Easy EMR Stimulus Money for Current EMR User

A common contributor to this blog lately has been BobbyG (check out his REC blog for more). He tells an interesting story that runs counter to my post about even existing EMR users not currently showing meaningful use.

Meaningful use is in fact quite doable — at least in the outpatient setting

One clinic I visited yesterday in northern Nevada — Silver Sage — will be an exemplar for me (I’m an REC adoption support workflow specialist). They look to be a shoo-in for Meaningful Use compliance. They use eMDs, and they are really using it. eRx? Check. CPOE? Check. 2-way lab interface feeding back structured data? Check. Reminders? Check. Patient cohort lists by various problem areas? Check. Active meds list (incl drug-drug, drug-allergies, formularies)? Check. Patient portal? Check… etc, etc, etc.

With the Final Rule relaxation of the MU criteria and what I saw in operation yesterday, I’m now of the “stop-whining-and-just-DO-it” mindset. Use your Regional Extension Center services, too. We’re not in it for the money, we’re in it to improve healthcare, period.

Yes, you will need a viable, highly “usable” system, and will need to use it in a way that goes beyond just an electronic filing cabinet (e.g., scanning everything in sight into TIFF files, etc). Yes, you will need to re-do workflow in order to eliminate process waste and align information flow. Of course. Just do it. You’ll improve both patient outcomes and your bottom line, attacked adroitly…

While I have many concerns with the way this whole HITECH Act thing has been rolled out (and with U.S. health care policy more broadly), it’s time for everyone to pull together and make this work.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Thanks, John.

    I’m seeing the gamut. I recently engaged with another small primary care clinic also on eMDs, very nice operation, highly successful. But, THEY are using it largely as an electronic filing cabinet, scanning everything in sight and attaching the tiff files to the docs’ “charts.” We’re gonna have to do a ton of workflow redesign with them to wean them away from that if they’re to hit MU.

  • Amen to all the comments above; Yes its all about the structured data and that’s what will help the Physician, Patients, Payers and healthcare in general to drive efficiencies and have transition from Curing to Preventing.
    Scanning anything that’s out there could be a start; and actually there was a guest post in John’s blog some time back and it was by Digital Records Inc; they seem to be able to bring back at least some relevant data from the scanned files into the system as structured data.
    Yes; going forward, the ‘Structured Data’ is only thing that makes sense. eCabinet is a glorified change from the current Paper Cabinets.
    Anthony Subbiah

  • While this article is somewhat HOPEFUL about EMR and what the impact of the ARRA incentives can be, this particular clinic is NOT a great example that should be used as a predictor of success to come.

    First, this is a two-provider, family practice clinic in Reno, NV. They may not be high volume or do many procedures. They clearly do not have any specialists on staff. This is significant because where any of the above three criteria are present, the failure rate of EMR implementation goes up dramatically. And its already documented at more than 50% already. “Meaningful Use” will only make that more challenging.

    We agree with Mr. Gladd’s comments, below (or above!). There are enormous productivity benefits for a practice to implement EMR just for moving from paper charts to electronic ones. But expecting high performance practices and specialists to document exams and generate acceptable notes with one of the “point and click”, certified EMR’s is not working well…or has a significant negative performance/financial impact. Thats why it seems that many “successful” EMR users today are, as Mr. Gladd says, are doing little more than using the certified EMR as a electronic filing cabinet and scanning things in.

    This will mean huge workflow changes for those providers if they ever hope to achieve “meaningful use” Many will find the slow down, performance and financial penalties too costly to do.

    Until usability becomes a measured criteria for “certified EMR”, there will continue to be much disappointment and angst for providers who pursue that route in search of the elusive $44,000.

    Providers…especially specialists and high-volume providers…need to find a system that HELPS their practice to run better, function smoothly and not cost them many patients a day. Workflow can be improved w/o changing the way exams are documented…thats the hybrid approach. Until “certification” includes productivity and usability…it may be the ONLY viable way for many practices.

  • Although any provider using e-MDs may be much further along toward attaining Meaningful Use of Certified EHR Technology, everyone should keep in mind that there are no systems “Certified” at this point, and even systems like e-MDs will need some additional capabilities to get certified.

    Here are some things to check as you get ready to claim your incentives for EHR Meaningful Use under the HITECH Act. This information is based on (EPs) qualifying for the Medicare incentives.

    1) Start talking to your vendor about their plans to submit their EHR software for certification as “Certified EHR Technology”. The system does not have to be certified as of January 1, but it does need to be certified by the end of the 90-day period you are using to attest to your EHR Meaningful Use.

    2) Keep in mind that if you are using a stand-alone EMR product with an existing legacy practice management (PM) system, the system needs to be Certified EHR Technology also. This is because some of the functions of a certified system, such as recording patient demographics electronically, are most likely functions of your PM system, not the EMR product. So talk to that vendor, too.

    3) Verify that any eligible provider attesting to meeting EHR Meaningful Use objectives provides 10% or more of his/her Medicare services in an outpatient setting (not inpatient or in a hospital ED). CMS will look at the percent of services rendered in an outpatient setting for the fiscal year ending 09/30/2010 to determine the IP/OP percentages. Your EHR healthcare consultant must be qualified to do the analytical and reporting work in preparing the self-attestation report, based on the current fiscal year and the individual EHR Meaningful Use objectives in place, starting January 2011.

    4) Make sure all eligible providers you are planning to certify for EHR Meaningful Use have an NPI number and are enrolled in PECOS.

    5) For EPs in group practices, confirm the tax Id number – group or personal – of each provider for payment of the incentive amount. Payments can be made to either number.

    6) CMS will be establishing an Internet-based enrollment process for EPs planning to apply for incentive payments. Keep checking this site for the Registration process, and enroll when it is available.

    7) As soon as you start the clock on your 90-day period, make sure you are meeting all the EHR Meaningful Use objectives applicable to your practice, and, for objectives with numerical thresholds, that you are attaining the levels specified. If your EHR system is Certified EHR Technology, it should be capable of supporting all Stage 1 Meaningful Use objectives.

    8) Monitor the CMS website on EHR Incentive Programs to determine the format of the attestation for 2011. And keep in mind that accuracy is paramount; attesting to EHR Meaningful Use is making a claim to a Federal program. And the penalties for false claims are significant!

    Attestations can be completed as early as April, 2011, and CMS has stated payments will be made in May. For EPs seeking incentive payments under the Medicaid / Medical program, visit the CMS website for further information.

  • Jim,
    Thanks for the list. I really appreciate you sharing it. So much so that I created a post of your list for other people to see.

    I’m interested to know where you got some of the details as far as the percentage of Medicare services and which year CMS will use for that percentage.

    I also assumed that CMS would have an electronic claim process for the incentive, but have never heard them say that. Have you heard them say it?


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