Hospitals face hurdles meeting proposed meaningful use EHR criteria

As the health care industry takes a deeper look into federal meaningful use requirements, providers are wondering how to ensure they have implemented electronic health records (EHRs) in time to meet the strict deadline.

The Centers for Medicare & Medicaid Services in late December released its proposed rulemaking governing how hospitals and doctors have to use EHRs and other  technology for it to be deemed "meaningful" and therefore eligible for financial incentives. Since then, providers are questioning whether some of the criteria are too restrictive or even feasible.

Among the requirements are installing computer physician-order entry (CPOE) systems, maintaining medical information in structured electronic records, reporting quality data and providing patients with electronic copies of information upon request. The rule explains in detail how eligible hospitals and eligible professionals should calculate the time that goes into using each of those requirements. Providers also are told how to collect the data needed to demonstrate to CMS that they are, indeed, practicing meaningful use and are qualified for financial incentives.

Incentives have been allocated through the American Recovery and Reinvestment Act of 2009. The stimulus package included $34 billion in payments to help ensure that providers implement health information technology with the goal of improving care and efficiency. Incentives begin in 2011, and by 2015, all providers participating in Medicare and Medicaid will be required to use EHRs or risk financial penalties.

Hospitals still face major hurdles to getting to adoption, according to Paul Hensler, CEO of Kern Medical Center in Bakersfield, Calif. While the meaningful use requirements laid out in the proposed rule were expected, "it's a very aggressive time schedule," he said.

Hospitals that are unprepared for a health IT implementation project will have until fall of this year to be operational if they want to take advantage of the full five years of incentive payments. But choosing an electronic record and a vendor to work with, then building consensus among medical staff to use it, is a difficult process, Hensler said. "It's not just installing a system; you have to train your entire staff."

Kern Medical has been using an open source EHR (OpenVista) based on the U.S. Department of Veteran Affairs' VISTA system. Staff members have been excited about using the technology, which has led to millions of dollars in savings on paper and medical record management, Hensler said. The hospital estimates that it will be eligible for up to $9.1 million in incentives over the five years.

Even for hospitals that are in the midst of health IT projects, the implementation schedule is tight, said Robert Murphy, a physician who is chief medical information officer at Memorial Hermann Healthcare System in Houston.

The nine hospitals within the system currently are going through a standardization of EHRs so they are all using the same system, Murphy said. The plan had been to roll that out through the next four years, but with the meaningful use requirements starting next year, "we're trying to figure our way around that."

Some of the elements in the rule make it difficult to plan those projects, he added. He pointed to the CPOE requirement. As it's currently written, the rule requires hospitals to prove 10% of its orders are conducted electronically. Regardless if 10% or 90% of orders are submitted electronically, the same platform must be built to support that system—which includes physicians at the bedside, computers in the pharmacy and medical staff getting the medication to patients—he said. It's going from zero electronic orders to 10% that is the "large gap."

There's no question that many of the technologies outlined in the proposed rule are in general accepted by providers as being helpful to patients. Murphy said when the health system was ready to start using electronic messaging between doctors and patients, physicians were reluctant to start. Now, it's embraced, he said.

That acceptance will come with other elements of technology as they are implemented, he added. "Incrementally showing value helps get everyone on board."