Ring 2: Readmission Reductions
April 13, 2015Ring 4: Bundled Payments
April 24, 2015
A recent discussion with a physician friend of ours started out as a cordial conversation about Electronic Medical Records (EMRs), and turned into a red-faced spit-flying tirade. We remained calm, and diplomatically expressed empathy for the rage caused by “these stupid IT systems.”
The effective use of EMRs by physicians is essential to successful implementation, and it requires a commitment of time, energy and patience. As the physician (and the hospital) soon discovers, the primary struggle with EMRs is the charting input, which happens as they simultaneously engage with the patient. As a result many physicians, in lieu of yet another training session on the EMR, request the aid of a scribe to push keys and click through myriad menus during the patient interaction, which defeats many of the expected efficiencies of an EMR.
Paper medical records have been optimized for physicians use over the last 100 years. In contrast, electronic medical records are progressing toward, and are not yet optimized for, physician use. Most doctors have iPhones, and use apps for various personal applications. However, when it comes to applying smart-phone apps for clinical documentation, the interaction by the physician becomes more daunting than expected.
The Federal government kicked off a frenzy of Electronic Medical Record development with the financial crisis bail-out. The American Recovery and Reinvestment Act of 2009 (ARRA 09) allocated billions of dollars of payments to promote the proliferation of EMRs and medical information exchanges. This allocation was done through the Health Information Technology for Economic and Clinical Health (HITECH) act, and the amount of government funds in play as incentives to build out EMRs was boosted by the Patient Protection and Affordable Care Act of 2010 (ACA).
The objective of the government action on supporting EMR growth was to modernize and reform the US healthcare system. The longer term goals were to integrate healthcare information and allow easy, yet secure, access to a patient’s health info. Access to this information is intended to yield significant results, such as, higher quality healthcare services, greater efficiencies with lower costs of delivered services, improved patient satisfaction.
The Centers for Medicare and Medicaid Services (CMS) were required to review the status of the provider’s EMR, and award or penalize the provider accordingly. There are three Stages of Development, referred to as levels of “meaningful use” in a physician and hospital practice setting. Hospitals and physicians were offered a significant incentive payment ($30-50 Thousand) if they could attest to specified levels of effective operation of their IT systems, i.e., the “Meaningful Use Levels” of a certified EMR system.
Since 2011, the “start date” of the EMR incentive program, the “Meaningful Use” criteria became a moving target with requirements for percentages of digitized patient records, computerized physician order entry, electronic prescription delivery etc. Systems were evaluated and judged, and once the provider accepted a Meaningful Use payment they were required to move toward the next stage within a maximum amount of time, or be subject to penalties.
Today, “Meaningful Use” incentives are not cash rewards, but avoidance of penalties. The bolus of government funding has been largely distributed, and now providers must maintain their Meaningful Use status to avoid reimbursement cuts, or directly applied penalty payments. Large and small health systems alike are attempting to integrate population health, and Clinical Decision Support Systems (CDSS) across the continuum of care delivery. The era of mobile computing, and big data analytics for healthcare is unfolding in front of us today.
The budget allocated by healthcare providers to build, maintain, upgrade their EMR systems currently dominates their technology acquisition goals. For a non-IT technology supplier to win serious consideration of their solution, that supplier must provide a value-based assessment of their solution that includes the clinical process improvements, work flow efficiencies and the related cost reductions. Otherwise, the provider will likely maintain their current path and invest allotted capital funds in their next level of EMR development.
As of today, the status of the EMR in the U.S., as an integrated healthcare information system, has not been realized, and we have many years and challenges ahead before that goal will be attained. As a supplier, positioning your solution to:
- integrate easily and “flex” with the provider’s evolving EMR
- improve the clinical quality of healthcare services
- increase the operational efficiency
- improve financial performance
…will provide the basis of a value-driven collaboration with the healthcare provider, that should assist you in building a credible business case that supports a decision to acquire your solution.
By:
Total Innovation Group, Inc. Senior Partner
and
Gunter F. Wessels, Ph.D., M.B.A.
Total Innovation Group, Inc. Practice Principal, Parter
To Read more about 5 Rings of Healthcare Reform℠ see other Blog post below: