stock company, such reports are available to all). Given that AthenaHealth carries out Practice Management (billing) on behalf of its clients, when asked whether Meaningful Use income would be a “collection” upon which a fee would be levied, Jonathan Bush (CEO, President and Chairman) stated, “Are you kidding me? We work our tails off to get that money. We’re taking our piece.”

An alternative for clinicians
Practice Fusion recognizes this muddled picture among EHR vendors, and offers a fairly clear alternative.

(1) We will have built all the remaining pieces necessary to become a Certified Complete EHR as a one-stop solution for our users by this summer (in ample time to demonstrate 90 consecutive days in 2011 needed to access Meaningful Use money). This includes Clinical Quality Measures and Clinical Decision Support, immunization and public health reporting, and all the other elements.

(2) As a web-based product, the most-recent version (the Certified one) is immediately available to all users everywhere. There is no need to upgrade anything locally. And, consistent with our business model, all the pieces needed for a physician to achieve Meaningful Use will be offered. No hidden fees.

(3) We will build easy at-a-glace dashboards into the product so that users can quickly see their progress toward achieving all the necessary pieces for Meaningful Use Attestation. We hope this will set the bar high, and will encourage other vendors to do something similar (though it will likely mean yet more product upgrades in the field).

(4) As clinicians who use our product are able to achieve and demonstrate Meaningful Use, the money is yours. Not ours – yours. All of it.

We hope this approach will resonate with clinicians everywhere. It is disruptive in the industry – but it is an industry that needs disruption. Getting to the desired goal of widespread adoption of EHR technology by clinicians, especially those in small group and solo practice (who have struggled with such adoption in the past), is something that will help move health care delivery in this country forward – into the modern era.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR