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Electronic Health Records and Meaningful Use

Helping you deliver better health care.

Electronic Health Records

Electronic health records (EHRs) play a critical role in establishing a higher-quality, safer, more effective health care system. Why? Because EHRs allow you to do things that are difficult, if not impossible, with paper medical records.

EHRs make a patient’s health information available whenever and wherever it is needed. They offer you a more complete picture of a patient’s health, enabling you to diagnose health problems earlier and make better recommendations for care. They let you share information more easily with other health care professionals involved in your patient’s care, including labs and pharmacies, supporting more coordinated care. And they save you time and money by reducing your paperwork and reporting burden.

For patients and their families, EHRs promise convenience and greater involvement in their own care. Patients won’t have to fill out or answer the same questions about their health every time they visit you. They’ll get preventive care reminders automatically. You can even order their prescriptions before they leave your office. With EHRs, they can receive electronic copies of their medical records and share their health information securely over the Internet with their families.


Meaningful Use: What Is It?

To encourage providers to switch to EHRs and support the adoption and use of certified EHR technology to improve health care, the federal government has committed unprecedented resources through the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH’s goal is not merely adoption of EHRs, but their meaningful use – their use by providers to make significant advances in care.

So when eligible providers and hospitals achieve certain objectives to improve health care processes and outcomes using EHRs – when they achieve Meaningful Use – they qualify for Medicare or Medicaid incentive payments, whichever they choose.

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Who is Eligible:

  • Under the Medicare EHR Incentive Program:
    • Doctors of medicine or osteopathy.
    • Doctors of dental medicine or dental surgery.
    • Doctors of podiatry.
    • Doctors of optometry.
    • Chiropractors.
  • Under the Medicaid EHR Incentive Program:
    • Physicians (primarily doctors of medicine and doctors of osteopathy).
    • Dentists.
    • Nurse practitioners.
    • Certified nurse-midwives.
    • Physician assistants who furnish services in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant.

The provider must also have a minimum 30 percent Medicaid patient volume, be a pediatrician with a minimum 20 percent Medicaid patient volume, or practice predominantly in an FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals. There are different eligibility requirements for hospitals.

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Incentives and Penalties:

Incentive payments are given as providers adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. Providers can receive:

  • A maximum of $44,000 over five years under the Medicare program.
  • A maximum of $63,750 over six years under the Medicaid program.

Although providers are not required to participate in either the Medicare or Medicaid EHR incentive programs, they will see reductions in their Medicare reimbursements if they don’t achieve Meaningful Use by 2015. These reductions start at 1 percent the first year and increase each year thereafter, up to 5 percent. There are no Medicaid penalties.

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Objectives and Measures:

With public and professional input, the government has identified the objectives that providers must meet to qualify for the bonus payments (in addition to the technical capabilities required for certified EHR technology). Providers have to complete:

  • 15 core set objectives. These include using EHRs to order prescriptions, submit clinical quality measures, and exchange patient health information electronically.
  • Five of 10 menu set objectives. These include using EHRs to send reminders to patients for follow-up care; generate lists of patients by specific conditions to use for quality improvement; provide patients with timely electronic access to their health information, such as lab results; and perform medication reconciliation.
  • Six clinical quality measures, which include three core measures or three alternate core measures, and three of 38 menu set measures.

Requirements are different for hospitals.

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Challenges to Achieving Meaningful Use

EHRs require an initial investment of money and time. The cost of EHR systems varies widely depending on the functions included. And it takes time to implement an EHR system and achieve Meaningful Use, from the time needed to transfer data to that needed to adjust workflow and train staff.

However, hundreds of thousands of providers have already seen the benefits of EHRs in their practice. In addition to receiving bonus payments, providers have reported spending less time locating charts, transcribing, and communicating with labs and pharmacies. They have reported better documentation, more accurate coding, and reductions in reporting burden. They have experienced increased billing and faster accounts receivable processes. Ultimately, they have improved their health care decisions and patient outcomes…the largest return on investment.

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How to Get Started

If you’re interested in participating in the Medicare or Medicaid EHR Incentive Program, you should first do the following:

  1. Determine if you are eligible.
  2. Apply for a national provider identifier (NPI) and open accounts with the National Plan and Provider Enumeration System (NPPES) and Centers for Medicare & Medicaid Services Provider Enrollment Chain and Ownership System (PECOS) if you haven’t done so.
    1. To apply for a NPI, visit www.cms.gov/NationalProvIdentStand.
    2. To enroll in PECOS, visit www.cms.gov/MedicareProviderSupEnroll/01_Overview.asp.
  3. Register for the incentive program online.
  4. Select and install an EHR system.
    1. Determine what functions you want in a system.
    2. Choose a system that has been certified by an ONC-Authorized Testing and Certification Body. For more information, visit http://onc-chpl.force.com/ehrcert.
  5. Evaluate the system, transfer data, adjust workflow, and train staff.
  6. Begin work to complete the objectives and measures of Meaningful Use.

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Help for You

From HMSA
As part of its commitment to building a better health care system for Hawaii, HMSA has entered into an agreement with the Hawai‘i Health Information Exchange (Hawai‘i HIE), through the Hawai‘i Pacific Regional Extension Center (HPREC), to help HMSA providers adopt, implement, and become meaningful users of EHRs. HPREC was established by the Hawai‘i HIE in 2009 and is one of over 60 regional extension centers nationwide that help providers transition from paper records to EHRs. It has already helped 200 providers implement EHR systems, 17 of which are now eligible to receive incentive payments.

If you are still using paper records, HPREC will:

  • Evaluate your practice for computer readiness and implementation of an EHR system.
  • Assist with vendor demonstrations and selection.
  • Assist with installation, implementation, and troubleshooting support.

If you already have an EHR system, HPREC will:

  • Create a customized Meaningful Use project plan and perform gap analysis.
  • Redesign your work processes and update staff roles and responsibilities.
  • Assist you with implementing interfaces with Hawai‘i HIE and other organizations.

For more information on HPREC or to sign up for services, please contact Jeff Gregg at jgregg@hawaiihie.org or (808) 441-1344 on Oahu. If you are interested in participating in an HMSA pilot program with HPREC, please contact Donna DeLepine at donna_delepine@hmsa.com or (808) 952-7591 on Oahu.

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Other Resources

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