In 2004, President George W. Bush set the goal of implementing electronic health records by 2014, and the economic stimulus package of 2009 provided financial help and incentives to meet this goal.
Kentucky established the Kentucky Health Information Exchange (KHIE), a central resource to help hospitals and physicians implement EHR technology and share patient information with other providers, which Kentucky health care IT professionals proudly told Shepherd showed great foresight. And four years ago, Kentucky became the first state to issue incentive payments for meeting the federal standards for meaningful use of EHRs.
As defined by HealthIT.gov, meaningful use requires users to improve quality, safety, efficiency and reduce health disparities; engage patients and families; improve care coordination, and population and public health; and maintain patient information privacy and security.
These goals are meant to be reached in stages. As providers demonstrate they have completed each stage, they earn incentives and avoid penalties.
One of the greatest concerns of providers is the great cost of implementing an EHR system and the added cost of remaining compliant. Dr. David Bensema, chief medical information officer at Baptist Health, and Cheryl Brown and Dr. David Danhauer, information technology leaders at Owensboro Health, readily attest to this, Shepherd reports.
“Bensema and Danhauer each estimate their respective health-care systems to date have invested well over $100 million on software and third-party packages. Costs soar into the hundreds of millions when factoring in the time to orient physicians and allied personnel to the program interfaces, reporting mechanisms and added procedures to follow, Bensema said,” Shepherd writes.
And while the federal and state meaningful-use payments are considered “valuable,” they don’t “come close to the expenses hospitals and medical practices have incurred trying to implement EHR to proscribed federal standards,” Bensema told Shepherd.
“As of Oct. 1, the Kentucky program has made 4,860 payments totaling $200.2 million to providers, according to KHIE, and federal meaningful-use incentive programs and the CMS have injected another $337.6 million into Kentucky,” Shepherd reports. That totals $537.8 million.
Nationally, CMS has spent more than $30 billion in incentive payments, Lexington physician Steven Stack, president of the American Medical Association, told Shepherd. The writer puts that into context: “Over that same time period, the U.S. health system is estimated to have spent close to $9 trillion.”
Despite the great expense and many frustrations involved with implementing EHRs , most providers support them and recognize their potential value in health care. “The majority of physicians do not want to go back to paper records,” Stack told Shepherd.
But providers say CMS is trying to accomplish too much too fast, without assessing the success and failures of the first phase before moving onto the second, and the current cost of compliance outweighs the current value of the system. Providers say they need a system that doesn’t require so much data entry that it takes away from patient care, that has interoperability between systems; and and EHRs that are more user friendly, like smartphones.
Stack has presided over a series of online AMA-sponsored town hall meetings titled “Break the Red Tape” to address these issues by gathering feedback from physicians regarding the current state of EHR technology.
“No one is arguing that meaningful-use objectives aren’t worth achieving,” Stack told Shepherd. “But after creating Meaningful Use Stage 1 out of whole cloth, Stage 2 was initiated before there was any critical evaluation of how Stage 1 was working. And CMS has chosen to continue down this pathway without any attempt at course corrections based on feedback from EHR’s primary users.”
Some physicians have expressed their frustrations by dropping out of the Meaningful Use program during implementation of Stage 2, Stack told Shepherd, willing to accept the penalty because it’s more affordable than trying to keep up.
Danhauer expressed concern that the current meaningful-use standards will contribute to the physician shortage in Kentucky by pushing out experienced physicians in their 50s and 60s by making them change their entire way of working. He said the standards need to be modified and their time frames relaxed.
It is difficult to measure the potential value of EHRs, Shepherd writes. Although Baptist Health has projected it could save a minimum of $18 million annually after EHR is implemented and refined, “That figure was on the low end of the scale,” Bensema said. “I believe it’s likely to be much more.”
Brown said Owensboro Health can now transmit public health data to two organizations, since it successfully attested to Meaningful Use Stage 2.
Shepherd writes, “The resulting ability to organize and share patient history, imaging and medication information among hospital services, primary care providers and specialists, Danhauer said, will have an enormous impact on raising patient care quality in Kentucky by reducing medication errors and unnecessary duplication of services.” Brown said EHRs also “enable public health entities to better track trends in diagnoses and disease.”
Predicting that patients will drive health care’s embrace of EHRs, as many already have at Owensboro Health, Danhauer said, “There is a generation of people who are accustomed to conducting business and managing finances electronically. They want their health information, lab results and X-rays in front of them with their doctor or surgeon answering their questions.”