More than 250,000 eligible professionals have successfully attested to meaningful use stage 1, and plenty more are sure to follow before stage 2 begins in 2014. Meeting stage 1 requirements, however, does not mean that providers will be adequately prepared for the next stage of meaningful use. In fact, many chose to opt out of stage 1 objectives that are going to be mandatory in meaningful use stage 2.

For stage 1, providers were required to meet 5 of 10 menu objectives and could defer the rest to stage 2. Many did so, knowing that in stage 2 the objectives would likely become mandatory. The objectives that were deferred most often, according to an American Medical Association article, include:

• Summary of care record for each transition of care/referrals (84 percent)


• Send reminders to patients for preventive/follow up care (80 percent)


• Provide electronic syndromic surveillance data to public health agencies (68 percent)


• Provide patients with timely electronic access to their health information (66 percent)


• Medication reconciliation (55 percent)

Of these, syndromic surveillance is the only one that will remain a menu objective in stage 2. The others have all become mandatory core objectives, and providers will need to attest to them in order to qualify for meaningful use incentives.

Many of the deferred objectives are related to interoperability, which is a major focus in meaningful use stage 2. It requires being able to share data with third parties from EHR to EHR or through health information exchanges. Healthcare organizations that do not have the means to do so will have a lot of work to do to get the systems in place before 2014. Trying to tackle these stage 2 requirements without prior experience may make it more difficult to successfully attest on the first try. Another factor that could complicate meeting interoperability-related objectives is that they are going to carry higher thresholds for compliance in stage 2 than they did in meaningful use stage 1.

A good suggestion for providers leading up to meaningful use stage 2 will be to keep track of percentages for different objectives. This way, they can get an idea of whether or not they will be able to meet the thresholds required for stage 2. It is also going to be important for providers to work closely with their EHR vendor to ensure that interoperability requirements will be able to met.

Source: http://www.ama-assn.org/amednews/2012/11/05/bil11105.htm

Electronic prescribing is important for preventing medication errors and increasing compliance, and it can lead to higher quality care for patients. With this in mind, the Centers for Medicare and Medicaid Services included e-prescribing as a requirement for meaningful use stage 1. Of all of the objectives eligible professionals must meet in order to qualify for meaningful use incentives through the EHR Incentive Program, e-prescribing has been one of the most widely accepted.

According to a report released last month by the Office of the National Coordinator for Health Information Technology, as of June 2012, 48 percent of U.S. doctors were using EMR software to send prescriptions electronically via the Surescripts network compared to 7 percent in December 2008. Surescripts is the nation’s largest e-prescribing network. It is used by nearly 95 percent of pharmacies and by an overwhelming number of physicians across the United States.

The states with the highest percentage of e-prescribing physicians include:

• Massachusetts (77 percent)


• New Hampshire (74 percent)


• Iowa (73 percent)


• Minnesota (72 percent)

Meanwhile, the states that have the lowest number or physicians e-prescribing include Alaska (32 percent), Utah (36 percent), California and Nevada (37 percent). Despite their lower-than-average e-prescribing rates, even these states have seen a tremendous increase in e-prescribing participation from 2008 to 2012. In fact, only between 3 and 6 percent of physicians in these states were using EMR software to send e-prescriptions in 2008.

E-prescribing allows physicians to manage patient medications more safely and efficiently. It can reduce healthcare costs, increase medication compliance, and improve patient safety. In order to attest to meaningful use stage 1, eligible providers must generate and transmit e-prescriptions for more than 40 percent of patients. Meanwhile, compliance in stage 2 will increase to more than 50 percent.

Much of the talk surrounding the implementation of new healthcare information technologies is centered on EMR software and online patient portals, yet practice management (PM) software is just as essential to the functioning of a healthcare organization. It helps manage administrative processes and the financial aspects of a business, and it should be evaluated with the same criteria that is used to assess electronic medical record software.

The right PM system will meet your practice’s current and future needs, integrate with existing workflow, and have the capability to support future upgrades, such as the upcoming conversion to ICD-10. Systems that do not meet those needs can lead to significant coding and billing challenges, reduced efficiencies, and gaps in the revenue cycle. Therefore, choosing the right PM software – whether you prefer an all-in-one EMR/PM or a product that interfaces with your current system – is equally important to your organization as implementing the right EMR.

Here are a few suggestions for selecting an appropriate practice management system for your practice:

Analyze your practice’s revenue cycle. Employees involved in the revenue cycle, and those that will use or be directly affected by a practice management system should be involved in the assessment process. These staff members will be able to help you understand your current revenue cycle workflow, as well as how an automated system can help increase efficiencies and reduce administrative costs.

Identify features and functionalities. After analyzing your practice’s revenue cycle and the processes used by your employees to accomplish financial and administrative tasks, you will want to identify the features and functionalities that will benefit your practice most. Consider how your practice handles tasks such as patient scheduling and registration, billing and collections, and interoffice communication – and think about how a PM system could help perform those tasks in a more efficient way.

Make a list of other requirements for the vendor. Aside from system requirements, determine other areas of importance that you would like to discuss with the practice management vendor. This could include:

• Vendor references from other physicians
• Ability to interface with EMR software
• Hardware requirements
• HIPAA and ICD-10 compliance
• Maintenance and support from technicians with health IT certification

Having a checklist or a list of questions prepared to ask the vendor will ensure that you cover all your bases and that you have a clear understanding of each PM system before making the final purchasing decision.

To qualify for federal incentives, healthcare providers eligible for the Medicare and Medicaid Meaningful Use programs must implement certified EMR software and use it in a meaningful way. Purchasing and implementing this software requires time and money, but most of all it requires capable staff members, IT technicians and trainers – all working together to adopt a system than can greatly benefit patient care. On the contrary, the lack of IT resources and proper training can make it difficult to successfully integrate an EMR system with existing processes and workflows, leading to a potential decline in quality of care.

Following are some of the challenges that providers face on the road to becoming meaningful EMR users, as well as how they can overcome them.

Inexperience

A great number of the providers participating in the EHR Incentive Program are first-time EMR software users with little to no experience using an electronic charting system prior to meaningful use. For these users, taking EMR training seriously is especially important, as charting errors could compromise patient health. Unfortunately, this does not always happen. Instead, in the rush to meet meaningful use stage 1 criteria, physicians often gloss over training or do not give it the importance that it deserves. Many organizations even set a “go live” date without their staff having undergone proper training, thinking that EMR-related tasks can be learned on the job. This is an unwise move, and could end up costing patients and providers gravely.

To avoid EMR mishaps due to inadequate training and IT setup, physicians should talk to other EMR users who have successfully implemented the software for the first time. These users could provide other physicians with insight as to obstacles that might come up, as well as advice on how to overcome them.

Lack of resources

Inexperience is not the only reason healthcare professionals skip training. Many practices lack the resources – whether due to cost constraints or a shortage of qualified techs – to customize their EMR software and adequately train staff on how to use it. Poor training can lead to disruptions in care, loss of productivity, and even erroneous or fragmented data documentation. This means that careful training is just as important as EMR selection, and it is a necessary factor in improving patient care. Small practices that need technical assistance and EMR support can turn to regional extension centers (REC) for help with meaningful use stage 1 criteria. A complete list of RECs is available here.

Finding the right EMR software and successfully implementing it in your practice can be a time-consuming process – and healthcare providers shouldn’t have to go through the ordeal more than once. For this reason, many health IT consultants recommend adopting software solutions that include electronic medical record, practice management and patient portal software all in the same bundle.

Although a physician’s primary activity is examining patients and recording health data, all aspects of the patient visit – from registration to billing – are interconnected. This means that to achieve maximum efficiency and productivity, each of a healthcare organization’s systems must be able to communicate seamlessly.

The benefits of EMR/PM solutions

With all-in-one solutions, providers can document patient encounters in the EMR and rest assured that diagnoses and procedure codes will be available to medical billing staff through the practice management module. Additionally, patient data entered into the EMR at check-in is also available to billing staff for insurance purposes, which means that data doesn’t have to be entered twice or manually transferred from one system to another.

The patient portal feature also participates in the software connectivity, making it easier for doctors and patients to maintain open, active communication. For example, patients using an EMR/PM-integrated patient portal can:

• Access their health data, including visit summaries and medication lists
• View billing information, such as current balance, and even pay their bills online
• Submit scheduling requests for appointments
• Send secure messages to their doctor, as well as requests for prescription refills

These are some of the ways that all-in-one electronic medical record systems are making it easier for physicians to manage their clinical, financial and administrative operations all from the same easy-to-use platform. It is important to remember, however, that there are some drawbacks to these systems, which can make them less than optimal for use in many care settings.

Why an all-in-one solution might not work

Before purchasing a package deal, physicians should consider their organization’s workflows and company structure, which may not be suited for an all-in-one EMR. For example, a small physician practice participating in an accountable care organization (ACO) might use the same software as a large hospital within the same ACO network, despite the fact that the needs of these two facilities are starkly different. In this case, physicians may choose to set up interfaces with the EMR in order to use their own practice management software or patient portal, which can be customized to meet the requirements of their providers and patient base.

While all-in-one solutions can allow providers to skip multiple implementations, cut down on training time and eliminate gaps in productivity, they are not for everyone. Therefore, before purchasing an EMR system, it is important for healthcare professionals to do their research and to consider how the software might suit their organization, its workflows and charting needs.

Measuring return on investment for an electronic health record system isn’t easy. In fact, many healthcare professionals are unsure as to how to measure the EHR ROI at all considering that the many of the software’s benefits are not financial. According to a report by the Center for Information Technology Leadership (CITL), a HIMSS-supported nonprofit research organization, a health IT solution’s value is defined by the sum of its financial, clinical and organizational benefits.

Financial

Financial values refer to physical costs that can be measured in dollars and cents. Some values that can be measured monetarily include:

• Cost Reductions: Decreased staffing or administrative fees and financial gains, which might include improved charge capture and higher patient volume
• Supply Costs: EHRs reduce paper-based expenses and eliminate filing costs altogether
• Transcription Fees: Electronic charting eliminates transcription costs, as doctors are able to enter data quickly in the EHR during the patient visit
• Charge Capture: Improvements in charge capture ensure that physicians get paid for each of the services performed

Clinical

Clinical benefits are a lot more difficult to measure, but they are equally, if not more, valuable to physicians than financial benefits. Therefore, when conducting an electronic medical record ROI analysis, it is important for physicians to take clinical factors into account. To measure clinical value, according to CITL, healthcare professionals should consider improvements in clinical decision support and the quality of patient outcomes. For example, EHR software can reduce medical errors and adverse drug reactions, while increasing medication adherence.

Organizational

Organizational value is perhaps the most difficult ROI factor to measure, as it deals with patient and caregiver satisfaction with the electronic medical record system. For employees this can include nurses spending less time on administrative tasks and doctors spending less time charting. For patients, organizational value can be measured through decreased wait times and a perception that care quality has improved. To measure this, data can be collected from patients, providers, nurses and other staff through feedback surveys and opinion polls.

Physicians considering implementing a patient health record system should focus on educating patients about what is PHR software and how to use it.

Although Stage 2 of meaningful use deadlines are in the distance, many providers have already started thinking about the patient engagement portion of meaningful use requirements. In order to successfully attest to stage 2, physicians will need patients to access a patient health record (PHR), online portal, or other EMR-integrated solution. Stage 2 requirements call for some type of involvement from patients on two separate measures:

1. The measure for the core objective "provide patients the ability to view online, download and transmit their health information with four business days of the information being available to the EP" requires that more than 5 percent of patients take advantage of this information and access it online.

2. For a new objective, "use secure electronic messaging to communicate with patients on relevant health information," meaningful use guidelines also specify that more than 5 percent of patients must take advantage of this feature and send at least one secure message to their provider.

Healthcare providers who are worried that only patients of a certain age, income or education level will be inclined to use a PHR need not worry. A recent study by University of Central Florida researchers shows that PHR use is linked to an understanding of e-health and not to age or socioeconomic factors.

Of the 562 patients surveyed for the study, 77 percent aged 41 to 55 indicated a willingness to use a PHR. Of those with a high school education or less, 71 percent expressed an interest in using PHR technology. Meanwhile, 75 percent of patients in the lowest income category also reported wanting to use a PHR.

A common factor among patients willing to use a patient health record is that 65 percent indicated a high level of health literacy across different age groups, income brackets and education levels. This means that patients who understand how to access their health information online, as well as what that information means, are more likely to view it than those who do not. This is good news for physicians who can prepare for stage 2 by working with patients to improve their e-health literacy. This starts by getting patients more involved in their own health, emphasizing the importance of accessing their patient health record, and explaining important topics such as “What is PHR?” This can be accomplished by:

• Showing patients how easy it is to access their health data


• Addressing privacy concerns


• Showing patients how to interpret the information that is available to them


• Explaining what the benefits are of accessing their health information

Mobile health technologies are gaining popularity with healthcare professionals and even patients; yet, there is no mention of mHealth in meaningful use stage 1 or 2 guidelines. Will we see it included in stage 3?

Electronic medical record software is improving patient care in many ways and helping physicians streamline workflows and become more efficient. EMRs have also allowed healthcare professionals to improve care in other ways by incorporating additional IT solutions, such as mobile health technologies. Yet, despite the growing prevalence of mHealth in the medical industry, government officials have not yet included anything about it in regulations for meaningful use. Will this change for the third and final stage?

What is mHealth?

Mobile health refers to health-related services that are supported by mobile devices, such as cell phones and tablets. mHealth technologies can help physicians monitor patient health, collect medical data, deliver information to patients and colleagues, and even provide care at a distance. mHealth applications also allow patients to monitor certain aspects of their health themselves, leading to greater involvement in their own care.

How might mHealth be addressed in stage 3 meaningful use?

With a growing number of patients using mobile devices for health information, and even more physicians using their smartphones and iPad medical apps to access electronic medical record software, it is only a matter of time before federal officials mention mHealth in their EHR Incentive Program. Although the rules for the final stage of meaningful use are not yet finalized, physicians can expect a greater focus in stage 3 on patient-reported outcomes and device interoperability. This means that mobile devices and mHealth applications will need to be able to read and transmit data sent from other devices and that security issues will need to be addressed.

In anticipation of these requirements, California congressman Mike Honda is set to introduce a bill which would create an Office of Mobile Health at the Food and Drug Administration (FDA). Known as the Healthcare Innovation and Marketplace Technologies Act (HIMTA), the legislation would also establish a support program at the Department of Health and Human Services (HHS). The purpose of the FDA office would be to provide recommendations on mobile health application issues. Meanwhile, the HHS program would help ensure that app developers comply with HIPAA standards and other privacy regulations.

This shows that officials are taking mHealth technologies seriously – not only in how they are able to benefit patient care, but in how they could potentially harm patients’ health, as well.

Since EMR software came on the scene, there has been no shortage of studies regarding the pros and cons of electronic medical record technology. In fact, you can find EMR studies for just about anything: Do EMRs reduce costs? Do they increase productivity? Is paper use really down with electronic charting? The list goes on and on. Now, researchers have found solid evidence that EMR use could lead to better quality care, according to a recent study published in the October issue of The Journal of General Internal Medicine.

In the study, researchers with Weill Cornell Medical College and New York Presbyterian Hospital analyzed data from 466 physicians that participated in a Hudson Valley Initiative project. From that data, they determined that there is a definite correlation between the use of EMR software in physician practices and the delivery of high quality patient care. In fact, EMR use was linked to higher quality of care overall for nine different clinical care measures. Scores were significantly higher on the following four measures:

• Breast cancer screening
• Chlamydia screening
• Colorectal cancer screening
• A1c testing in diabetes

Though past reports have been conflicting as to whether EMRs can actually improve care delivery, the Hudson Valley study seems to reflect the fact that healthcare professionals are getting more comfortable with their EMR systems and are eager to put them to good use beyond just incentive programs, such as meaningful use stage 2. This includes using their new software systems to increase office efficiencies and improve patient care.

Of course, while EMR software may help physicians improve quality of care for patients, it is only one component of healthcare delivery – and simply having an EMR does not guarantee that care quality will improve. Medical professionals need to be properly trained on using their EMR, and the software needs to be integrated properly into the healthcare facility’s workflows.

Attesting to meaningful use is not an easy feat, and trying to accomplish that while balancing other IT projects makes it even more difficult to do. For this reason, many medical professionals are turning to healthcare IT consultants for guidance. Health IT experts possess the tools to help physicians get the job done – and physicians are starting to see the value of meaningful use consulting services.

KLAS, an independent research firm, confirmed this when it released a report this past July entitled “Rapid Growth of Meaningful Use Consulting: Why Providers Are Reaching Out.” As part of their study, KLAS researchers found that many primary care providers are seeking third-party consultants to help implement meaningful use. This is due to the fact that physicians are increasingly juggling several IT projects at the same time, and staff resources get spread thin causing employees to become overwhelmed.

The solution for healthcare organizations in this situation is to seek assistance from outside consultants such as the EMRapproved 4Med Network. This makes it possible for medical facilities to carry out multiple IT-related projects at the same time with little or no stress.

As part of their study, KLAS identified 51 consulting firms that have worked on one or more meaningful use projects, offering a wide range of services. The four main areas in which consulting firms are helping physicians include:

1. Quality measures and reporting;
2. User adoption (go-live support, training, computerized physician order entry (CPOE), and clinical transformation);
3. Software upgrades and updates; and
4. Understanding meaningful use requirements.

Additionally, physicians continue to turn to consulting companies because they see a high success rate in meeting healthcare organizations' expectations. In fact, aside from Meaningful Use Stage 1, it is estimated that a large percentage of physicians will continue working with healthcare IT consultants for future EMR-related projects and subsequent stages of meaningful use.

Looking for Meaningful Use Stage 2 information? Check out Meaningful Use Stage 2 summary.