Physician EMR Adoption: What 'Meaningful Use' Means After Implementation

Jennifer Dennard, E-Media Marketing Specialist
July 19, 2010


The road to Meaningful Use has been long, and not without a few bumps. Providers and vendors have made a lengthy trip to reach the final ruling on the term - released just last week - submitting to the government more than 2,000 comments on the rule. All in an effort to have some say in the process by which physicians and hospitals can qualify for funding for the adoption of electronic medical records (EMRs).

At the news conference announcing the final ruling, David Blumenthal, M.D., National Coordinator for Health Information Technology, said he is "confident the use of electronic health records will become a core competency among physicians, who will eventually lead the way in adoption," according to a recent report on HealthcareITNews.com. However, federal officials at the conference also acknowledged the challenges providers encounter at the beginning of the EMR adoption process.


Cardiology & Cardiovascular Consultants' Journey
What are the challenges providers can expect to encounter, especially those smaller practices that might not have a dedicated IT department, or other staff equipped to deal with the process? Are they easily solved? Billian's HealthDATA recently spoke with Cardiology & Cardiovascular Consultants (CCC), a specialist practice in Las Vegas, about its EMR implementation journey - the challenges encountered and the benefits realized.

Founded in 1990, CCC installed an EMR in 2008 after looking at close to six different systems over the previous two years. It worked with the EMR vendor during the installation process, which went fairly smoothly, and currently relies on that vendor for repairs and general assistance. Follow-up training/refresher courses have not been necessary. "The tutorials within the EMR are very user-friendly," says Heather Ruggeroli, Administrator at CCC. CCC's three physicians and 10 staff members use the system, fully adopted at this point.

Two major concerns have arisen since implementation, according to Ruggeroli: "When our wireless goes down, a major halt in work ensues since half of our computers in the office are wireless. The second is that the process to propose changes to the EMR program is lengthy. For instance, we don't like how limited our interoffice email is through the EMR program. We can email our vendor, and if they receive enough emails about this particular issue, they will design a patch to override the current method. But many, many users need to voice the same concern about the same problem to have a change made."

In addition to the $12,000 in reimbursement from the government CCC hopes to qualify for next year through the ARRA/HITECH Act, the EMR has afforded CCC several significant benefits. "Due to implementing the EMR, we have been able to reduce the number of employees since so many tasks can be managed from one location. This, in turn, has eliminated some cost to the business, particularly the need for a full-time transcriptionist.

"Another area of the practice where EMRs have proved useful in revenue recoupment is in the area of billing for the 'established patient office visit' and a 'new patient consult.' Most of our physicians used to bill on average a Level 3 for a patient's visit, but based on the physician's dictated note, the EMR codes these visits on average at a Level 4, meaning an increase in reimbursement from the insurance company."

Starting Out
Choosing the right EMR is perhaps one of the most important stages in implementation. Ruggeroli advises other practitioners to "determine what the needs of your practice are in all areas, i.e. cost of the system, billing capabilities, interoffice communication, dictation capabilities and scheduling capabilities to decide what system will work best for you."

Shane Danaher, Vice President of Client Services at Divurgent, a healthcare consulting firm that offers vendor selection among its many advisory services, has additional advice for those practices starting out on the road to EMR implementation: "Step back and make sure you enter the process armed with the right knowledge to ensure success," he says. "For some practices, this may require hiring an expert to assist with implementation, and for some it will require dedicating an experienced point person internally."

Danaher adds that an understanding of government incentive timelines is also crucial to selecting and implementing the right EMR, as well as the need to create a governance structure within the practice. "When you have one that is correctly set up, you can ensure that all parties have had a chance to inject their thoughts, and you can help balance some of the political aspects that can prevent successful usage of the system after implementation."

Moving Ahead
The recent release of final Meaningful Use criteria will hopefully make it easier for more providers to select and implement an EMR, and for practices like CCC to determine what upgrades will be necessary to become 100-percent compliant.

Danaher says that it also adds a level of complexity to the entire process. "It is easy to say that 'all vendors will have a certified version, or else they will no longer be a going concern,' but there are tidbits surrounding that matter. For example, is the version you are buying today the version that is certified? If not, what version will be and what will the upgrade cost be? Will that version have any impact on your IT infrastructure, thus causing additional costs outside of your EMR vendor relationship? Will your vendor have the abilities and bandwidth to ensure you are using that version in time for your practice to maximize incentives?"

Ruggeroli rests assured that CCC's EMR vendor will continue to provide the practice with upgrades necessary to remain compliant with meaningful use. "Recently we did activate programs within the software to become fully compliant," she says, adding that she will participate in a vendor-sponsored webinar early next month to go over the government's final determination of Meaningful Use.

Crossing the Finish Line
As healthcare providers, vendors and consultants take in the final Meaningful Use objectives, and determine what road to take over the next few months and years, it is plain to see that diligence is absolutely necessary on the part of all players. Coupled with a sense of urgency federal timelines have created, the road to realizing federal incentives grows shorter with each passing day.

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