Recognizing the need to strike a balance between the urgency of modernizing our health care system and the pace of change that can be absorbed by providers and health IT vendors, CMS and ONC have implemented the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs in three stages, with each stage adding increased functionality and advanced concepts designed to improve patient care, enhance care coordination, and increase patient and family engagement. Released in July 2010, the final rules for Stage 1 focus on functionalities that support the electronic capture of data and allow patients to receive electronic copies of their own health record.

It’s important that providers take the steps now to register for the EHR Incentive Program on the CMS website. October 3, 2012, is the last day for eligible professionals who want to collect the maximum Medicare EHR incentive payment to begin their 90-day reporting period in 2012. Eligible professionals who wait until next year can still participate but will receive reduced incentives.

How Meaningful Use Can Improve Outcomes and Efficiencies

Many providers are already seeing how meaningful use of health IT like EHRs can help to improve outcomes and result in efficiencies, such as those who are working with the regional extension center (REC) established by the North Carolina Area Health Education Center Program (NC AHEC). Through the use of EHRs and features like clinical decision support and point of care reminders, the positive impact on quality of care has been significant.

NC AHEC

The NC AHEC has incorporated quality improvement and medical home services into the culture of practice systems which has provided additional benefits that translate into even larger improvements in preventive and chronic care while substantially lowering costs. As an example, the Roanoke Chowan Community Health Center was able to decrease the number of patients with a Hemoglobin A1c measurement greater than nine from 40% to less than 10% in their diabetic population. As measurement and templates in their system became consistent and point of care reminders were implemented A1cs less than seven  have increased to 60% of the diabetic practice.

Meaningful Use Stage 2

The Stage 2 Meaningful Use final rules we recently issued were intentionally designed to help providers implement health IT that will allow them to improve care and transform delivery. The Stage 2 rules focus on increasing standards-based health information exchange between providers and with patients. We expect that future stages of meaningful use will continue to advance health IT capabilities by focusing on advanced clinical decision support and patient engagement tools. The staged implementation of the meaningful use criteria is being leveraged to harmonize quality measures across federal agencies—all with the goal of improving care for patients and resulting in better health more generally and to simplify the process for providers so that they can focus on the needs of their patients.

New Orleans AIDS Task Force

The New Orleans AIDS Task Force (NATF) is just one example of an organization that has been working to develop innovative approaches to meet those goals, and the effects of Hurricane Katrina helped NATF rapidly implement a meaningful EHR system. NATF has implemented a multifactor disease-specific risk stratification based on a patient’s lab and vital sign values. Risk scores, are then determined for these values based on evidence-based clinical guidelines. Each disease has its own registry that displays a list of patients and their risk score, the clinical staff reviews the registry and proactively identifies patients who may need to meet with a nurse care manager who can make appropriate referrals, establish goals pertaining to care, and educate patients. This process has helped improve clinical outcomes which are monitored quarterly. For example,  the agency has documented an increase in HbA1C test administration for diabetic patients from 88.5% during the first quarter to 98.5% during the most recent quarter.

Meaningful Use Is Ambitious

Implementing an EHR system so that it can optimally support providers isn’t easy. EHR implementation requires practices to transform many of their existing systems, which can be costly and time consuming. Because most providers are focused on providing high-quality care to their patients, they may have limited knowledge/expertise about how to make the changes necessary to easily meet all of the meaningful use criteria. Despite these challenges, however, providers such as those working with the Virginia Health Quality Center (VHQC) understand the potential for technology to improve health care delivery and they are ready to take on the challenge.

VHQC

VHQC is the Virginia REC and Quality Improvement Organization that has been helping providers implement activities related to meeting the Stage 1 Meaningful Use and Physician Quality Reporting System (PQRS) clinical quality measures  for smoking cessation intervention—a goal of the HHS Million Hearts program. In Virginia, VHQC and the program providers are working to increase rates of screening and intervention across the commonwealth. VHQC estimates that achieving this goal will impact 237,000 patients. Assuming a national 19.3%  rate of smoking-related illness and an average annual cost of $2.08 Billion in Virginia, this can potentially save as much as $440 million. Achieving the Million Hearts benchmark, which includes reaching  every Virginian who sees a primary care physician, would exponentially increase the impact.

Meaningful Use Is Happening Across the U.S. in Every Practice Setting

There is strong support for the EHR Incentive Programs across the country.  More than 350,000 providers have either registered to participate in the program or agreed to work with an REC to achieve meaningful use in the next two years. The EHR Incentive Programs has already paid more than 120,000 providers and tens of thousands of other providers are preparing to get paid this year. Even providers in areas with historically low EHR adoption rates are aggressively working toward achieving meaningful use. For instance, more than 70% of primary care providers in rural areas and those working with federally qualified health centers (FQHC) are committed to achieving meaningful use in the next two years.

Lone Star Circle of Care

One provider who has seen meaningful results is the Austin, Texas-based Lone Star Circle of Care (LSCC).  LSCC is an FQHC in central Texas with a Level 3 Patient Centered Medical Home Recognition. LSCC utilized meaningful use of its EHR as an accelerant for change by establishing previously non-existent electronic communication between patients’ primary care providers and case managers at the health district. They also used analytics from clinical quality measures to drive automated calling queues for clinical specialists, shifting the focus away from encounter-based alerts and toward population-based outreach. This process identified and then rectified missed care opportunities. LSCC also created real-time web reports that showed each provider’s performance scores on threshold objectives to further improve performance.

Now Is the Time to Act

If you haven’t already begun the process of working toward achieving meaningful use, you should start now.

• The first step is to register for the EHR Incentive Programs. You can learn more about how to do this on the CMS website.

• If you’ve registered for the Medicaid EHR Incentive Program, you should try to apply for your Adopt, Implement and Upgrade funds this year so you can get the resources you need to achieve meaningful use. If you’re registered for the Medicare EHR Incentive Program, you should remember to begin your 90 day reporting period no later than October 3 of this year, if you want to get your maximum EHR incentive payments.

• Finally, if you are having trouble understanding the meaningful use criteria or don’t know where to start, you should reach out to your local health IT REC. They can provide you with a variety of services/information that can help you transform your practice to achieve meaningful use.  A list of RECs can be found on the ONC web page.

Many providers have already attested to Stage 1 meaningful use and are meaningfully using their EHRs to improve patient care. By sharing these stories, providers can learn from those who have already attested and obtain a better understanding of how they too can make Meaningful Use meaningful.

ONC conducted a challenge to obtain these stories and received 21 submissions—two submissions were chosen as winners and two were chosen as runners up. Highlights of these submissions can be found on ONC’s website.

For More Information

• HealthIT.gov: Meaningful Use
• CMS EHR Incentive Programs website

Farzad Mostashari, National Coordinator for Health IT; Rob Tagalicod, Director, Office of E-Health Standards and Services, CMS; and Mat Kendall, Director, Office of Provider Adoption Support, ONC