Technology Feature - April 2010
RECs to the Rescue: Regional Centers Help Physicians Use HIT
Tex Med. 2010;106(4):61-67.
By Crystal Conde
Physicians know that properly implemented electronic medical records (EMRs) can improve quality of care, simplify office workflow, speed access to patient records, and allow medications to be prescribed electronically. But fear is motivating a small primary care group in the Texas Hill Country to ditch paper records in favor of an EMR system.
A family physician in the group says it decided to go electronic to better respond if the group is picked out by Medicare's recovery audit contractor (RAC) program or receives a billing inquiry by another governmental agency. The doctor asked to remain anonymous out of concern he'd be targeted for an audit if he spoke out publicly.
"The decision to adopt an EMR is more of a risk management issue for us than anything else. We're scared to death of the RACs and the Office of Inspector General. I think that if we're audited it will be easier for us to access data and put together documentation with electronic records," he said. (See "TMA Prepares You for Possible Audits.")
Sidney Ontai, MD, MBA,chair of the Texas Medical Association's Council on Practice Management Services and a member of the Ad Hoc Committee on Health Information Technology (HIT), says EMRs are valuable in disputing inaccurate rankings by insurers, as well.
"Insurers are using claims data to rank physicians on what they claim to be evidence-based measures. EMRs are capable of sophisticated data mining, which will help physicians not only improve performance, but also contest erroneous insurance company rankings," he said.
Whatever the reason may be, more physicians are switching to EMRs, according to the results of TMA's 2009 EMR Survey [PDF]. The Hill Country physician says his practice plans to adopt an EMR within the next six months. He's not alone. The survey shows 16 percent of physician respondents plan to implement an EMR within six months. (See "TMA Survey: More Physicians Adopt EMRs .")
The physician says his practice has postponed EMR implementation because finding a quality product that's the right fit for his specialty is daunting. He and other physicians who've held off on jumping into EMRs stand to benefit from the services of regional extension centers (RECs) that will be set up around the state.
Last year, the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) solicited grant proposals to create RECs. Texas was absent from the list of grant recipients HHS announced in the first round of funding in February. (See "HHS Awards Nearly $1B for RECs, HIE, Job Training.")
Texas submitted four applications for grant awards. At press time, TMA anticipated the funding announcement that included Texas recipients to be made March 19.
The RECs will be established much like agricultural extension centers and will offer education, outreach, and technical assistance to help physicians implement and "meaningfully use" certified electronic medical record technology. They will focus on helping primary care physicians and practitioners who have prescriptive authority, such as physician assistants and nurses, "meaningfully use" EMRs.
"I think RECs could really prove valuable from an implementation standpoint. Physicians want to know how long setup takes, how user-friendly systems are, and how well they simplify office workflow," the Hill Country physician said.
In the long run, he says EMR adoption will benefit his practice and his patients.
"I don't anticipate it being faster, but it will make record keeping and documentation much cleaner and more accessible to the patient. I'm looking forward to getting rid of our 15,000 paper charts," he said.
RECs in Texas
When the ONC called for grant proposals, Texas responded with an ambitious and coordinated plan to divide the state into four regions. They are the North Texas Regional Extension Center, anchored by the Dallas-Fort Worth Hospital Council; the West Texas Regional Extension Center, headed by Texas Tech University Health Sciences Center; the CentrEast Regional Extension Center, directed by Texas A&M Health Science Center-Rural and Community Health Institute; and the Gulf Coast Regional Extension Center, led by The University of Texas Health Science Center at Houston. (For a map of the REC regions, see "Texas Regional Extension Centers.")
Each of the four RECs applied to the Centers for Medicare & Medicaid Services (CMS), which could grant a maximum of $30 million to each applicant.
"The West Texas REC has to cover a space that's equivalent to the distance from Washington, D.C., to Maine," said Joseph H. Schneider, MD, MBA, chair of TMA's Ad Hoc Committee on HIT and chief medical information officer for Baylor Health Care System. "Texas RECs face great challenges, given the state's geography and population size. All four RECs will work together and collaborate to reach primary care physicians. Each REC has a tremendous task. In addition to outreach, education, and technical assistance programs, they must help physicians improve quality of care, thereby meeting 'meaningful use' criteria and qualifying for Medicare and Medicaid incentive payments."
Under the portion of the stimulus package known as the Health Information Technology for Economic and Clinical Health (HITECH) Act, non-hospital-based physicians who accept Medicare patients and demonstrate "meaningful use" of a certified EMR technology could earn up to $44,000 in incentives from 2011 to 2016. For those who meet the requirements by 2011 or 2012, the first Medicare incentive payment is $18,000. The incentives then drop to $15,000 by 2013 and $12,000 by 2014. (See "Physician Medicare Incentive Payments, by Year of Eligibility.")
Non-hospital-based eligible physicians with at least 30 percent Medicaid patients could receive up to $63,750 over six years, beginning in 2011 ($21,250 for year one and $8,500 for each of the next five years).
Non-hospital-based eligible pediatricians with at least 20 percent Medicaid patients could receive up to $42,500 during the same period ($14,167 for year one and $5,667 for each of the next five years). The last year a physician may begin using an EMR system to qualify for the Medicaid incentives is 2016. The stimulus legislation says the government will not penalize Medicaid physicians for not adopting a certified technology. Physicians can't receive incentive payments for both Medicare and Medicaid.
At press time, CMS was finalizing "meaningful use" criteria. TMA's Ad Hoc Committee on HIT prepared comments to the more-than-500-page proposal on "meaningful use" criteria and submitted them to CMS in March. According to Dr. Schneider, "TMA is working to ensure 'meaningful use' is meaningful to both patients and physicians and not just a list of criteria for the government."
To stay up to date on "meaningful use" criteria and for additional information about the incentives, visit www.texmed.org/HITREC.
Dr. Schneider says coordination among the Texas RECs is crucial to their success.
"The goal of the RECs is to provide physicians in all parts of the state the same level of assistance or support as other doctors in the state. The RECs will help physicians with EMR vendor selection, implementation, and optimization, including helping physicians connect their systems with the rest of the world," he said.
The government subsidies from the ONC to the regional centers will phase out. During the first two years RECs are up and running, the government covers 90 percent of their operating costs. That reduces to 10 percent of operating costs for years three and four. By the fifth year, the subsidies end. That's why RECs must develop sustainability plans, which could include charges for services. Each center will determine what it charges physicians for services.
RECs will be able to tap into some of TMA's educational and support services. Dr. Ontai says TMA could expand availability of its Web-based selection tool, which compares EMR vendors with the largest Texas market shares on pricing, features, and compliance with evolving state and federal "meaningful use" criteria. The EMR selection guide is available on the TMA Web site . (See "TMA HIT Resources Aid Physicians.")
TMA has also worked hard to make sure physicians control the majority of the seats on the REC governing boards.
"The implementation of the HITECH initiative could have profound effects on physician practices, and we need to have a strong voice at the table," Dr. Ontai said.
What's In It for Doctors?
Among the services RECs offer primary care physicians, on-site technical assistance will be vital and account for a large portion of REC activities, says Kim Dunn, MD, a Houston internist who's the lead with the Gulf Coast Regional Extension Center at UT Health Science Center at Houston.
In addition, RECs will support physicians with vendor selection, group purchasing, implementation, project management, workflow redesign, interoperability, health information exchange, and best practices in privacy and security.
Identifying the primary care practitioners in the region served by the Gulf Coast Regional Extension Center and assuring that those physicians have access to cost-effective communications support are priorities for Dr. Dunn.
"The Usability Lab at UT Health Science Center at Houston will be the lead in the state for establishing a process to create a uniform evaluation of EMRs to assure they meet interoperability standards and meaningful use," she said. "We're also testing systems to determine the actual amount of time it takes physicians to install them, train staff to use them, and enter patient data into them."
Dr. Dunn has identified four ways in which the RECs will benefit physicians. They will be able to:
- Tell physicians which information systems and communication tools are worth the money;
- Develop sustainability strategies to help physicians get a return on their investment;
- Help physicians qualify for "meaningful use" incentives via EMRs and health information exchange; and
- Help restore integrity to the patient-physician relationship by giving physicians access to the right data at the right time.
"RECs will help physicians take patient data and translate that into information that's actionable," Dr. Dunn said. "Having the resources to provide patients with the best possible care will foster trust in the physician."
Dr. Schneider says the extension centers will keep physicians from "having to reinvent the wheel," adding, "RECs will also provide the protections to small practices that otherwise might not be able to negotiate strong contracts with vendors."
He says RECs won't be able to support the more than 300 EMR vendors currently in the market. That means vendors are going to have to vie for preferred status; physicians who buy products from a preferred vendor will reap the benefits RECs have accrued from those companies, such as discounted pricing and premium service. The criteria for achieving preferred status are being developed. He says physicians who go with a nonpreferred vendor can still receive REC assistance, but it will be limited.
"Physicians need to urge their vendors to participate in the preferred vendor process. There are over 300 vendors, and not all of them can be chosen," Dr. Schneider said.
Vendors began submitting requests for proposal for preferred vendor selection to the RECs on March 1. At press time, RECs were reviewing EMR products submitted for preferred vendor status to determine their ease of use and functionality.
Drs. Ontai and Schneider say the RECs' services will help physicians improve practice management.
"Most practice management functions these days require some form of computerization, but even more importantly, attention to staff workflow and training that allows effective use of computer systems," Dr. Ontai said.
"It's in the best interest of doctors and patients for doctors to learn to use EMRs in the best possible way. RECs can help them achieve that," Dr. Schneider said.
Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by e-mail at Crystal Conde .
TMA Prepares You for Possible Audits
The federal government is looking for fraud and abuse in the Medicare system and has hired audit firms across the country to pore over records for improper payments. It's called the Recovery Audit Contractor program.
To help physicians prepare for possible audits by Connolly Healthcare, hired by the Centers for Medicare & Medicaid Services to conduct audits in Texas, TMA is conducting "Recovery Audit Contractor Reviews: Self-Audit Is Your Best Defense" seminars throughout the state. Three were held in March. Five more are scheduled in April: in Houston on April 7; in Lubbock on April 8; in Dallas on April 13; in Tyler on April 14; and in Fort Worth on April 15.This program is designed for physicians who treat Medicare patients, compliance officers, office managers, and billing and coding personnel.
To register online for the course, worth 3.75 AMA PRA Category 1 Credits TM , click here.
Physicians insured by the Texas Medical Liability Trust may earn a professional liability insurance discount of up to $1,000.
For more information, call (800) 880-1300, ext. 1421, or (512) 370-1421.
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TMA HIT Resources Aid Physicians
For tools to help physicians assess whether their practices are ready to adopt an electronic medical record (EMR) system and for information about health information technology (HIT), log on to the HIT page on the TMA Web site, www.texmed.org/hit.
Resources include TMA's EMR Implementation Guide , which offers up to 3 hours of continuing medical education credit and TMA's EMR Readiness Assessment Questionnaire and white paper. Additional materials include HIT-related articles and case studies that offer firsthand physician accounts of implementing an EMR.
The HIT Department also offers an EMR comparison tool to aid physicians in shopping for an EMR system.
For more information, contact TMA's HIT Help Line at (800) 880-5720 or e-mail Health Information Technology .
In addition, TMA Practice Consulting can provide doctors with a practice assessment and workflow analysis to start them on the path to adopting and implementing an EMR system. Information is available by calling (800) 523-8776 or e-mailing TMA Practice Consulting .
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TMA Survey: More Physicians Adopt EMRs
Texas physicians' use of health information technology continues to rise, according to the 2009 TMA Electronic Medical Record (EMR) Survey [PDF]. The survey measured physicians' utilization of office technologies such as EMRs, e-prescribing, and health information exchanges.
Forty-three percent of responding physicians reported using an EMR, up from 33 percent in 2007 and 27 percent in 2005.
"There's good and bad news in this survey," said Joseph Schneider, MD, chair of TMA's Ad Hoc Committee on Health Information Technology. "More physicians are using EMRs, but a significant portion are having technology and usability problems that in some cases threaten physician practice viability, patient safety, and continuity of care. Physicians need EMRs that are much more intuitive and easy to use, like Amazon, Google, or the iPhone," he said.
The full survey report is on the TMA Web site. Click here and scroll down to Articles.
The percentage of physicians with no plans to implement an EMR system decreased to 16 percent in 2009 from 25 percent in 2007. Similar to 2007, younger physicians are more likely to use EMRs. Sixty percent of respondents younger than 40 currently use EMRs, up from 48 percent in 2007 and 37 percent in 2005. Fourteen percent of respondents report having previously used an EMR system they either discarded or replaced. A majority of these - 65 percent - replaced it with another EMR system.
When asked what they like most about their EMRs, 76 percent of respondents reported electronic charting, followed by e-prescribing (42 percent) and coding assistance (41 percent). When asked what they least like about their EMRs, 50 percent reported the data input was difficult or time-consuming, followed by new kinds of possible errors (37 percent) and reduced productivity (32 percent).
Dr. Schneider, chief medical information officer for Baylor Health Care System, says the survey indicates physicians continue to increase their adoption of EMRs.
"Physicians are seeing the value in EMRs. When properly implemented, EMRs can improve patient care and streamline office workflow. TMA is concerned about the unintended consequences and problems that improperly implemented EMRs are causing for physicians," Dr. Schneider said.
The survey also indicates that EMR costs are decreasing. The median reported purchase, training, and implementation costs are $18,000 per physician, down from $25,000 in 2007. Physicians reported monthly maintenance costs of $350 per physician, down from $425 in 2007.
When asked how purchase and implementation costs compared with initial vendor estimates, 57 percent of physicians reported costs as being equal to initial vendor estimates. Forty-one percent of respondents reported costs as being more than initial vendor estimates -- on average, 31 percent more.
Among physicians who plan to implement an EMR system, 14 percent are doing so now, up from 11 percent in 2007. Of those physicians who reported waiting more than two years to implement a system, the majority - 58 percent - reported the cost as being prohibitive or indicated that they were waiting for critical mass adoption (21 percent).
The Health Information Technology for Economic and Clinical Health Act allows incentive payments for physicians who demonstrate meaningful use of an EMR system. The majority of respondents - 59 percent - indicated they would attempt to qualify for the stimulus funds.
TMA will use the survey results to tailor services and resources to help physicians achieve meaningful use of EMRs and qualify for Medicare and Medicaid incentives provided as part of the federal stimulus package.
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HHS Awards Nearly $1B for RECs, HIE, Job Training
The U.S. Department of Health and Human Services (HHS) and the Department of Labor are granting almost $1 billion to help health care professionals adopt health information technology (HIT) and train workers for health care jobs. They said the awards would help make HIT available to more than 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology.
The $761 million in HHS grants announced in February are part of a federal initiative to help physicians and other health care professionals adopt and use electronic medical records (EMRs) in a "meaningful" manner that can improve the quality and efficiency of health care for all.
Forty states and qualified state designated entities will get $386 million to create state health information exchanges (HIEs), while another $375 million will go to an initial 32 nonprofit organizations to develop regional extension centers (RECs) to help physicians use HIT.
The more than $225 million in Department of Labor grants announced will train 15,000 people in job skills needed to access careers in health care, HIT, and other high-growth fields. Through existing partnerships with local employers, the recipients of these grants already have identified roughly 10,000 job openings for skilled workers that likely will become available in the next two years in areas like nursing, pharmacy technology, and information technology.
The grants will fund 55 separate training programs in 30 states to help train people for secure, well-paid health jobs and meet the growing employment demand for health workers. Employment services will be available via the Department of Labor's local One-Stop Career Centers, and training will be offered at community colleges and other local educational institutions. Two of them are in Texas -- The University of Texas Medical Branch at Galveston and North Central Texas College in Gainesville.
The awards are part of an overall $100 billion investment in science, innovation, and technology the Obama administration is making through the Recovery Act to spur domestic job creation in growing industries and lay a long-term foundation for economic growth.
Texas submitted four applications for grant awards. There were no Texas RECs in the first funding announcement, but at press time, TMA anticipated the funding announcement that included Texas recipients to be made March 19.
More information about HIE, job training, and RECs funding is posted online at http://healthit.hhs.gov/portal/server.pt and at http://healthit.hhs.gov/extensionprogram .
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