"As part of the American Recovery and Reinvestment Act of 2009, Congress has allocated $27 billion for the adoption of EHRs," said Dr. Boland, assistant professor, Wilmer Eye Institute and Health Sciences Informatics, and director of Information Technology, Wilmer Eye Institute, Johns Hopkins University, Baltimore. "The money will be made available via the Center for Medicare and Medicaid Services (CMS) to eligible professions such as physicians, optometrists, podiatrists, dentists, and chiropractors; and hospitals."
The government has allocated these funds for several reasons, he continued. First, the adoption of EHRs has been slow. Less than 20% of physicians have a system in place. In addition, the incentives for EHRs are not aligned correctly in the current system, where the costs are borne by the providers, but the benefits go to payers.
"Electronic medical records have been successful, however, in institutions where those incentives are better aligned, as with the VA and Kaiser," he noted.
The stated priorities of the meaningful use program include the following:
How to receive certification
To receive CMS payments, the EHR used by any clinician must be certified by an organization approved by CMS. This certification is based on standards for functionality and actual testing of the system using case scenarios. Certification has now begun under the new rules, Dr. Boland explained.
Fortunately, clinicians don't need to worry about the details of the certification process. Instead, they need to make sure their current or planned system has been certified. A current list of such systems can be found at http://healthit.hhs.gov/CHPL.
Of more concern to clinicians is the need to achieve meaningful use of their electronic medical records once they are deployed. Demonstrating meaningful use requires satisfying 15 core objectives, and five of 10 menu objectives. The broad categories of requirements include collecting data electronically, using those data, and sharing data with others (connectivity). Careful attention to these requirements is an essential step toward receiving the EHR incentive payments.
Electronic data collection requires maintaining lists of problems, allergies, and medications for patients, and recording data such as demographics, vital signs, and smoking status. Physicians may also choose to incorporate lab results as data for patients.
Objectives related to data use include:
Data sharing objectives include submitting quality measures to CMS or states, and exchanging key clinical information with other providers or with patient-approved entities. In addition, through your EHR, you can choose to submit data to immunization registries, and submit syndromic surveillance data to public health agencies, though most ophthalmologists will not select these menu options.