The Road to EHR Implementation is Paved with Incentives and Challenges
Source: Managed Care Outlook – January 1, 2010, Volume 23, Number 1
By: Managed Care Outlook
On February 17, 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) to promote the adoption and meaningful use of health information technology (IT). More than $19 billion was allocated in the Act, including $17.2 billion in incentives for electronic health record (EHR) use and $2 billion for grants and loans for health IT advancement. It is now up to hospitals and doctors to implement computerized medical records or miss out on their share of those incentives.
The Department of Health and Human Services will begin paying incentives to providers who have made the switch to EHRs starting in 2011. Those incentives begin to decrease in 2012 and zero out by 2015. As of 2015, monetary penalties begin for any providers not utilizing an EHR.
“There are both positive and negative financial incentives to be compliant with the HITECH Act,” explains Ron Wince chief executive officer of Guidon Performance Solutions (www.guidonps.com). “On the front end, if you are compliant with meaningful use and have electronic medical records (EMRs), you will be one of the ones receiving a financial incentive. The longer it takes you to implement, though, the less the incentive will be, and if you haven’t met compliance by 2015, there will be penalties.”
Challenges that Providers Face
There are a number of challenges that providers face as they work toward these deadlines, says Wince. One of the biggest challenges for those that have not yet begun the implementation process is the task of finding a vendor that can help with this effort.
“There are only a certain number of people who provide EMRs; if you haven’t already started down that path, you are going to have a bigger challenge trying to find a vendor who has the bandwidth to be able to do it at this point in time,” he notes.
Another challenge is access to capital. “If you don’t have it within your own operating systems, you are going to have a difficult time finding it out in the market,” says Wince. “The capital markets have been tight for a while. They are improving, but it is still difficult.”
The lack of access to capital is compounded by the fact that many providers are simply capped out. They have downsized as much as they can, and they have patient volumes that are significantly challenging their resources. Providers often put technology on the back burner, but doing so with EHRs will begin to have financial implications as of 2011.
“It seems like a lot of people think the deadline for EHRs and meaningful use will be extended again and again, much like the deadline for digital cable was extended,” says Wince. “There are people making assumptions that the federal government has put too optimistic a timetable on things and will have to move the deadline. The bad side of that is, if it’s not extended, those people are going to miss out on the money. At the end of the day, the incentive was supposed to be a positive thing; if it gets to the point where people are penalized, they are just going to figure out how to operate in that new environment, so they’ve got to figure out a way to make it a win-win for everybody.”
Keys to Successful Implementation
One of the biggest mistakes that providers make when it comes to implementation is the failure to understand the implications of the way they conduct business, says Wince. In many cases, these providers simply automate whatever their existing process is. They often hire a software company that designs a program based on what is currently in place —or at least the perception of what is in place. Unfortunately, the current process may include steps and processes that do not add any value, so the software company ends up automating an inefficient process.
An important first step to avoid this is to truly understand the process, explains Wince. One way to do so is by making sure that the right people are involved when the software company designs the workflow for the implementation of the EHR. There must be more than just a business analyst in the room. Those with direct knowledge of the day-to-day process must be there.
“You have to get with the people that have the so-called “tribal knowledge” and have them map out the process,” stresses Wince. “If you reach out to the people who actually do it for a living, they will tell you where all of the skeletons are. The company can then fix those problems before they are automated. It allows the company to streamline the process and make it more efficient from the start. Unfortunately, that just does not happen in most cases. Even many of the largest hospitals do not couple their process improvement team with their business intelligence EMR team. If those two elements are working in unison, they become very powerful.”
When this does not happen, several problems may occur, says Wince. The first and most obvious problem is that of widespread dissatisfaction of staff members who are “stuck” with a system they do not know how to use. The second problem is the impact this can have on a company’s bottom line. With the new recovery audit contractor (RAC) audits coming out from the Centers for Medicare & Medicaid Services (CMS), there could be substantial fines and penalties if the newly automated workflow leads to missed or incorrect billings of different service offerings or code.
Communication with Health Plans
One final piece of the puzzle that cannot be overlooked is the ability of health plans to communicate effectively and efficiently with whatever a provider has implemented as its EMR, says Wince. This can be a huge challenge because there is no national standard at this time.
“What we are seeing is that there is a lot of rework on the data when it comes to the health plan,” he explains. “We have several clients that are health plans, and what they end up doing is manually manipulating and massaging the data to get it to fit in their system that is already in place. When you do that, you end up with opportunities for failure. You have data that gets dropped off, fields that are incorrectly labeled, and so on. It is critical that these systems be able to communicate.”
Reprinted from Managed Care Outlook, January 1, 2010, Volume 23, Number 1, with permission from Aspen Publishers, Inc., Wolters Kluwer Law & Business, New York, NY, 1-800-638-8437, www.aspenpublishers.com
All contents © 2010 Managed Care Outlook. All Rights Reserved.
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