In addition to her private consulting practice, Rosemarie Nelson serves as an MGMA Principal Consultant and a member of the CCHIT Ambulatory Workgroup, which is revising certification criteria to match the Stimulus Plan’s definition of “meaningful use.”
Rosemarie Nelson has her finger on the pulse of private practice physicians. Rather than commenting myself on the newly adopted “Meaningful Use Matrix” and the implications for physicians, I want to share with you her thoughts and insights. The following are her responses to an interview conducted this week:
Evan Steele: Do you think the Economic Stimulus legislation will be successful in encouraging widespread EHR adoption?
Rosemarie Nelson: Physicians should not try to implement an EHR if the sole purpose is to earn the incentive money—physicians should make their EHR decision based on what will be right for their practice. They need to honestly assess (and if necessary, take steps to improve) their readiness, and then evaluate EHRs on the basis of how they will impact practice workflow and efficiency.
The Economic Stimulus plan has definitely created a buzz about EHRs and will get more physicians to consider implementation. Depending upon the “meaningful use” requirements ultimately adopted, we could experience what happened with PQRI—while some physicians will successfully qualify for the incentives, the middle majority might try, but determine that it is just too difficult and not worth the negative impact on productivity. Physicians should weigh the costs and benefits of their options and then do what is best for their practice.
Evan: Do physicians understand the legislation and what will be required to qualify for the incentive payments?
Rosemarie: The legislation is complex, and many do not understand that it is not as simple as buying an EHR and automatically receiving a check to assist with the cost. Incentive payments are not a given, and must be earned by physicians.
With all the demands on physicians these days, it is understandably difficult for them to stay on top of all the issues. My suggestion is that they try to get engaged by attending professional society meetings—when this issue is on the agenda—or delegate responsibility by empowering staff or look for guidance to a consultant with specific expertise in healthcare IT legislation.
Evan: What do you think about the new “Meaningful Use” Matrix that was adopted at last week’s HIT Policy Committee meeting? Are the expectations of physicians realistic?
Rosemarie: If the intent is to spur on the use of electronic health records to improve outcomes and quality of care, the bar needs to be realistic. It certainly seems that the first objective on the matrix, CPOE [Computerized Physician Order Entry], creates a hurdle to adoption, not an incentive. This type of physician direct entry presents a burden on a physician’s very busy schedule, reducing the number of patients he/she could see and ultimately adversely impacting access for many patients. Clearly, that is not realistic, and not the intended outcome! If we aren’t applying a technology solution that improves the daily operation for the nurse and physician, that nurse and physician won’t use the technology and we won’t be able to deliver on the desired health outcomes and care goals.
Evan: How do you think physicians will respond to the need to document exam notes via point-and-click data entry in order to gather the data the government seeks?
Rosemarie: That will be very tough for a lot of physicians. I have worked with hundreds of physicians in the private practice setting, and many continue to dictate notes because they find it the most efficient method to document the encounter. If physicians spend minutes entering data when they could be seeing patients, then we are wasting a valuable resource in society.
There is a disconnect between the decision-making committees at HHS [Department of Health and Human Services] and the physicians who are out seeing patients. I would most certainly look closely at physician and nurse workflow around the patient encounter. Then we would understand how onerous the demands of point-and-click data entry and CPOE are.
That voice—the voice of the practicing physician—is not being heard in Washington.
RosemarieNelson@alum.syracuse.edu
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I think you bring up some very interesting points here. What would you say to practices that generate a high volume in Medicare revenue once Medicare decides to begin deducting a percentage of their revenue because they are not using a certified system?
Practices need to weigh the costs of lost productivity associated with a point-and-click EMR against the potential loss of Medicare revenue. In addition, they need to assess the risk associated with the purchase, i.e. the chance that the physicians will not be able or willing to use the “certified” EMR in the manner required to meet the definition of “meaningful use”. My experience with orthopaedic practices is that these specialists, in particular, are not willing to stop dictating exam notes to spend the time pointing and clicking their way through patient visits. In this case, the practice is stuck with an EMR they did not want and do not use fully, and they would still be subject to the penalties. Also, keep in mind, the penalties do not begin until 2015.