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Should physicians convert to an Electronic Health Records System?

BY LISA WOOD, Senior Vice President, Commercial Lending, BB&T Bank

Numerous studies of Electronic Health Records systems (EHRs) have shown the benefits of such tools. Proper use of EHRs can slash drug interaction rates, decrease mortality rates among the chronically ill, cut nurse staffing needs, and lower costs. EHRs help practices run more smoothly while improving quality and safety. They have built-in checks to eliminate problems related to physicians’ notoriously poor handwriting. EHRs have system capabilities to help physicians keep abreast of medical advances, match patients with appropriate therapies, coordinate prescriptions, and communicate with other treatment teams.

Physicians are not the only ones to benefit from an EHR. Many systems being marketed today feature a “patient portal” that gives individuals immediate access to their lab results, x-ray reports, lists of medications, and other information. Patients can communicate securely via e-mail with their physicians and other medical staff.

Yet the adoption of EHRs in the U.S. has been slow. Only about ten percent of physicians use what might accurately be described as a fully functioning electronic medical record system, while slightly more than 50 percent have at least partial EHR systems in place. By contrast, 90 percent of doctors in the Netherlands, the United Kingdom, and New Zealand use EHRs.

In 2009, as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, the federal government set aside $27 billion for an incentive program that encourages hospitals and providers to adopt electronic health records systems (EHR). Billions more were allocated to help train health information technology workers and assist hospitals and providers in setting up EHRs.

The Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs provide incentive payments to eligible professionals, eligible hospitals, and critical access hospitals (CAHs) as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. The financial incentives offered by the federal government are substantial. The average physician with at least 30 percent of his or her patients covered by Medicare is eligible for up to $44,000 in total incentives. A physician with at least 30 percent of his or her patients covered by Medicaid is eligible for even more, up to $63,750. While the 2012 deadlines have passed to earn the full incentives, it is not too late to implement an EHR and still earn a substantial portion of them. To earn any of that money though, physicians must do more than simply purchase an EHR system; they are required to show that they have achieved “meaningful use” of that system in terms of improving quality. At a minimum, that will mean having systems capable of e-prescribing, reporting quality data, and exchanging data among providers.

There are two EHR Incentive Programs. CMS oversees the Medicare EHR Incentive Program, and the state Medicaid agencies manage the Medicaid EHR Incentive Program. The two programs are similar, but there are some differences between them. Links for information about the two programs can be found at:

• https://www.cms.gov/Regulationsand-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginner s_Guide.pdf

• https://www.cms.gov/Regulationsand-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicaid_Guide_ Remediated_2012.pdf

Going from paper recordkeeping to an EHR system is not easy. While EHRs hold great promise for improving quality of care and practice efficiency, the adoption of such systems can be a challenge for physicians and practices. The efficiency benefits of EHR’s are not always immediately apparent as new workflows and new processes must be learned.

Implementing an EHR can be costly, but it is not necessarily the cost of an EHR system that can be the most expensive. The most significant cost involved may be lost revenue incurred during the months of preparation, planning, training, and workflow redesign that typically comes with implementing an EHR. To help physicians overcome these obstacles, the HITECH Act has established a network of 62 Regional Extension Centers (RECs). The RECs are specifically charged with supporting providers in quickly becoming adept and meaningful users of EHRs. They offer seminars, advice, and, even direct technical support to practices. Find out more information about Texas’ RECT at http://www.texmed.org/rec/. Private insurers and large employers are also facilitating the adoption of HIT. Many major health insurers have some sort of incentive program to adopt EHRs and/or meet the meaningful use requirements.

As word of the financial and quality-related benefits of EHRs spreads, more physicians are likely to consider an EHR. Physicians should discuss plans to purchase and implement an EHR with their banker, as practices may need financing assistance with the purchase of the system and a line of credit for working capital during implementation. A loan repayment plans may be partially structured around the expected receipt of government incentives for the EHR.