When the American Recovery and Reinvestment Act of 2009 passed it included $19.2 billion for health information technology allocated to help hospitals and physicians’ offices for implementation of electronic medical records (EMR) often called electronic health records (EHR). Whichever name it goes by, healthcare providers had until January 1, 2014 to convert and prove the conversion was successful by demonstrating and documenting “meaningful use.”
What Is Meaningful Use Of
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EMR?
As it relates to Health Information Technology (HIT) “meaningful use” is using a certified EMR that serves to,
- Improve health quality
- Improve health safety
- Improve health delivery efficiency
- Reduce disparities in health care
- Interact with patients and families
- Advance coordination of medical care
- Secure and keep private information contained in the patient’s EMR
The government through the Centers for Medicare and Medicaid offers incentives to Medicare providers of up to $44,000. Medicaid offers incentives of up to $63,750. But, this money is not “just for the asking.” In 2011 and 2012, healthcare providers (hospitals, physician offices, and critical access hospitals) had to attest to Stage 1 meaningful use, which is the ability to capture and share data. Stage 2 is in effect now with attestation and audits of advance clinical processes and 2016 is Stage 3 where expectations are that providers show improved outcomes.
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Stage 1 Meaningful Use
So, Stage 1 goals for all participants are primarily informational such as recording and maintaining an active medication list, an active allergy list, vital signs, and height and weight, BMI and growth charts for children. Other examples include generating and transmitting medication prescriptions where allowed by state law, keep up an up-to-date list of patient problems that is current and has active diagnoses, document smoking status for patients over age 13.
Other documentation items are needed to meet the Stage 1 requirements as well.
Stage 2 Meaningful Use
By providers achieving Stage 2 Meaningful Use the intention is to increase the exchange of health information between healthcare providers and between health care providers and patients. In addition, patient access to their EMR is online.
Provider Challenges
Most providers already had computer systems for practice management before they moved to electronic health records. For many practices, integrating an EMR with a legacy practice management and billing system was simply impossible. These practices had two choices:
- Spend their incentive dollars on a new self-contained practice system or
- Look into cloud based Software as a Service (SaaS) programs that integrated with or were part of a practice management system.
Knowledgeable practice leaders chose option two. There are no new server costs. Monthly user costs are affordable and expensed rather than depreciating software and hardware. SaaS is flexible and scalable. When the practice expands its number of providers, it can easily expand the SaaS system with no capital outlays. The system is accessible from any site that has an Internet connection, meaning that physicians can enter notes or look up patients away from the office. This feature is very attractive for responding to emergency calls away from the office on any device – even a Smartphone.
When making hospital rounds, patient notes go directly to the office chart from the patient’s bedside.
Providers can write their office notes at night from home and regain time with family.
But, most importantly, many SaaS EMR vendors hold certification for meaningful use Stage 1.
Audits for Compliance
The Centers for Medicare and Medicaid (CMS) is the authority for paying Medicare providers meaningful use incentives. Each state Medicaid program holds that responsibility for Medicaid incentive payments. CMS advised providers that post payment audits will occur in 2014. Accordingly, they suggest that providers keep all relevant electronic or paper documentation that supports meaningful use attestations for six years and documents supporting payments follow current document retention practices.
Interestingly, the original thought was that all audits performed were complete audits of meaningful use. But, providers are also undergoing “limited use” audits that may audit only one aspect of meaningful use. Providers not ready for either a full or a limited audit are risking civil and even criminal (fraud) penalties.
