An Update in Electronic
Health Records
Mark Seigel, MD, FACOG
Assistant Professor,
Obstetrics and Gynecology,
George Washington University
Disclosure
I have no financial interests or industry relationships
to disclose.
Learning Objectives
■ Understanding the advantages and disadvantages
of Electronic Health Records.
■ Deciding if Meaningful Use is for you.
■ Seeing how the EHR field is changing.
EHR Features
■ Single record per patient
■ Document management system ■ Clinical Decision Support
■ Secure messaging system ■ Patient portal
■ Lab portal ■ E-Prescribing ■ Meaningful Use
Office Infrastructure
Office Infrastructure
■ Desktop workstations ■ Tablets ■ Scanner ■ Printer ■ Camera ■ Wireless network■ Internet service provider
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Disadvantages of EHR
The Betamax factor – The fear it will soon be obsolete!
Disadvantages of EHR
Making the transition – EHR Purgatory
Disadvantages of EHR
Vendor lock!
Cost
■ Software purchase $30,000
■ Hardware purchase $10,000
■ Software maintenance $6,000/year
■ Internet contract $4,000/year
■ First year expenses $50,000
American Recovery and
Reinvestment Act of 2009
■ $17 billion to fund physician adoption of EHR by 2015
■ Meeting criteria of “meaningful use” may allow physicians to receive $44,000 over 5 years, depending on
Medicare/Medicaid patient mix and meeting meaningful use objectives.
MU Payment
MU Core Objective Measure CPOE CPOE is used for at least 30% of all Medication orders Implement Drug‐Drug, Drug‐Allergy checks EP has this functionality enabled Maintain an Up‐To‐Date Problems list 80% of unique patients seen during reporting period have at least one entry or an indication no problems exist. E‐Prescribing At least 40% of prescriptions are sent electronically. Maintain an Up‐To‐Date Medication list 80% of unique patients seen during reporting period have at least one entry or an indication no medications exist. Maintain an Up‐To‐Date Allergy list 80% of unique patients seen during reporting period have at least one entry or an indication no allergies exist. Patient Demographics At least 50% of unique patients seen during reporting period have the following data for each patient: DOB, Gender, Race, Ethnicity, Preferred Language Vital Signs At least 50% of unique patients (2 and older) seen during reporting period have the following data recorded for each patient: Blood Pressure, BMI, Height, Weight Smoking Status At least 50% of unique patients (13 and older) seen during reporting period have a “Smoking Status” d d
MU Core Objective Measure
Report Clinical Quality Measures Report numerators/denominators for 6-9 CQMs. No performance measures required
Clinical Decision Support Rule Implement one clinical decision support rule Provide electronic copies of health
information
Provide electronic copies of health information for more than 50% of patients who request it electronically.
Clinical Summaries Provide a clinical summary to patients for more than 50% of all office visits within 3 business days.
Electronically exchange key clinical information
Perform at least one test of EHR technology to electronically exchange key clinical information. Protect Electronic Health Information Conduct or review a security risk analysis.
MU Menu Options Measure
Implement Drug Formulary Checks This functionality has been enabled. Incorporate Lab test results as structured
data
More than 40% of lab orders have their results entered into the EHR.
Generate a list of patients by condition Generate at least one report of patients by a condition Send reminders to patients for care More than 20% of patients between ages 5-65 are sent
MU 1
MU Menu Options Measure
Provide patients with access to patient portal
At least 10% of patients are provided access within 4 business days of when data was updated in the record. Identify patient-specific education
resources
More than 10% of all patients seen by the EP are provided patient-specific education resources.
Medication Reconciliation Med Rec is performed for more than 50% of patients that are transitioned to the provider.
Transitions of Care A summary of care record is provided to another care setting for more than 50% of patients transitioned to another care setting.
Submit Immunization Record At least one immunization record is submitted electronically to immunization registries
Submit electronic syndromic surveillance At least one test is performed to provide electronic syndromic surveillance data to public health agencies.
Meaningful Use Dashboard
The tool depicted below allows providers to have an up-to-date perspective on their compliance with MU measures
Providers can filter the report to an exact 90-day period.
Numerator/Denominator and corresponding % for each measure.
Indication of a passing or failing performance to the MU goal.
Listing of the Meaningful Use Objectives
MU Requirements
■ In order to receive incentive payment, practices must “attest” to meaningful use and report to CMS that objectives are
being met.
■ Stage 1 requires meeting 13 core objectives and 5/10 menu objectives
■ Stage 2 requires 17 core objectives and 3/6 menu objectives. ■ Both require reporting on quality measures.
Meaningful Use 2
Problems with EHRs and MU
■ EHRs can improve healthcare, but are expensive. ■ Few are designed to improve documentation.
■ Documentation needed to justify level of service, but too much makes it unreadable and wastes time.
MU 2 Problems
■ Requirement of patients to participate in patient portals depends on patients to do it.
■ Communication with immunization and cancer registries depends on state exchanges.
■ Only 200 of 1400 Vendors have been MU 2 certified. This could require a change in EHR.
Choices?
■ For many independent obgyns, simple option is not to participate in MU 2.
■ Following the first year payments, incentive is less than $8500.
■ Loss in productivity and real cost of compliance may not be worth it.
Recommendation
■ Over 500,000 eligible professionals and hospitals are
registered in Medicare and Medicaid EHR Incentive programs. ■ As of end of 2014, only 1203 providers attested to MU 2.
■ Recommend continue to use EHR to improve patient care, help improve EHR products, but not participate in MU 2.
SERMO Poll
■ 55% of physicians do not plan to attest to MU 2. ■ Only 4% had met Stage 2 requirements.
■ AMA has urged eliminating penalties and shortening the reporting period to ease the MU burden on physicians.
MU Mandates Lost Their
Purpose
■ Metrics we are required to report often have no relevance to patient.
■ Useful information is often buried in chart surrounded by clutter.
■ Tedious box checking does not promote good clinical outcome.
MU Mandates Lost their
Purpose
■ MU 2 requires patients to use patient portal. Active portals require vendors to provide interface.
■ Patients don’t always want to use portals. ■ Poor and elderly don’t have email ability.
MU Mandates Lost their
Purpose
■ Compliance is difficult, costly and time consuming.
■ Hospitals and large networks have IT departments devoted to this, smaller practices do not.
■ Need more docs involved with the design process for a real-world, workable system to benefit patients.
A Changing EHR field
■ Consolidation of Vendors
■ Internet of Things
Internet of Things
Electronic devices that monitor data and are connected to a cloud, enabling them to trigger events. This can include car maintenance, smart homes, smart cities, and healthcare applications. Connected devices with unique identifiers can deliver health care data to physicians to monitor health
parameters, or to hospitals to monitor bed use, location of equipment, dispensing of medications.
Apple Watch
■ Wearable technology that is linked to a healthcare platform aids clinical communication.
■ It could lead to a more customized experience at hospital, clinic or at home.
■ Could it begin to monitor health on a personal level and look at health risks and issue alerts?
Apple Watch Apps
■ Messages – gives haptic feedback, easiest way to look at messages at work.
■ Mail – can be provided securely ■ Social media
■ Badge entry, check in ■ Appointment information ■ Note dictation
