Those who implement electronic health records early will reap the benefits, including receiving a greater amount of incentives for which they will be eligible.

With Medicare and Medicaid financial incentives for meaningful use of certifiable electronic health records (EHRs) becoming available to eligible hospitals and physicians Oct. 1, 2010, providers should act rapidly to establish eligibility and quality for the maximum incentive money. Providers should leverage their existing information-technology infrastructure, use a best-of-breed strategy and partner with vendors offering risk-sharing approaches.

The American Recovery and Reinvestment Tax Act (ARRA) uses a "carrot-and-stick" approach to drive inpatient and outpatient use of EHRs by 2015. The carrot is that the earlier facilities begin using EHRs, the greater the amount of incentives for which they will be eligible. Based on the number of annual discharges and other factors, early adopters can receive a minimum of $2 million to a maximum of $11 million payable over four years.

The primary question for providers is how to create an ARRA-qualified EHR. The easiest and most expedient way for facilities is to piggyback on their existing infrastructures.

The stick is twofold. First, institutions that start using EHRs in 2014 and 2015 will receive lower incentive payments for three and two years, respectively. Second, and more importantly, those that fail to adopt or use EHRs after 2015 will have Medicare reimbursement reduced by 1 percent annually starting in 2015, reaching up to 5 percent in later years.

Hospitals and health systems that already have adopted or are on the path toward adoption are best positioned to receive higher incentives. Organizations in the preliminary stage of considering EHRs can catch up by acting aggressively. Though the definition of meaningful use is being defined, providers will be better off buying an EHR now instead of later. Further, there is no reason to risk delay in qualifying for incentives when vendors will upgrade systems to meet meaningful-use criteria.

The primary question for providers is how to create an ARRA-qualified EHR. The easiest and most expedient way for facilities is to piggyback on their existing infrastructures, using them as a foundation. This strategy will not be too jarring for many organizations, as it will simply reinforce a development that already is under way at many facilities.

A prominent trend among providers over the past decade has been to look for a single-vendor solution. The current economic environment, however, makes a single-vendor strategy economically unfeasible. ARRA’s staggered meaningful-use deadlines leave hospitals little margin for error if the vendor encounters technical difficulties or fails to come through. Consequently, organizations should use their existing infrastructure as a baseline platform, while adding proven, best-of-breed clinical solutions to address areas of need.

Another reason for this approach is that vendors of large hospital-information systems (HIS) historically have struggled to automate high-acuity areas, such as the emergency department, intensive-care units, labor and delivery units, neonatal intensive-care units, operating rooms, and post-anesthesia care units. Meaningful use can only be achieved by collecting and distributing meaningful data that resides primarily in those high-acuity areas.

When selecting EHR vendors, hospitals would be wise to partner with either HIS companies that have acquired best-of-breed high-acuity solutions through mergers or partnerships, or with companies that specialize in automating clinical-documentation solutions they need. Whatever HIS vendor EHR a facility selects should interoperate with best-of-breed, high-acuity solutions and vice versa.

To further minimize risk and ensure optimal IT investment, facilities should:

Seek vendors willing to enter into risk-sharing or performance-based pricing models. This model ties payment to performance on metrics, such as decreased average length-of-stay, improved staff efficiency and retention, and reduced costs.

Use the revised recommendations the federal Health Information Technology Policy Committee approved as a guideline for evaluating EHRs. Under the proposed requirements for 2011, organizations must use computerized physician order entry for 10 percent of all orders of any type and provide patients with an electronic copy of their health information upon request.

The U.S. Department of Health and Human Services (HHS) will use the recommendations to develop a proposed administrative rule to implement the incentives. The rule, which will be released by Jan. 1, 2010, is expected to provide greater detail and clarity about meaningful-use requirements.

Prioritize areas for automation. The growing need for high-acuity applications should be balanced with the hospital administrator’s challenge of deciding where to begin implementing those solutions. One approach is to group clinical modules around "functional clusters," or strategic functions or initiatives.

Hospitals will be best served by creating an HIT infrastructure emphasizing outcomes-relevant, connected and simple use of enterprise EHR systems for mobile and busy clinicians. This means putting the power of patient information, a streamlined ordering process, easy access to drug/clinical decision-support database information, and medical-device interface interoperability at the clinician’s fingertips.

Progress has been made in improving quality and eliminating inefficiencies that cost the health system billions of dollars, but only 1.5 percent of hospitals have adopted a comprehensive EHR, according to a New England Journal of Medicine survey. By providing $17.2 billion in incentives to encourage hospitals and physicians to use EHRs, the government is addressing the financial barrier that has kept providers from automating care delivery.

As HHS moves to finalize meaningful-use requirements, facilities, vendors and other stakeholders should collaborate to meet meaningful-use requirements and improve the quality, safety and cost effectiveness of care.

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Alan Portela is chief operating officer of CliniComp International, San Diego.

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