The confusing world of EHR incentives

The federal government's substantial incentive program for electronic health records is no reason to rush out and buy one. Final rulings on how to interpret issues such as “meaningful use” won't be decided upon until the summer. Diligence is needed to choose a system that matches the practice workflow.

Doctors have asked staff at the Center for Practice Improvement and Innovation whether they have to buy an electronic health record (EHR) system within the next month to meet new government regulations. The quick answer to this question is no, but the question itself demonstrates the rumors floating around regarding EHRs and the new federal incentive programs.

The federal government started a substantial incentives program that provides practices up to $44,000 in Medicare funds for meaningful use of a certified EHR. This program, along with a comparable Medicaid program, was started as part of the American Recovery and Reinvestment Act (ARRA) and is frequently referred to as “meaningful use.” Incentives under the program will be available from 2011 to 2015, after which the federal government may start to reduce physicians' Medicare payments by 1% per year if they cannot demonstrate the meaningful use of an EHR system.

The government is still defining the specific rules of the program, and ACP expects the final rules to be issued in mid-June. What is clear from the proposed rules is that the tasks required to become a meaningful user of a certified EHR system will be substantial, and that the types of certifications for EHR systems will be more complex than the existing Certification Commission for Health Information Technology (CCHIT) process. Internists can find information and resources about meaningful use on ACP's Web site.

As internists look to adopt an EHR to qualify for meaningful use, they should develop a business case that does not count on receiving meaningful use funds. Given the expected rigor of the meaningful use criteria, many doctors may fail to qualify for the incentive payments. When developing a business case, physicians should consider the additional costs associated with meaningful use, such as laboratory interfaces.

It's also best not to rush the selection process. Finding an EHR that fits a practice's workflows and documentation styles will have a far greater financial impact than the funds received by meeting meaningful use criteria. Physicians and staff should make an effort to understand and implement the basic functions first before attempting the higher-level functions required for meaningful use. Focusing on more complicated functions may create inefficiencies that will cause substantial headaches and incur costs in the long run. Also, many of the higher-level tasks required in meaningful use assume that doctors are effectively using the EHR's basic functions. For instance, physicians should take time to standardize documentation processes across their practices and make sure to use their systems' templates, as these steps will affect how easily and accurately the EHR can perform population reporting tasks.

While there are new incentives for the use of EHR systems, there's no rush. Physicians should take the time to conduct a diligent search of potential EHRs to find the one that best fits their practices. For more information on meaningful use and EHR selection, please see ACP's HIT resource page.