Organizational Structures and Leadership_ 3 of 4 Discussion

T he business of health care is more demanding than ever, with concerns about payment reform and govern-

ment incentive programs that impose penalties for non-participation on top of the normal stresses associated with run- ning a medical practice.

You have likely asked yourself within the last year if you should consider adopt- ing or upgrading your healthcare informa- tion technology and taking part in these incentive programs. Most physicians I talk with would like to embrace the benefits this technology allows but are stretched for re- sources to dedicate to the task of under- standing all the regulations and guidelines, not to mention finding the time to under- take this project.

There is a lot of money to be gained from participating in EHR incentive pro- grams through the Center of Medicare and Medicaid (CMS). It is difficult and unwise to advise anyone to completely discount the potential of leaving that amount of money on the table. Practices should also consider whether the penalties associated with non- participation are too large to ignore. If after weighing the pros and cons you decide to proceed, then now is the time to turn your attention from the financial motivations back to the clinical improvements you wish to accomplish with the adoption of an EHR.

Before choosing a software solution that will have such a large impact on the culture and workflow of your practice, there should be clear goals set that will de- fine at the end of the process whether the implementation was a success. This is the one step that is physician- and practice-spe- cific; no one else can define those for you. It is best to use a team approach with at

least one physician taking the lead. Make sure your team represents all areas of your practice, such as nurs- ing, medical records, administra- tion, billing, registration, in-house lab, etc. Potential goals you might set for your practice could include cut- ting patient phone call volume by 30 percent with the implementation of ePrescribing, web-based appoint- ment scheduling, nurse triage ques- tions and patient educational materials. You may also wish to de- fine the clinical areas you want to target for quality improvements, such as patient reminders for blood level monitoring or yearly preventive testing. Whatever the goals defined for your practice, once they have been identified, that criteria will be the driver for all your decisions about product selection.

CHOOSING YOUR SYSTEM Technology solutions are diverse and there is no single solution that would meet the requirements and preferences of all med- ical practices. There are obvious places to start your selection search, such as the Cer- tified Health IT Products List (CHPL), which includes all EHR systems that have met federal criteria for the incentive pro- gram (not every EHR system is eligible). However, with more than 600 (and grow- ing) products for ambulatory providers, the CHPL list can be daunting. The qualifi- cations for inclusion are strictly based on functionality and this list does nothing to rank or rate usability.

Knowing which EHRs are certified is a start but which of those 600 products is the

easiest to use and the best fit for your prac- tice? Which ones have the right functional- ity to meet the goals you have defined? Which best meet your physicians’ needs for usability and documentation? Which of them have the right contract terms and meet requirements for your patient care as well as your business needs? Where can practices go to get expert direction and help on choosing the right system?

THE TMA CAN HELP Since January, the TMA has added new re- sources in eHealth Services to help mem- bers receive updates, clarification on government programs, and a forum to have their questions about health information

EHR Adoption: Help is Here for Your Decision-Making Process By Angie Madden, CHC, CAPM

35Tennessee Medicine + www.tnmed.org + OCTOBER 2011

SPECIAL FEATURES

(Continued on page 37)

www.tnmed.org/vsp

maries sent by PCPs to specialists with a re- ferral, consultation summaries sent by a specialist back to the PCP – utilizing the data standards identified and recom- mended by the workgroups of the S&I Framework initiative.

CHALLENGING TIMELINES The timelines of Meaningful Use have proven to be very challenging. There have been delays in vendors testing their certi- fied versions and releasing them to cus- tomers. Even some practices and hospitals that were established on EMRs have not been able to implement the certified ver- sion of their EMR and thus begin the re- porting period for Meaningful Use. As a result, the HIT Policy Committee an- nounced in June that it will likely recom- mend to CMS a staggered timeline that would allow those eligible providers and eligible hospitals that attest to Stage I Mean- ingful Use in 2011 to move on to Stage II in 2013. But those providers and hospitals

that do not begin their first year until 2013 or 2014 would still be able to receive in- centives in those years for meeting the cri- teria of Stage I. Under the currently published rule, providers and hospitals not starting until 2013 must meet the (not yet published) criteria for Stage II.

Regardless of any Meaningful Use time- lines, the availability of essential informa- tion about at patient in a timely manner, i.e., at the time the patient is present, with these transitions of care could reduce hos- pital readmissions, avoid adverse medica- tion events, avoid repeating diagnostic studies, and provide patients and families with information needed for them to par- ticipate in care and be involved in their own health.

THE ULTIMATE VALUE Dramatic quality improvement in the care of priority chronic diseases, such as dia- betes and heart failure, in closed systems with EMRs like the Veterans Administration

hospital system and Kaiser Permanente have demonstrated the value of having clin- ical information in structured (standard- ized) format; this is one of the main driving forces behind efforts to enable information exchange that would make such improve- ments also possible in the diverse systems that exist across most of our country. To match the quality improvements achieved in closed healthcare systems requires in- teroperable data exchange, which is the aim of the S&I Framework initiative. If the same double digit disparities in safety and adverse events we see in health care existed in another realm – let’s say the airline in- dustry – can you imagine what the public response would be? +

Dr. Leftwich is the chief medical informat- ics officer for the State of Tennessee’s Office of eHealth Initiatives. Contact him at 615- 507-6465 or [email protected].

SPECIAL FEATURES

technology answered. The newest element of the TMA’s eHealth Services Division is the Vendor Standards Program (VSP). This program offers a list of vetted vendors who have agreed to the TMA’s special terms on best practices in training and implementa- tion, safeguards in contracting language to protect physicians, and a TMA member

cost reduction in their base fee. For physi- cians stretched for resources, this is a ben- efit of their membership and an added level of confidence as they navigate the over- whelming path of EHR adoption.

Vendors who have joined the VSP in- clude Allscripts, NextGen and Sage. All of them meet terms and conditions and offer

a client server model as well as a web-based subscr ip t ion product, so there are ap- p r o p r i a t e choices for any size practice on any budget.

If you need help and direction on your EHR journey, please contact the TMA’s eHealth Services Division. We can answer questions and offer assistance with healthcare tech- nology adoption, incentive programs and EHR selection, as well as any other eHealth questions. Please visit the TMA website for all your eHealth resource needs at www.tnmed.org/ehealth. +

Ms. Madden is director of the TMA’s new eHealth division. Formerly with the state Office of eHealth Initiatives, she has a background in medical practice admin- istration, EHR consulting and imple- mentation. Contact her at 800-659-1862 or [email protected].

Join us for our webinar “A Case for EHR” to learn more about EHR adoption

and our VSP program.

Wednesday, October 26

1:00 pm Central/2:00 pm Eastern

www.tnmed.org/ehealth

EHR ADOPTION: HELP IS HERE FOR YOUR DECISION-MAKING PROCESS (Continued from page 35)

37Tennessee Medicine + www.tnmed.org + OCTOBER 2011

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