Keys to understanding EHR adoption

Dec. 20, 2010
Troy Young

Jumping into EHR technology too early may be painful and costly, but standing on the sidelines could be devastating.

For most medical practices in the U.S., implementing an electronic health record (EHR) is not a question of if; it is pretty much a foregone conclusion that electronic records in one form or another will dominate the future landscape of medicine.

The bigger challenge is weeding through the plethora of facts, claims, regulations (actual, proposed or rumored), incentives, standards, vendors and increasingly vocal patient demands to understand when and how to jump into the fray. Adding to the uncertainty is the fact that, for many practitioners, the fundamental question of why — and especially, why now — still begs a compelling answer.

In this article, we offer four keys to understanding the EHR adoption landscape and how to plan your entry in a way that fits your specific situation and goals.

Key #1: Don't panic
We recently met with a very busy solo practitioner who, like many in this situation, has a good basic understanding of what is happening with EHR but is simply too pressed for time just keeping up with patients and life to delve into the details. Her fear of making an EHR mistake was quickly becoming overwhelmed by the fear (with a little help from all the current media hype) of missing out on the government incentives. Her solution was to “jump in now before it's too late.”

The good news is that there is no need to panic. Given current incentive phase-out schedules, there is plenty of time to make a methodical, well-founded decision. That doesn't necessarily mean postponing the decision. It does mean you have time to assemble and consider all the facts and implications before making a decision.

Key #2: Get the facts
An easy way to cut through the hype and get to the core issues with regard to implementing an EHR and maximizing incentives is to utilize an EHR incentive calculator (example is included at

With just a few simple inputs derived from your practice-reimbursement profile and planned-implementation timing, these tools will calculate annual allowable incentive payments over the life of the incentive program. Most importantly, you can input various what-if scenarios with regard to implementation timing and immediately see the impact on total incentives. Using this type of approach, our solo-practitioner friend discovered that, given her practice's goals and profile, she had more than a year to begin her initial EHR implementation and still receive maximum incentive payment.

The other important facts to understand are the impact and timing of meaningful use, which you will be required to demonstrate in order to qualify for the incentives. A simple way to get your arms around these issues is to leverage the knowledge of EHR vendors whose products will have to comply. Have them summarize the standards and provide a roadmap for their products' compliance. Look for vendors who demonstrate an understanding of the evolving standards and show commitment to making your qualification for meaningful use as simple and painless as possible.

Key #3: Why now?
While there is no need to panic with regard to EHR implementation, there are a number of good reasons not to delay the decision.
First, consider the experience factor. Meaningful-use requirements start out fairly simple in the first year, but they increase in intensity with each succeeding stage. Moving to an electronic record is a non-trivial process for most practices. Learning and mastering it over time in lockstep with increasing requirements will be much easier than diving into the deep end in the year incentive requirements ratchet up. An earlier start will allow you and your staff to grow comfortably into the more complex use of the system and reporting. Over time, not only will meaningful-use requirements increase in complexity, but the EHR software itself will require enhancements to accommodate those more complex requirements. However, ramping up a new EHR is not always a year-long process. Another solo practitioner, Dr. Kim Jackson of Point of Light Family Medicine, went from planning stage to full implementation in 90 days on a Web-based EHR from AdvancedMD.

Second, private payers are quickly moving toward providing incentives of their own, based on demonstrated improvements that will, in many cases, parallel government requirements. These pay-for-performance bonuses can add up to an additional 8 percent in reimbursement. A system that substantiates these requirements quickly and easily, based on an experienced and knowledgeable staff, can improve your reimbursement and profitability picture that much sooner.

One additional point to consider: Delays in rolling out updates to premises-based systems can impact your ability to comply and receive incentive payments. Typically, an on-site upgrade is required not only to the EHR system, but often to other components of the computer system as well. These delays can run into months and, in some estimates we've seen, even years. Make certain that your vendor will be ready to install when you are ready to go. One fail-safe way to ensure this is to go with a Web-based, hosted system; this approach eliminates the need for onsite servers, software and upgrades.

Key #4: Beyond the incentives
While change seems to come slowly in the healthcare industry, a new era of rapid change is upon us. Technology, policy, public demand and economics are all aligning to drive some of the biggest movements in the industry to date. While jumping into technology too early may be painful and costly, standing on the sidelines could be even more devastating in the long run.
The downside of delaying implementation hits directly at the core of your ability to survive and thrive into the future. Our industry is rapidly moving to an electronic platform as the expected way of doing business. This not only impacts your ability to get paid — by both government and private entities — but will increasingly impact other important aspects of your practice. As your colleagues adopt automated systems, they will gravitate toward those practices and institutions that are easier to do business with, whether sharing patient records, orders, test results or collaborative communications. Hospitals and vendors will also find it difficult and costly to interact in a non-automated world.

As physicians become comfortable with modern technologies, such as the software-as-a-service (SaaS) subscription model, they grow to rely on anytime, anywhere access to their patient data, making the EHR invaluable for significantly improving both productivity and quality of life. These same SaaS EHR-based benefits are available to smaller practices that have traditionally been at a disadvantage to larger groups that could afford the high-end applications and high acquisition costs.

Patients will increasingly drive demand for services. They will seek out ahead-of-the-technology-curve practices that make it easy for them to interact, communicate and manage their health. On the cost side, better-trained, forward-thinking staff will select practices that support their technology-enhanced productivity and experience.

Notably, technology provides a powerful upside potential, particularly for smaller, independent practitioners in an era of acquisition and conglomeration. Just as the Internet has allowed the smallest of companies to compete on a level playing field with the largest of enterprises, technology can provide the smallest, most-remote practice with the technical sophistication and connectivity to play on equal footing with large, integrated systems.

Troy Young is chief architect, AdvancedMD Software.

NOTE: Shirley Garcia, Product Manager, EHR, AdvancedMD Software, contributed to this story.

Calculate your way to incentives

AdvancedMD Software offers three calculators on its Web site to estimate incentives for meaningful use of EHRs based on allowable Medicare charges. Using these tools, you can calculate Medicare volume, time of EHR usage for maximum incentive and Medicare incentives or penalties. According to the site, the first year of meaningful use of EHR technology requires 90 consecutive days of use of that particular EHR technology. To qualify for the maximum incentive for year-one use, you may need to use your EHR technology longer than 90 days.

The company's “notes and disclaimers” listed on the site's page apply to all three calculators and contain interesting and useful information:

•    Incentive payments will be equal to 75 percent of the allowed charges for all covered professional services furnished up to a maximum annual payment determined by the year in which your practice achieves meaningful use.
•    Eligible professionals predominantly furnishing services in a health professional shortage area will receive an additional 10 percent increase in their bonus payments.
•    There will be no incentive payments for those who adopt EHRs after 2014.
•    Penalties will take the form of a reduction in the normal reimbursement schedule for those who are not “meaningful users” of a certified EHR by 2016. Penalties for non-use begin in year 2016 with a 1 percent penalty that year, incrementing 1 percent annually with a maximum penalty of 5 percent in year 2020.

Note: Calculations are estimates provided for informational purposes only and are offered without guarantee by AdvancedMD.

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