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Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

EHR Data – Is it Improving Healthcare?

Posted on June 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve written pretty regularly about the wave of data that’s coming to the world of healthcare. It’s really something quite extraordinary. However, data in itself doesn’t solve anything. So, I was bothered by this tweet which suggested that technology was improving healthcare by illustrating that more and more health data was being collected by technology.

Here’s the tweet:

Attached to this tweet is the following image which doesn’t illustrate the above assertion at all.

No one believes that technology can help improve healthcare more than me. However, it’s not right to make that assertion on Twitter and then use the increased collection of healthcare data as proof of this fact. We can collect all the data in the world and healthcare can remain exactly as it is today.

This reminds me of when the government suggested that HITECH (Meaningful Use) was a success based on graphs that show that most organizations have adopted an EHR. I guess if EHR adoption is your goal, then it was a success. However, if your goal is to use technology to improve healthcare, then EHR adoption is a vanity metric.

We need to stop focusing on adoption and start focusing more on metrics that really matter. Are we improving care? Are we lowering the cost of healthcare? Are we improving the efficiency of our healthcare providers? If technology can’t help you in one of these areas, then we should question why we’re doing it. Let’s bring some sanity back to our approach to healthcare technology.

Will New Doctors Hate EMRs the Way Older Doctors Do?

Posted on March 22, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Oh! Just the idiocy of it all!

That’s a quote from an email I got from an older doctor in response to a discussion about EHR software and in particular programs like meaningful use and now MACRA. This is a doctor who I’ve exchanged many emails with over multiple years. Needless to say, he’s not happy with what’s happening with EHR software and sees it as an awful thing for medicine. I think this is the view of most older doctors.

While most older doctors feel this way, I wonder if the next generations of doctors will feel the same. I’ll never forget my med school friend who said he hated rounding at a doctor’s office that didn’t have an EHR because he types faster than he writes. Or the middle-aged doctor that’s been a friend of my family since I was a kid that’s been on EHR so long that he once told me “I’ve never really known anything but an EHR, so I can’t imagine practicing medicine without it.”

I understand the doctors who complain about EHRs and more importantly complain about the regulations which are reflected in the features EHR software companies push out. EHR was a massive change for many of them and that can be brutal. Plus, there are plenty of issues with many EHR software and EHR implementations out there. Some that can be resolved and some that can’t. Not to mention that many regulation requirements aren’t clinically useful. We should be glad doctors are upset over this.

However, will the next generation of doctors care?

Besides the fact that new doctors are digital natives who grew up with technology, there’s also the fact that new doctors won’t know what life in a medical office was like before EHR. EHR documentation will just be part of the status quo for them and when you don’t know about the alternative, then you don’t hate it as much. It’s just a required part of the profession and it’s always been that way.

The reality for most new doctors is that there are so many things that are screwed up with our healthcare system, that the EHR is just one more to add to the pile of things that don’t make much sense. They’ll just consider it a feature of the profession and likely not complain much.

The one thing that could change all of this is for a new EHR or related solution to come out and blow all the current EHR vendors off the map. It would have to be something so dramatically better for organizations that healthcare organizations can’t resist it. Think of the way the iPhone made us rethink cell phones. It needs to be a solution which is that much better. Does such a solution exist? Can such a solution be built? Or do the current healthcare regulations prevent such a solution? Will it take changes in regulation and reimbursement to enable a new EHR that doctors love and not a change by an EHR software vendor?

DeSalvo Says We Need Common Interoperability Standards – I Think There’s More To It

Posted on September 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across an article on FierceHealthIT which has a really fascinating quote from Karen DeSalvo, National Coordinator for Health IT. Here it is:

“What seems that it would have been helpful is if we had agreed as an ecosystem–the government, the private sector–that we would have a set of common standards that would allow us to have more seamless sharing of basic health information,” she said. “We’re moving toward that with the industry, but I think what that’s created is a complexity and aggregation of data … In hindsight, maybe some more standardization, or a lot more,” was necessary.

Is lack of a standard what’s keeping healthcare from being interoeprable?

I personally don’t think that’s the biggest problem. Sure a standard would help, but even with the best standards in the world if organizations see data sharing as contrary to their best interest then no standard will overcome that view. It’s been said many times that we have an issue of desire and will to share data. It’s not a technical problem. Sure, a standard would be helpful once there is a will to share data, but if organizations wanted to share data they’d figure out the standard.

Later in the article, CommonWell Executive Director Jitin Asnaani said “Standards are not standards because we say they are; standards are standards because everybody uses them.

This is the problem. People don’t want to share health data and so no standard is being used. I still wish they’d blow up meaningful use and use the rest of the money to incentivize organizations to start sharing. People went bat crazy implementing an EHR as they chased government money. I’d love to see healthcare organizations go bat crazy becoming interoperable as they chased the rest of the government meaningful use money.

Is Meaningful Use For Mental Health Providers On The Way?

Posted on June 10, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

If you look at the policy statements issued by ONC, it sounds as though the organization is a big fan of putting behavioral health IT on the same footing as other aspects of care. As the agency itself points out, 46% of Americans will have a mental health disorder over the course of their lifetime, and 26% of Americans aged 18 and older live with a mental health disorder in any given year, which makes it imperative to address such issues systematically.

But as things stand, behavioral health IT initiatives aren’t likely to go far. True, ONC has encouraged behavioral health stakeholders on integrating their data with primary care data, stressed the value of using EMRs for consent management, supported the development of behavioral health clinical quality measures and even offered vendor guidelines on creating certified EMR tech for providers ineligible for Meaningful Use. But ONC hasn’t actually suggested that these folks deserve to be integrated into the MU program. And not too surprisingly, given their ineligibility for incentive checks, few mental health providers have invested in EMRs.

However, a couple of House lawmakers who seem pretty committed to changing the status quo are on the case. Last week, Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas) have reintroduced a bill which would include a new set of behavioral health and substance abuse providers on the list of those eligible for Meaningful Use incentives.

The bill, “Helping Families in Mental Health Crisis Act,” would make clinical psychologists and licensed social workers eligible to get MU payments. What’s more, it would make mental health treatment facilities, psychiatric hospitals and substance abuse mistreatment facilities eligible for incentives.

Supporters like the Behavioral Health IT Coalition say such an expansion could provide many benefits, including integration of psych and mental health in primary care, improved ability of hospital EDs to triage patients and reduction of adverse drug-to-drug interactions and needless duplicative tests. Also, with interoperable healthcare data on the national agenda, one would think that bringing a very large and important sector into the digital fold would be an obvious move.

So as I see it, making it possible for behavioral health and other medical providers can share data is simply a no-brainer.  But that can’t happen until these providers implement EMRs. And as previous experience has demonstrated, that’s not going to happen until some version of Meaningful Use incentives are available to them.

I imagine that the bill has faltered largely over the cost of implementing it. While I haven’t seen an estimate of what it would cost to expand eligibility to these new parties, I admit it’s likely to be very substantial. But right now the U.S. health system is bearing the cost of poorly coordinated care administered to about one-quarter of all U.S. adults over age 18. That’s got to be worse.

Assessment Released of Health Information Exchanges (Part 1 of 2)

Posted on January 6, 2015 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Like my Boston-area neighbors who perennially agonize over the performance of the Red Sox, healthcare advocates spend inordinate amounts of time worrying about Health Information Exchanges (HIEs). Will the current round of exchanges work after most previous attempts failed? What results can be achieved from the 564 million dollars provided by the Office of the National Coordinator since 2009? Has the effort invested by the government and companies in the Direct project paid off, and why haven’t some providers signed up yet?

I too was consumed by such thoughts when reading a reported contracted by the ONC and released in December, “HIE Program Four Years Later: Key Findings on Grantees’ Experiences from a Six-State Review. Although I found their complicated rating system a bit arbitrary, I found several insights in the 42-page report and recommend it to readers. I won’t try to summarize it here, but will use some of the findings to illuminate–and perhaps harp on–issues that come up repeatedly in the HIE space.
Read more..

Who is Adopting EHRs and Why: ONC Turns up Some Surprises

Posted on December 15, 2014 I Written By

Andy Oram is an editor at O’Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space.

Andy also writes often for O’Reilly’s Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O’Reilly’s Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A high-level view of the direction being taken by electronic health records in the U.S. comes from a recent data brief released by the Office of the National Coordinator. Their survey of physician motivations for adopting EHRs turns up some puzzling and unexpected findings. I’ll look at three issues in this article: the importance of Meaningful Use incentives and penalties, the role of information exchange, and who is or is not adopting EHRs.

Incentives and Penalties
The impact of the Meaningful Use bribes–sorry, I meant incentive payments–in the HITECH act are legendary: they touched off a mad rush to adopt technology that had previously aroused only tepid interest among most physicians, because they found the EHRs outrageously expensive, saw no advantage to their use, or just didn’t want to leave the comfort zone of pen and paper. The dramatic outcome of Stage 1, for instance, can be seen in the first chart of this PDF.

This month’s data brief reconfirms that incentives and penalties played a critical role during the period that Meaningful Use has been in play. In the brief’s Figure 3, incentives and penalties topped the list of reasons for adopting records, with nothing else coming even close (although the list was oddly chosen, leaving out credible reasons such as “EHRs are useful”).

The outsized role payments play is both strange and worrisome. Strange, because the typical $15,000 paid per physician doesn’t even start to cover the costs of converting from paper to an EHR, or even from one EHR to another. Worrisome, because the escalator (a favorite metaphor of former National Coordinator David Blumenthal) on which payments put physicians is leveling off. Funding in the HITECH act ends after Stage 3, and even those payments will be scrutinized by the incoming budget-conscious Congress.

In addition, Stage 2 attestations have been dismally low. Critics throughout the industry, smelling blood, have swooped in to call for scaling back, to suggest that meaningful use provisions be eased or weakened, or just to ask for a more concentrated focus on the key goal of interoperability.

The ONC knows full well that they have to cut back expectations as payments dry up, although penalties from the Center for Medicare & Medicaid Services can still provide some leverage. Already, the recent House budget has level-funded the ONC for next year. Last summer’s reorganization of the ONC was driven by the new reality. Recent initiatives at the ONC show a stronger zeal for creating and urging the adoption of standards, which would be consistent with the need to find a role appropriate to lean times.

Health Information Exchange
I am also puzzled by the emphasis this month’s data brief puts on health information exchange. Rationally speaking, it would make perfect sense for physicians to ramp up and streamline the sharing of patient data–that’s exactly what all the health care reformers are demanding that they do. Why should somebody ask a patient to expose himself to unnecessary radiation because an X-Ray hasn’t been sent over, or try to treat someone after surgery without knowing the discharge plan?

Actually, most physicians would. That’s how they have been operating for decades. Numerous articles find that most physicians don’t see the value of information exchange, and can profit from their ignorance of previous tests and treatments the patient has received.

And that’s probably why, after taking hundreds of millions of dollars from governments, the heavy-weight institutions called Health Information Exchanges have repeatedly thrown in the towel or been left gasping for breath. At least two generations of HIEs have come and gone, and the trade press is still searching for their value.

So I’m left scratching my head and asking: if doctors adopt EHRs for information exchange, are they getting what they paid for? Redemption may have arrived through the Direct project, an ONC-sponsored standard for a low-cost, relatively frictionless form of data exchange. Although the original goal was to make HIE as simple as email, the infrastructure required to protect privacy imposes more of a technical burden. So the ONC envisioned a network of Health Information Service Provider (HISP) organizations to play the role of middleman, and a number are now operating. According to Julie Maas of EMR Direct, nearly half a million people were using Direct in July 2014, and the number is expected to double the next time statistics are collected next February.

So far, although isolated studies have shown that HIEs improve outcomes and reduce costs, we haven’t seen these effects nationwide.

What Hinders Adoption
Some of the most intriguing statistics in the data brief concern who is adopting EHRs and what holds back others from doing so. The main dividing line is simply size: most big organizations have EHRs and most small ones don’t.

I have explored earlier the pressures of health care reform on small providers and the incentives to merge. Health care technology is a factor in the consolidation we’re seeing around the country. And we should probabaly look forward to more.

Americans have trouble feeling good about consolidation in any field. We’re nostalgic for small-town proprietors like the pharmacist in the movie It’s a Wonderful Life. We forget that the pharmacist in that movie nearly killed someone by filling a prescription incorrectly. In real life, large organizations can pursue quality in a host of ways unavailable to individuals.

One interesting finding in the data brief is that rural providers are adopting EHRs at the same rate as urban ones. So we can discard any stereotypes of country hick doctors letting teenagers set up the security on their PCs.

Lack of staff and lack of support are, however, major barriers to adoption. This is the last perplexing question I take from the data brief. Certainly, it can be hard to get support for choosing an EHR in the first place. (The Meaningful Use program set up Regional Extension Centers to partially fill the gap.) But after spending millions to install an EHR, aren’t clinicians getting support from the vendors?

Support apparently is not part of the package. Reports from the field tell me that vendors install the software, provide a few hours of training, and tip their hats good-bye. This is poetic justice toward physicians, who for decades have sent patients out weak and groggy with a prescription and a discharge sheet. Smart organizations set aside a major percentage of their EHR funding to training and support–but not everybody knows how to do this or has grasped the need for ongoing support.

I certainly changed some of my opinions about the adoption of EHRs after reading the ONC data brief. But the statistics don’t quite add up. We could use some more background in order to understand how to continue making progress.

Purpose of EHR Incentive Program According to CMS

Posted on September 9, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I was reading through the EHR Certification flexibility final rule, I found a really interesting part of the rule (pg.49-50) that describes what CMS sees as the purpose of the HITECH act and all the money their spending on EHR software:

The entire overarching purpose of the EHR Incentive Program is to move providers towards advanced use of health IT to support reductions in cost, increased access, and improved outcomes for patients.

It’s been one of my pet peeves lately. People always come on this site or on social media and say “that goes against the purpose of the HITECH act.” I often would reply, “what is the purpose of the HITECH act?”

My problem with people’s comments about the purpose of all this spending on EHR software is that purpose changes depending on perspective. I’ve written before about the misalignment between “incentives” and “purpose.”

While I think the purpose for something changes based on whose perspective you’re talking about, I think it’s really important to know where CMS is coming from when it comes to the EHR incentive money and meaningful use. Now we know. They made it quite clear in the final rule.

How do you think the EHR incentive money is doing at achieving CMS’ purpose?

What is Direct?

Posted on June 10, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that’s part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

John’s Update: Check out the full series of Direct Project blog posts by Julie Maas:

The specialist down the street insists he wants to receive your primary care doctor’s referrals, but only if it’s digital: “Sure, I’ll take your paper file referral sent via fax. But the service will cost an extra $20, to pay the scribe to digitize the record so I can properly incorporate the medical history.”

Does it really sound that far off? Search your feelings, Luke…

Will getting medical treatment using paper records soon be like trying to find somewhere to play that old mix tape you only have on cassette?  Sound crazy?  Try taking an x-ray film to a modern radiology department, and see if they still have a functioning light box anywhere to look at it.  It’s all digital now.

There are, of course, other factors.

Because MU2.

Because nobody, and I mean no small company and no large company, wants to be referred to as a data silo anymore.

Direct Exchange is a way of sending and receiving encrypted healthcare data, and certified EHRs must be able to speak it, beginning this year.  Adoption of Direct is increasing rapidly, and its secure transfer enables patient engagement as well as interoperability between systems that were previously dubbed silos.  Here is a brief overview of where Direct is currently required in the context of MU2 (please refer to certification and attestation requirements directly, for full details):

Certified ambulatory and acute EHRs need to use Direct for Transitions of Care (170.314(b)(1) and (b)(2)). They have to be able to Create a valid CCDA and Transmit it using Direct, and they have to be able to use Direct to Receive, Display, and Incorporate a CCDA. In the proposed MU 2015, the Direct piece may be de-coupled from the CCDA piece and modularized for certification purposes, but the end to end requirement would remain the same.

EHRs or their patient portal partner additionally need to demonstrate during certification that patients can View, Download, and Transmit via Direct their CCDA or a human readable version of it.  Yes, you heard correctly, I said patients.  As in patient engagement.

So, how does a healthcare provider get Direct?

1. Get a Direct account through your Direct-enabled EHR vendor

One way HIT vendors offer Direct is through a partnership with one or more HISPs (OpenEMR, QRS, Greenway, and others).  Others run their own HISPs (Cerner, athenahealth, and others).

2. Get a Direct account through an XD* HISP that’s connected to your EHR

HIT vendors alternatively enable access to Direct through an XD* plug-and-play (mostly) connector.  These “HISP-agnostic” EHRs allow healthcare organizations a choice between multiple XD*-capable HISPs when meeting MU2 measures (MEDITECH, Epic, Quadramed, and other EHRs have implemented Direct this way).  EMR Direct, MaxMD, Inpriva, and a few other HISPs offer XD* HISP services; not every HISP offers XD* service at this time.  Of course, there is a trade-off between this flexibility and the extra legwork required of the practice or hospital in setting up Direct.

3. Get a web-based or email client-based Direct account not tethered to an EHR or Personal Health Record (PHR)

 

Direct doesn’t have to be integrated into an EHR to transfer information digitally. Non-tethered accounts cannot attest to the sending side of (b)(2) nor the receiving side of (b)(1) on their own, but they can be Direct senders and receivers nonetheless, participating in Transitions of Care or data transfer for other purposes.  They may also be used to exchange health data with patients, billing companies, pharmacies, or other healthcare entities who are Direct-enabled. In fact, some very compelling use cases involve systems who may not have their own EHR, but want to receive digital transitions of care—one such example is skilled nursing facilities.

By the way, patients are also an integral part of the Direct ecosystem.  Several PHRs are already Direct-enabled, and more are on the way.

So, go digital and get your Direct address, and begin interoperating in the modern age!

The Time Has Finally Come for MU, It Really Is Now or Never

Posted on March 27, 2014 I Written By

The following is a guest blog post by Lea Chatham.
Lea Chatham

The healthcare industry has been talking about Meaningful Use (MU) for years now. The program started in 2011, but there were discussions and planning going on years before that. It’s become a ubiquitous topic in healthcare publications and blogs. So much so that many providers probably still think that they have time to decide if they are really going to attest or not.

The truth is that 2014 is last year to initiate participation for Medicare to receive incentive payments. To avoid the first adjustment of 1%, providers must attest for Stage 1, Year 1 no later than the third quarter of 2014 (July 1 – September 30, 2014). You can still start MU in future years to avoid additional penalties, but you won’t get any incentives and you will still have the 1% deduction on your Medicare Part B Claims starting in 2015. That penalty doesn’t go away if you start MU in 2015 or 2016.

What this means is that the estimated 40% of America’s physicians who don’t’ have an EHR and haven’t yet begun to attest for MU have a decision to make—now. And there are essentially three options:

  1. Choose an EHR and attest in 2014
  2. Accept the penalty (which increases each year)
  3. Request a hardship exception.

Here is what you need to know about each of these options so you can make the right choice for your practice.

Choose an EHR & Attest

Over $16 billion in incentives has been paid out to providers who have been attesting for MU. If you start in 2014, you’ll still get $24,000 over three years for your efforts. You’ll also avoid the penalties, which start with 1% in 2015 and increase each year for a minimum of three years. The larger your Medicare pool of patients, the more sense this makes financially.

If you are going to adopt an EHR now, be sure to choose the right solution for your needs. Many of the providers who have not yet implemented an EHR, are small practices (10 or fewer providers). According to a survey conducted in January by SK&A, the smaller the practice, the lower the adoption rate. Small, independent practices don’t have staff, time, or money to waste. So it has to be right the first time. Take these factors into consideration:

  1. Cost: There are now free and low cost EHRs that can offer almost any specialty the tools they need to reap the benefits of an EHR.
  2. Cloud-based and Mobile: Its 2014, don’t choose an EHR unless it offers anytime, anywhere access and true mobile connectivity.
  3. 2014 Edition Certified for MU: As of January 1, 2014, you need a 2014 Edition certified EHR to attest for MU. Only about 12% of complete EHRs have this certification, which narrows the field.
  4. Total Integration: You can get more from your EHR if it is fully integrated with your practice management and billing system. You can meet MU and streamline many other functions. As a bonus it can actually increase both charges and collections. A UBM white paper showed that the average increase in revenue was $33,000 per FTE provider per year!

Accept the Penalty

So you are thinking you’ll just take the penalty. This may be because you don’t serve Medicare patients or at least not that many. It could also be that you are planning to retire soon and don’t think you’ll be around in another couple of years. But consider this, with MU, PQRS, and eRx penalties, it reaches over 10% in total adjustments to your Medicare Part B claims in five years. If you do start seeing more Medicare patients (as your patients age) or you don’t retire, 10% is nothing to sneeze at. If you are a solo doc and you generate an average of $30,000 a month and about 30% of your patients have Medicare, that’s $10,000 a month. A 10% cut adds up to $12,000 a year. To make that up, you would have to conduct about 100-120 more patient visits a year (if your average visit reimbursement is around $100-150).

And here is something else to consider. Perhaps you are willing to take that hit, and you are sure that you don’t want to attest for MU. But does that mean you don’t need to implement an EHR? Not these days. Patient expectations are changing, and to stay competitive you need to meet those expectations. A study conducted by the Optum Institute showed that 62% of patients want to correspond with their physician online and 75% are willing to view their medical records online. Another survey conducted by Deloitte showed that two-thirds of patient would consider switching to a physician who offers secure access to medical records online. You need patients to stay in business so take their changing needs seriously or you may struggle to stay competitive in changing times.

Request a Hardship Exception

The first thing that needs to be said here is that not everyone can apply for a hardship exception. If you’d like to attest for MU, but need more time AND you meet one or more of the criteria, then you should definitely consider this option. This is a summary, check the CMS tipsheet to find out more:

  1. Your area lacks the necessary infrastructure (i.e., no broadband)
  2. You’re a new provider
  3. Natural disaster or other unforeseen barrier
  4. Lack of face-to-face interaction with patients
  5. Practice in multiple locations
  6. EHR vendor issues (i.e., your current vendor was unable to certify for 2014 edition)

For most providers who are practicing full time in a single location and have not yet chosen an EHR, these exceptions won’t apply. This leaves you with choices and one and two above. You will still need to decide if you want to attest or not.

If you are still on the fence, consider this… Beyond MU, practices are facing the ICD-10 transition and a changing reimbursement landscape with ongoing reform from of the Affordable Care Act (ACA). Technology can be a very effective tool to help you manage these changes and turn this set of challenges into an opportunity to optimize your practice and position your business for success no matter what comes your way.


About Lea Chatham

Lea Chatham is the Content Expert at Kareo, responsible for developing educational resources to help small medical practices improve their businesses. She joined Kareo after working at a small integrated health system for over five years developing marketing and educational tools and events for patients. Prior to that, Lea was a marketing coordinator for Medical Manager Health Systems, WebMD Practice Services, Emdeon, and Sage Software. She specializes in simplifying information about healthcare and healthcare technology for physicians, practice staff, and patients.