ARRA/HITECH, which was signed into law in early 2009, was intended to stimulate the adoption of EHRs in medical practices and hospitals. It began with fits and starts — the two important stipulations of a “certified EHR” and conforming to “meaningful use” were not defined until December of 2009 and June of 2010, respectively. In some ways, things have now settled down and many providers are beginning to line up to take advantage of the stimulus — up to $44,000 for providers with a significant number of Medicare patients, and an even higher amount — up to $64,000 — for Medicaid.
But many providers are apparently still sitting on the sidelines, and some are turning their backs entirely on ARRA/HITECH. Of course if a practice has no Medicare or Medicaid patient load, they wouldn’t qualify for ARRA/HITECH funds. But even then this ignores the business and clinical cases for EHRs: better clinical documentation, patient safety, better billing and reimbursement, structured data that can be searched and analyzed, to name just a few.
Even the most basic advantage is sometimes lost in the debate — the ability for more than one person in the practice to access the complete patient record. See if this scenario seems familiar: Patient has lab test. Patient calls back practice for result. Practice can’t find patient file so patient must call back. Practice finds patient file but lab result isn’t in the file. Practice has to locate lab result and put it in the file and give to the physician to approve. Patient calls back for result but the file is in the provider’s office/car/home/etc. Finally this fire drill is played out over several days such that the only successful resolution is when the patient file is sitting in front of the right person in the practice at the exact same moment that that particular patient is on the phone.
For years physicians have complained that they shouldn’t be the ones to foot the bill for EHRs because, they argue, the other two players in the healthcare “triangle” — patients and payers — benefit more from automation than do providers. But now someone is offering to pick up the tab, and providers are still staying away in droves. And there is a limited window on this offer that begins to close in just over a year, in late 2012.
Most industries are on their fourth- or fifth-generation IT and automation systems, where they continue to increase efficiencies and streamline processes to wring more costs out of their systems. Their IT systems are indispensible to them, and are an integrated part of their core processes.
In some healthcare circles, by contrast, there is an argument about whether IT and automation are even a good idea. The argument is that healthcare is somehow different, that it is too complex, and that IT and automation cost too much to make a difference. Some even argue that it could harm patient care. There have been widespread reports — many of them anecdotal — of dissatisfaction among providers, with some EHR systems even being de-installed.
There is no question that any EHR system, if poorly selected and configured, could actually negatively impact both patient care and practice viability. But any new process has a learning curve. ARRA/HITECH is designed to help providers get over that learning curve.
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