Key Issues a Health Care Provider Should Consider When Converting to an EHR (EMR)

The rules are changing weekly on the features that will be required by the Federal Government in an EHR system. This unpredictability is causing EHR vendors a difficult time when creating products to offer doctors. Only a few months ago it seemed clear that a CCHIT 2008 or better certification is all that a doctor would need to satisfy Stimulus Incentive requirements. If you have decided to convert to an EHR, or you are just exploring the options, then you need to look beyond the basic evaluation criteria in determining the system that is best for you.

The basic fundamentals for evaluating an EHR system include: Features and Functions (what is best for your practice), Method /Options to Create a Note, Workflow of the System (compared to workflow of your practice), EHR only or Single Block (which includes an integrated practice management system), Contracting and Pricing (purchase a license for the software or a subscription model), Technology (client or web based), Vendor (training, implementation, ongoing support, and financial viability), and, Back-up and Data Capabilities.

Consider the following beyond the basics:

  • Assess why you are seeking to convert to an EHR and match the system with those goals. Reasons to convert include but are not limited to: Receiving Stimulus funds, to comply with the mandate, appearance of having a high tech practice (to show patients and referring physicians), efficiency and reduced costs, improve quality of care, and interoperability with other physicians, hospitals, labs, imaging centers, and RX.
  • Understand the capabilities of your providers and staff: Do they have the computer skills to generate and review medical notes utilizing a keyboard and mouse; and do you have buy-in from the staff as well as resources to implement a system? Buy in and support goes a long way in having a successful transition.
  • It is critical to conduct adequate research on the quality of the practice management and scheduling part of the system. Many Providers are focusing their attention on the EHR and fail to research the quality of the billing component of the system and later find that their collections are negatively impacted after the transition.
  • Understanding community efforts for Interoperability (the ability of an EHR to speak to other doctors or hospitals) and how this impacts choosing an EHR. There is a big push from the Federal Government and many State policy makers for the exchange of information between providers.
  • Under the current climate, you need to understand the value of a CCHIT 2008 system: Stimulus Incentives (through Medicare and Medicaid) will be available to eligible professionals who are “meaningful EHR users”. The term “Meaningful” is required by law to be defined by December of 2009. Though many CCHIT 2008 systems will most likely satisfy the requirements for Stimulus Incentives, a buyer in today’s market cannot be guaranteed. Also, purchasing a CCHIT 2008 system may be more robust and expensive than what you may need.

On August 17th CCHIT has announced a new certification, HHS Certification, which will simply verify that a system meets the requirements under “meaningful use” when “meaningful use” is finally defined.

Recent Proposed Requirements for an EHR to Satisfy “Meaningful Use” includes:

[Note: It is anticipated that this will change as CMS and HHS add their input.]

  • Computerized Physician Order Entry (CPOE) for all orders and medications;
  • Drug‐drug, drug‐allergy and drug‐formulary checks
  • Electronic prescription;
  • Maintain an up‐to‐date problem list;
  • Maintain an active medication allergy list;
  • Send reminders to patients for preventive and follow‐up care;
  • Document a progress note for each encounter;
  • Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies;
  • Provide clinical summaries for patients for each encounter;
  • Exchange key clinical information among providers of care;
  • Perform medication reconciliation at relevant encounters;
  • Submit electronic data to immunization registries where required and accepted;
  • Provide electronic submissions of reportable lab results to public health agencies;
  • Provide electronic surveillance data to public health agencies according to applicable law and practice;
  • Comply with federal and state privacy/security laws and the fair data sharing practices in HHS' Nationwide Privacy and security Framework, released in December 2008;
  • Implement one clinical decision support rule relevant to a specialty or a high clinical priority;
  • Submit claims electronically to payers;
  • Check insurance eligibility electronically when possible;
  • Provide patients with timely electronic access to their health information;
  • Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and
  • Require the capability to exchange health information where possible in 2011, with participation in a national health information exchange by 2015.

Key points

    • The Recovery Act Requires the Definition of Meaningful use by December of 2009. This will define what features are required to receive Stimulus money. A CCHIT 2008 system may be missing features or have more features than needed which may not only be too costly but impact the efficiency of your practice.
    • When looking for an EHR product you should consider the proposed requirements for “Meaningful Use” when comparing features.
    • What system can actually improve your workflow and make your practice more efficient.

Key issues to think about

  • What system do I currently use for Practice Management and how does it compare to the single block systems I am looking at?
  • Do I need a CCHIT system?
  • What will be the alternative to the current CCHIT systems?
    • EMR Lite or Clinical Groupware?
    • Will the alternatives meet the requirements for Meaningful Use?
    • Will they be less expensive?
    • Will they be more flexible?
  • Do I need to join a RHIO or Health Information Exchange? What are the benefits?

Look to eINFO@PRI to stay up-to-date as these questions are answered.