Meaningful Use Gets Mixed Reviews From Users

Many physicians are frustrated and confused by the meaningful use criteria that spell out how they can receive incentive payments from Medicare and Medicaid for their use of electronic health records.

With that uncertainty, physicians are not jumping in with both feet to participate in the incentive program, even if they have purchased EHR systems. The Medical Group Management Association (MGMA), in an April survey of its members, found that 80% of those who had adopted an EHR system intended to participate. But at that time, only 14% said they were able to meet all the criteria.

The American Medical Association held a special session on meaningful use at its House of Delegates meeting in June. When Dr. Michael L. Hodgkins, AMA chief medical information officer, asked how many physicians were confused about what was expected of them, more than half raised their hands.

Physicians in smaller practices are especially challenged, Dr. Hodgkins said, citing data that some 300,000 doctors are in practices of 10 or fewer physicians. Among those, fewer than 15% have implemented an EHR system, and most are not yet capable of meeting the meaningful use criteria.

According to Dr. Hodgkins, there are many obstacles to meeting meaningful use, including selecting from the more than 400 EHR products certified by the federal Office of the National Coordinator (ONC) for Health Information Technology, part of the Health and Human Services department.

Another problem: “Aggressive” timelines set by the government, according to Dr. Steve Waldren, director of the Center for Health Information Technology at the American Academy of Family Physicians (AAFP). He says it takes 6-18 months from purchase to active meaningful use of a system.

It's been a tough road, he said. Physicians who don't have EHRs or who have just gotten on board are struggling to get them operational and to achieve meaningful use. Those who have owned systems for awhile may face upgrades to meet the meaningful use criteria.

Meanwhile, there's the system's financial cost, its training and maintenance issues, and workflow changes once a system is in place.

The Long-Time User

Some physicians aren't in a panic about the impending deadlines. Dr. Michael Mirro of Ft. Wayne (Ind.) Cardiology, a 24-physician group, said his practice has been using health IT since 1996.

“We knew that we had to ultimately modernize our practice,” Dr. Mirro said in an interview. Their current system has improved efficiency and quality, and has “supported a higher level of coding and reimbursement.”

The system has “pretty much complete functionality,” said Dr. Mirro. It provides the EHR, offers e-prescribing and decision-support tools, and can be used for direct quality reporting to the American College of Cardiology's PINNACLE registry.

The system is Web based, which reduces maintenance costs and IT headaches. The practice does not own the servers; it has local computers that interact with the vendor's servers and software. The system is certified by the Certification Commission for Health Information Technology and was updated to ensure that the practice would meet the meaningful use criteria. One helpful tool, according to Dr. Mirro: A meaningful use “meter” that tells the physicians how well they are meeting the goals.

Ft. Wayne Cardiology has already attested to the government that it was a meaningful user and has received the maximum $18,000 per physician incentive for 2011, Dr. Mirro said.

The annual cost is about $2,000 per physician per year. That's low, said Dr. Mirro, because his practice is owned by a hospital. The system is already ahead of the curve, as it already incorporates a patient Web portal (a stage 2 goal).

He said that he is sympathetic to physicians who are just getting started. “Any time you adopt technology at the point of care, it's going to require a change in workflow,” he said. That was definitely the case at Ft. Wayne Cardiology.

Dr. Mirro said that physicians looking to buy or expand their health IT should talk with one of the 60 regional extension centers established by the ONC. These centers have been charged to help rural and primary care physicians especially. They offer vendor recommendations, practice audits, and other advice for free.

A Model for Her Peers

In 2005, Dr. Jennifer Brull figured that she needed to get on board with health IT, even though it might be expensive and difficult for a family physician in a rural Kansas solo practice. A younger physician with whom she was collaborating suggested that having an EHR was the wave of the future, and would likely be a necessity going forward. She also had a practice-sharing arrangement with another physician, who was older. He was not as sure, Dr. Brull said in an interview.