At face value, the numbers are impressive: Nearly 100,000 physicians qualified for meaningful use incentive payments during the first four months of 2012. Yet a closer look reveals that many physicians have a long way to go before qualifying for payments under the Medicare or Medicaid EHR Incentive Programs.
Zubin Emsley, CEO of ChartLogic, shared his perspective on physicians' progress toward achieving meaningful use: "Although this is a significant number, it represents less than 13 percent of the estimated 780,000 practicing physicians in the U.S."
Emsley outlined five suggestions to help physicians get up to speed on difficult meaningful use requirements.
1. Require patients to self-report demographic data.
A key requirement of the meaningful use program, said Emsley, is the collection of patient demographic data such as gender, race, ethnicity and preferred language. "Many practices, particularly specialists, haven't traditionally collected all of this information and entered it as structured data into the medical record," he said. "Asking patients to self-report is the most efficient path to compliance." Some physicians may be worried about asking patients to do this, he added, but, surprisingly, most patients are used to entering this type of information on forms as it is. "The most direct route is to provide patients with laptops, tablets or kiosks in the waiting room to enter the information electronically."
2. Distribute clinical summaries via a patient portal.
Meaningful use requirements require a physician’s office to provide clinical summaries to patients within three business days of the visit. "In many busy specialist practices, physicians may see 50 patients per day, making it difficult to complete all the documentation before the patient leaves the office," said Emsley. "To fulfill this requirement without a portal, practices may need to mail the patient a printed summary. Printing and postage costs make this a costly, stop-gap solution." When the practice installs a patient portal, he added, staff can more quickly upload the clinical summary to the website. "Note that it is not currently required that patients download or read the clinical summary, just that it be 'provided,' which is generally interpreted as having been sent electronically," he said.
3. Delegate vital sign collection, and consider digital monitors.
Stage 1 meaningful use requirements compel practices to collect vital signs on each patient visit, said Emsley. This is another set of data many specialist practices – such as orthopedists and ophthalmologists – haven't generally collected. "It makes no sense for the physician to collect this information himself," he said. "The office workflow can be organized so that medical assistants collect the data." It may make sense to invest in a digital vital signs monitor, he added. "These machines can read weight, temperature and blood pressure, and automatically upload it to the EHR, eliminating the need to input it with a keyboard."
4. Dictation and custom templates speed physician input.
"Practice efficiency will be significantly impaired if the physician must manually type in each patient’s clinical information to a static EHR," said Emsley. Most advanced EHRs incorporate voice recognition and custom templates, he continued, which allow for accurate summaries to be created in seconds. "For example, some EHRs allow physicians to move from template to template by voice command, without clicking on pull-down menus," he said. "Many physicians prefer voice commands because of their long experience with dictation."
5. Look beyond initial incentive payments for long-term gains.
According to Emsley, smaller physician practices report that cost is the highest barrier to adoption of a certified EHR system that could enable meaningful use. "Practices that qualify in 2012 can earn up to $44,000 over the next five years in incentive payments," he said. "That's a large sum, but practice leaders still question whether it will justify all the costs of purchasing and installing the needed EHR system." Emsley said there are two factors to consider. First, an effective, full-featured EMR system can increase practice productivity. "Second, the meaningful use incentives, or 'carrots,' will soon turn into sticks. Physicians who do not meet meaningful use standards by October 2014 will face Medicare payment cuts of 1 percent in 2015 and 2 percent in 2016."