A few years ago, my partners in AHITA.org (a non-profit organized to help providers implement EHRs) and I implemented an electronic health record in a physician practice. Along the way, we evaluated every major product and discussed with the physicians in the practice what they needed and how to examine their workflows to automate.
It was very effortful, took almost a year, and cost the physician practice about $50,000 in consulting fees. At the end of the engagement, the AHITA partners decided in all good conscience that all the products sucked and wouldn’t help a small practice; we kind of drifted away from the idea of electronic health records. Our physician partner, who had written his own EHR, gave up in disgust because he couldn’t get anyone to buy it.
Now, Obama’s administration has given incentives that mandate EHRs. 2010 looks like it is going to be the year. And hopefully, many of the products have improved in their ease-of-use and financing programs during the past couple of years. There’s a lot of behavior change around implementing new technologies, and even practices that already own EHR technology need to learn to use it properly to qualify for the meaningful use incentives the government is offering. For most practices, this will mean an increased focus on workflows around ordering, e-prescribing, and clinical decision support and some attention to improving them, not just automating dysfunction.
As far as I can discern from listening to the Allscripts webinar I just heard, many of the incentives revolve around seeing more Medicare and Medicaid patients. All those physicians who were going to give up Medicare patients will be re-thinking that, because to qualify for the stimulus money they have to prove that 44 percent of their volume is Medicare, or 30 percent is Medicaid. And this is calculated by individual physician, not by practice.
For a physician, the Medicare part of the program starts this year. But this year you only have to prove that you used electronic records for 90 days during the year, and that at least 50 percent of your patient encounters have to be at a practice using a certified EHR.