Obama and Congress Send Message: Adopt EHR

Mix of incentives and penalties designed to speed implementation.

BY ELIZABETH F. WILLETT

The need to adopt an electronic health record (EHR) system has just become a pressing issue for ophthalmology practices that have not done so already.

With the recent passage of the $787 billion federal stimulus package, containing more than $20 billion earmarked to spur healthcare information technology (HIT) adoption, physicians and practice managers alike should recognize that the timeline for EHR implementation has shifted from "soon" to "now."

The stimulus package employs a carrot-and-stick approach through Medicare and Medicaid programs to encourage rapid conversion from paper to electronic records. Medical practices that can demonstrate "meaningful use" of EHR in 2011 will receive a bonus of $15,000. Decreasing incentives will be available during the ensuing 3 years. Concurrently, a national organization will be developed, tasked to coordinate EHR adoption and provide support to practices making the transition — particularly smaller practices of one to 10 physicians that have delayed EHR adoption because of daunting financial and technical constraints.

But the game gets even more compelling after 2014, when Medicare will institute penalties for practices that have not adopted EHR. This mandate will force many ophthalmology practices to immediately begin exploring implementation of health records technologies.

Practices Have Dragged Their Feet

EHR technology has been slow finding its way into healthcare, with only about 17% of all practices in the United States having already made the transition to computerized recordkeeping. Ophthalmology is no exception. While the technology has proven to help organizations process patient information more quickly while ensuring a high level of quality care, many practitioners have yet to add it to their repertoire.

One reason is that physicians are notoriously resistant to dramatic change. Replacing paper with a computer or PDA is no easy task. Healthcare practitioners are also quite risk adverse, curious as to what IT can do for them but not over-eager to adopt technology ahead of the curve.

"What has traditionally held back adoption of the EHR in eye care is the question of whether the technology was ready for prime time," according to Brett W. Katzen, M.D., president of Katzen Eye Group in Baltimore. "Ophthalmologists will not get on board unless they're sure the technology is 100% functional."

Moreover, technology purchases require a major capital outlay — currently between $35,000 and $40,000 per physician according to a recent Wall Street Journal article. At a time when most healthcare providers are feeling the financial pinch brought on by the sluggish economy and lower reimbursements, ophthalmology practices may dismiss EHR as a luxury they simply can't afford.

The fact of the matter, however, is that in this time of economic uncertainty and the new federal mandate, EHR is a necessity that practices can only overlook at their own peril.

Stability in Uncertain Times

"Crisis often breeds a different perspective, and we now have a situation where practices are hurting financially," asserts Charlie Jarvis, NextGen Healthcare's assistant vice president of Healthcare Industry Services and Government Relations. "This is now forcing organizations to take a hard look at how technology can improve their operations."

President Obama and Congress have demonstrated that they believe that national EHR adoption can also improve many aspects of the country's healthcare delivery system. And they are betting that healthcare IT will have a role to play in the country's fiscal recovery. The economic stimulus package allocates almost $20 billion for healthcare IT development, including funds for grants and affordable loans.

However, ophthalmology practices don't have to wait until the new Medicare payment incentives begin in 2011 to support their EHR strategy. Healthcare can immediately realize the benefits that IT offers, such as cost savings by eliminating paper, improved physician productivity with e-prescribing and participation in complex pay-for-performance programs, to name just a few.

The proof comes from organizations such as Katzen Eye Group. In 2003, the 17-physician practice was looking to inject efficiency into its operations by converting to an EHR system. A growing practice, Katzen's leaders knew it had to take advantage of the available technology to make its day-to-day operations easier.

Katzen's NextGen system has more than accounted for the two primary concerns physicians express about EHR: IT functionality and cost, according to Richard Edlow, O.D., COO of Katzen Eye. "Our health records are safer, more secure and more consistent than they've ever been, and we haven't had to search for a lost chart in 5 years." He adds that Katzen's investment in the EHR system — approximately $25,000 per physician for hardware and software licenses at the time — was easily recouped. "The benefits far outweigh the cost of the system. For example, in one location, we were able to convert the file room into three new exam lanes."

Traditionally operating on tight margins, ophthalmology practices rely on high patient volume to turn a profit, and Katzen Eye's EHR has stepped up to the challenge. Of the practice's 17 physicians, 16 are seeing more patients than they were prior to EHR adoption. The other physician — Katzen's busiest — records the same number of patients as before.

"When a doctor walks out of the exam room, printed chart notes, referral letters and diabetic reports are already prepared," Dr. Edlow notes. "Further, all coding has been completed, claims are ready to be sent to third-party payers, prescriptions are being faxed off to pharmacy and an eyeglass prescription is sent to the dispensary." The lightening of these administrative burdens facilitates increased patient volume.

The Interoperability Challenge

A traditional lack of technology standards among IT vendors has created an atmosphere of confusion that prevents the less-well-informed healthcare organizations from making important technology distinctions. And without interoperability, healthcare providers cannot depend on IT to reliably communicate important patient data with other providers.

The 2009 stimulus package addresses these issues by including timelines for standards adoption and by allocating $2 billion for a more muscular Health and Human Services' Office of the National Coordinator for Health Information Technology (ONCHIT) to finish developing the nation-wide health information network.

"This bodes well for healthcare IT companies that have been addressing standards and interoperability for some time," Mr. Jarvis says. "Physicians can practice a better brand of medicine when they receive more timely, accurate and consistent information accessible to them."

Among its EHR requirements, Katzen desired an interface between diagnostic equipment and the EHR, which creates workflow efficiencies while reducing the chance that errors are introduced into the record. The practice leverages this data for important medical programs such as the CMS Physician Quality Reporting Initiative and e-prescribing.

"Our practice sees 400 patients per day who are receiving diagnostic tests, including visual fields, A-scans, optic nerve testing and more. All the results need to be incorporated into the patient record," Dr. Edlow says. "It didn't make sense for us to print out all the diagnostic tests and add them to the paper chart, spending money on printers, paper and ink. We knew there was a better way of collecting the data and an EHR system was the answer."

The Future of EHR in Eye Care

Two major trends that will impact eye care going forward are an aging population that's increasingly dependent on ophthalmology services to treat cataracts, glaucoma, diabetic retinopathy and macular degeneration, for example, and the increasing minority populations in which epidemiologic studies have shown higher prevalence of glaucoma and diabetic retinopathy. "Demand for eyecare services will only increase," Dr. Edlow notes. "As a result, providers must find a more productive way to see patients."

The answer is in EHR, he believes, which will improve both operational and clinical efficiency, allowing practices to care for more patients while keeping administrative costs under control. And with greater regulatory compliance required for practices and physicians to get paid (Recovery Audit Contractor investigations and pay for performance, for example), documentation functionality that the EHR provides is increasingly important.

However, EHR implementation doesn't happen overnight. It takes a significant amount of time to investigate systems, install and integrate software and train users. "My concern is for my colleagues who are sitting on the sidelines. They are going to wake up one day to find the competition eating their lunch," Dr. Katzen concludes.

In addition, they will miss the opportunity to earn the government's incentive dollars — or, worse, find that eventual penalties are eroding their bottom line. OM