Sunday, June 6, 2010

What is Meaningful Use?

Meaningful Use is a set of 25 criteria categorized in 5 topics by the Federal Center for Medicare and Medicaid to measure how effectively and efficiently medical practices are using an Electronic Medical Record. If a medical practice reaches the Meaningful Use bench mark it will qualify for incentives payments up to $63,750 from Medicaid or Medicare.

Help with Meaningful Use in New York City

The tremendous challenge doctors face when implementing an EHR and reaching Meaningful Use can be daunting, however Regional Extension Centers are now established to help reaching the goal and demonstrating Meaningful Use.

The New York City Department of Health through the Primary Care Information Project who focuses on quality improvement and the Fund for Public Health established NYC REACH (Regional Electronic Adoption Centers for Health) as the regional center for New York City to help medical practices reach Meaningful Use. NYC REACH was created to assist Physicians with direct technical assistant and provide clarity and help implement each point of the 25 Meaningful Use criteria which can result on an incentive payment of $63,750 from Medicaid or Medicare.

Some of the questions physicians might need to clarify when trying to archive Meaningful Use can be,

  • Who qualifies for the incentive fund?
  • How to meet the federal criteria which is very high and seems impossible?
  • How does reaching Meaningful Use impacts a patients health care or physician are just wasting time in front of a computer and spending less time with their patients?
  • How do you prepare to apply for Meaningful Use?
It is surprising that NYC REACH it is not a free program. Medical practices have to further invest to be able to get assistance applying for these incentive funds through NYC REACH, with a member ship that will cost $600 dollars annually per providers and after the first ten providers it is free. You can visit their we site to see more information at and can also apply or email them for questions at
Here is a list of services NYC REACH offers to practices which can be very useful:
  • Training & Workflow Redesign: these are ongoing classes and site visits to HER use, Billing, and Privacy & Security.
  • Interoperability & HIE: Connections to health information exchange infrastructure, pharmacies, labs and other clinical settings.
  • Meaningful Use: Explanations of the rules and practice assessment.
  • Quality Improvement: How to use the advance quality features to improve care on site.

Friday, June 4, 2010

EMR Not a Rosy Picture Yet

The full implementation of an Electronic Medical Record can allow a physician to positively impact the continuum of a patient’s health care cycle, but it’s not an easy task to accomplish it.

An article published in the New York Department of Health Care Information Bulletin of March 2010, implies just the opposite. EMRs are promising health content management tools to organize medical offices and improve patients’ care. A vision pushed by the Obama administration which allocated about forty billion dollars in the Recovery Act through the federal government. This money is available to Physicians who implement an EMR and show Meaningful Use of the EMR to qualify for an incentive fund of about $63,000 from Medicare or Medicaid, not both. The funds are allocated to encourage and promote the implementation of EMRs.

The article published in the March bulletin called, “Working Together: Home Care in the South Bronx,” portrays Dr. Sahgal’s utter success transitioning his practice from paper to electronic medical records. It is absolutely possible that Dr. Sahgal now provides higher levels of care after fully implementing his EMR. However, the article fails to alert physicians to problems and difficult obstacles that will translate into higher costs for physicians and only paints a rosy picture of the process. The article gives EMR newcomers an unrealistic perspective of an EMR implementation, only emphasizing how in Dr. Sahgal’s practice telephone call efficiency was improved, how the doctor was able to develop a different model of care where some patients are visited at home in coordination with home nurses and social workers. It all sounded to me like a medical model I heard as a child implemented in the oppressive Cuban regime but that works. I am sure patients will love to get a health care visit from their primary doctors and not just a bill. The article also mentions ePrescribing medications, referrals are vaguely mentioned, as well as an increasing number of visits and other interesting facts that can be accomplished through an EMR; but fails to mention any logistics on how to accomplish these new work flows.

The article appears more like a sales pitch to physicians who want to purchase an EMR, without providing real and valuable information. An example of a feature that can be misleading is referrals. Referrals need to be tracked and this is a problem spot for a high percentage of EMRs. Let’s imagine that a referring physician gives a referral to a patient. The patient will go to the referred doctor, and once the visit is completed and the patient has the report, according to one of the rules of Meaningful Use, the referring physician needs to track the referral. But the doctors might have different EMR system that do not communicate with each other and even if they have the same system, often EMRs are not yet ready to electronically receive referrals as they ePrescribe or submit a claim. To track the referrals doctors will need to allocate new office resources and staff time to comply with the referral rule which will have a higher cost. The EMR alone will not track referrals.

Visiting patients at home presents also a similar situation where the practice needs to reach a higher level of coordination putting more stress especially on small practices that are already overwhelmed with work. The physician needs to search for patients with conditions that meet specific home visit criteria to generate a list of who needs a visit. This can be done through a searchable registry. The data needs to be available as structured data and not just as scanned documents. These details are completely overlooked in the article.

Wednesday, April 28, 2010

Electronic Medical Records Implementation Issues

BF3YQ5Z4E9HD Implementing and EMR system can involve a number of frustrating problems. The implementation of Jose Goris MD PC Electronic Medical Record was scheduled to take place in several stages. Staging the implementation was the proper way to move the practice forward, following an organized list scheduled events that took place over a few months. The Practice was required to complete each stage before moving to the next.

After what it seemed a long wait the practice completed all the implementation stages. The new workstations, fax server, mail server, scanners, network equipment were deployed and the Electronic Medical Record applications were installed. The staff and physicians were eager to begin the training.

These were offered by the EMR vendor. The trainings were thorough and also crammed with enormous amounts of exhaustive detailed information in a few hours time. Staff and health care providers often forgot the covered material when using the EMR after several days. The practice was technically ready to begin the transition into the paperless world of EMR, but the staff and health providers were not. The New York Department of Health provides post-training assistance as part of the contract with the EMR vendor, but it’s only offered weeks after the vendor training is over and physicians have had months of use which is not an efficient method to help transitioning into a completely new technology and one that at times is a cumbersome method of doing medicine as some of the physicians expressed. They feel medicine is not spending time in front of a computer but taking care of their patients’ needs.

The health care providers needed constant and immediate assistant after the trainings. If an issue or a question came up, a request for assistance needed to be submitted through a ticket system. People working with web development, web design and web hosting accounts are used to these types of support systems. The EMR vendor’s technicians will review a long queue of submitted requests, resolving issues as they go through the list. When your submitted ticket number is up, the practice gets a call.

By the time the practice gets the call from support to resolve the issue, the physician has already forgotten the details of the submitted ticket. It is difficult to recall or articulate the exact problem entered in the ticket number because the initial trainings were not sufficient to help the trainees internalize the information. EMR applications have an enormous number of details that are easy to forget if the system is not used constantly.

EMR are vast applications allowing complex medical workflows to be transferred into structured data for faster gathering and reporting. For this system to work effectively, health care providers have to know quick short cuts requiring just a few clicks to complete a patient’s visit. If the EMR does not provide a user friendly interface, with adequate shortcuts, the Physician will begin to experience strenuous work days. As mouse clicks begin to mount when accomplish a task that before was easily transcribed into paper, the process becomes mentally and physically draining. EMR that are click “Click Intensive” as Roswell Goris calls them, will make doctors work harder, making the transition into an Electronic Medical Records a frustrating process.

It is virtually impossible to know the user friendliness of an EMR by simply looking at a product presentation. Demos can be impressive and are easy to fall in love with, but physicians need to use a system for a few weeks before investing on a system that they will probably use during the next ten years.

The usefulness of an EMR is not measured strictly on what it can do, but also on how clearly it is remembered after training, how easy it is to implement and accomplish a work flow and whether or not it is “Click Intensive”.

All these issues can be mitigated with proper training. At Jose Goris MD PC medical practice the physicians at first were frustrated, experiencing a painful transition working with the new system. The trainings provided by the EMR vendor were not sufficient and IT staff was needed to ensure a quicker implementation.

Medical Practices need to do careful research before making an investment. Choosing a system used by colleague friends can help building a larger the support based.

Tuesday, March 30, 2010

First Steps to Reach Meaningful Use, by Roswell Goris

Meaningful Use until 2011 will be based on an honor system from both Medicaid and Medicare. The system will be regulated through federal audits set to randomly select practices to verify if they are meeting their Meaningful Use claims.

At the beginning, attestation or an honor system will automate electronic data collection to report and show if Meaningful Use is being met. But practices will need to collect plenty of documentation to be able to show Meaningful Use if audited. Practices are allowed at first to use paper to report their EMR implementation.

Only when the actual reporting of digital data for quality assurance begins, will practices have to initiate collection and mining the data to report Meaningful Use.  Practices will need to have Structure Data,  available. This is data that consist of characters, numbers, words which can be searched as oppose to scanned images.  A few samples in the proposed rules are listed below:

  • Lab Results that are entered as Structure Data. For example, a Comp Panel Lab where you find glucose, sodium, choloride, carbon dioxide, urea nitrogen, creatine, the results will need to be entered manually into the EMR if it's not electronically interfaced with the laboratories to meet the Structure Data requirement. The good news is that laboratories have already developed interfaces.
  • Clinical Summaries of patients' histories can be accomplished using flow charts. Flow Charts can allow practices to create a chronological history of the patient based on patient medical conditions, once the Structure Data becomes available. Patients' Clinical summaries can be setup mapping the patients' Structure Data to a particular condition, for example Diabetes, fresh updated charts will becomes available in real time as the data comes in to the health care providers.
  • Eligibility should be checked using the EMR.
  • Establishing work flows to track who is requesting health records information on a patient. One possible solution is creating a data entry for each phone call at time of the request.
  • ePrescribing, Health care providers will also need to order medications and to do consultations using electronic medical records.
These are a few criteria and the logistics to obtaining Meaningful Use can be daunting. The practices will need to develop effective work flows during the practice's daily operation that are efficient and cover key points listed in the Meaningful Use rule .

Roswell Goris Notes on Meaningful Use Incentive Payments

Under the American Recovery and Reinvestment Act for Medicare and Medicaid, a new rule was proposed at the end of 2009. The rule is called Meaningful Use. Medicare and Medicaid incentive payments will be offered under this rule physicians who are implementing an electronic medical record that is used to meet the requirements defined in this rule.

To reach the Meaningful Use criteria is beginning to look difficult if not impossible for practices that do not have the human resources or the IT expertise to ensure the electronic medical records are utilized according to the guidelines.

Roswell Goris says that practices, that want to apply for the incentive payments which can be substantial, will probably need to hire an external consulting firm to help them meet the criteria.

Many Medical Practices have purchased the necessary equipment and installed competent electronic medical records, but lack the IT expertise and support to use system to meet rules expectations as proposed. Using an electronic medical record does not automatically ensure qualification. Also the Meaningful Use proposed rule is not final. It's undergoing revisions. The Centers for Medicaid and Medicare, are still deciding on what has become a multimillion dollar question, what is Meaningful Use?

The idea is to improve the quality of patients' health through the continuum of care, more efficiency, coordination, fewer errors and in the future perhaps create a seamlessly electronic connection, where patients' medical records can be easily and securely shared with other health care providers with a click of a button.