Electronic Health Records and Meaningful Use
Questions & Answers

On January 24th, 2009 during President Obama’s first weekly address, he stated “to lower health care costs, cut medical errors, and improve care, we’ll computerize the nation’s health records in five years, saving billions of dollars in health care costs and countless lives.”  This single missive gave rise to the establishment of programs to improve health care through the use of information technology.  Included in these programs are fairly substantial payment incentives for eligible hospitals and eligible physicians who demonstrate “meaningful use” of certified electronic health records (“EHRs”).  These payment incentives are authorized through the 2009 American Recovery and Reinvestment Act (“ARRA”), more popularly known as the Stimulus Bill. 

The following set of Questions & Answers is intended to provide basic information about EHRs and Meaningful Use. 

QUESTION: What is EHR and Meaningful Use? 

ANSWER:  “EHR” is an acronym for Electronic Health Records and is used interchangeably with Electronic Medical Records (“EMRs”).  Meaningful Use (“MU”) is the use of certified EHR technology by providers: a) In a meaningful manner, such as e-prescribing, b) For electronic exchange of health information to improve quality of health care, c) To submit clinical quality and other measures.

QUESTION: What are the three stages of MU? 

ANSWER:  The first stage of MU involves:

• Capturing health information electronically to track key clinical conditions and communicating that information for care coordination purposes
• Implementing clinical decision support tools to facilitate disease and medication management
• Reporting clinical quality measures and public health information

The second stage encourages use of health IT for continuous quality improvement and the exchange of information in the most structured format possible and Stage 3 focuses on promoting quality and operational improvements, focusing on decision support for priority conditions, providing access to comprehensive patient data and improving population health.

Only the guidelines for phase I have been specified.

QUESTION: What technologies for radiology are impacted? 

ANSWER: Providers need to use technology that is certified by one of the testing agencies authorized by the U.S. Office of the National Coordinator for Health Information Technology (“ONC”).  Any IT technology can be submitted for certification. If a product does not meet all criteria for certification, it can be submitted for modular certification which includes RIS, PACS, reporting systems, decision-support systems, image sharing systems, patient image portals, business analytics, and data mining.  It may be that a combination of these technologies will be required.

QUESTION: What is modular vs. complete certification? 

ANSWER: “Complete EHR” is classified as such and is one that meets the criteria for the practice setting in its entirety. Modular EHRs must be combined in order to meet the criteria and each module satisfies one or more of the required criteria, e.g. an e-prescribing module or an e-health record module.  For more information see: http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2 

QUESTION: Will the payment incentives be repealed if health care reform is repealed? 

ANSWER:  No.  The demonstration of meaningful use of EHR technology is mandated through the ARRA and is not a part of the health reform bill.  While Congress may rescind “unobligated” Stimulus dollars that have not been spent, it is highly unlikely that the incentive payments would be rescinded as they have already been obligated.

QUESTION: Are radiologists eligible professionals (“EPs”)? 

ANSWER: Yes, radiologists are eligible.  Hospital-based specialists were excluded as EPs in the proposed language; however, the removal of outpatient settings (POS Code 22) from CMS’ proposed definition of “hospital-based” in January means that hospital-based radiologists are now eligible for both the payment incentives and future payment penalties. 

QUESTION:  How do I qualify for the payment incentives? 

ANSWER: The first step is to register with CMS online beginning January 3rd, 2011.  You should be receiving documentation from CMS advising you of your eligibility status with information about how to register.  You do not need to be demonstrating meaningful use of certified EHR technology in order to register and physicians must have their PECOS username and password.

Physicians may register at: https://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp 

QUESTION: What criteria must be met? 

ANSWER: There are 15 “core set” criteria that must be satisfied and five of 10 “menu set” criteria.  Several of these core and menu set measures offer exclusions to facilitate compliance by EPs with varying scopes of practice.  If a radiologist attests to meeting the exclusion criteria for a specific core measure, this counts as satisfying the requirements of that measure. 

Core set criteria: 

• Use CPOE for medication orders
  –     Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period
• Implement drug-drug and drug-allergy interaction checks
• Generate and transmit permissible prescriptions electronically (eRx)
  –     Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period
• Record demographics
• Maintain an up-to-date problem list of current and active diagnoses
• Maintain active medication list
• Maintain active medication allergy list
• Record and chart changes in vital signs: height, weight, blood pressure, calculate and display BM, plot and display growth charts for children 2-20 years, including BMI
  –     Exclusion:  Any EP who a) sees no patients 2+ years or b) believes patient’s height, weight, blood pressure have no relevance  to scope of practice
• Use CPOE for medication orders
  –     Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period
• Implement drug-drug and drug-allergy interaction checks
• Generate and transmit permissible prescriptions electronically (eRx)
  –     Exclusion: Any EP who writes fewer than 100 prescriptions during the reporting period
• Record demographics
• Maintain an up-to-date problem list of current and active diagnoses
• Maintain active medication list
• Maintain active medication allergy list
• Record and chart changes in vital signs: height, weight, blood pressure, calculate and display BM, plot and display growth charts for children 2-20 years, including BMI
  –     Exclusion:  Any EP who a) sees no patients 2+ years or b) believes patient’s height, weight, blood pressure have no relevance  to scope of practice

Menu Set Criteria: 

• Implement drug-formulary checks
• Incorporate clinical lab-test results into certified EHR technology as structured data
  –     Exclusion: An EP who orders no lab tests whose results are either in a negative/positive or numeric format during the reporting period
• Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach
• Send reminders to patients per patient preference for preventive/ follow up care
  –     Exclusion: An EP who has no patients 65 years old or older or 5 years old or younger with records maintained using certified EHR technology
• Provide patients with timely electronic access to their health information within four days of the information being available to the EP
  –     Exclusion: Any EP that neither orders nor creates any of the information listed at 45 CFR 170.304(g) during the reporting period
• Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate
• Perform medication reconciliation if patient is received from another setting or provider of care
  –     Exclusion: An EP who was not the recipient of any transitions of care during the reporting period
• Provide summary of care record for each transition of care or referral
  –     Exclusion: An EP who neither transfers a patient to another setting nor refers a patient to another provider during the reporting period
• Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission in accordance with applicable law and practice
  –     Exclusion: An EP who administers no immunizations during the reporting period or where no immunization registry has the capacity to receive the information electronically
• Capability to submit electronic syndromic surveillance data to public health agencies and actual submission in accordance with applicable law and practice
  –     Exclusion: An EP who does not collect any reportable syndromic information on their patients during the reporting period or does not submit such information to any public health agency that has the capacity to receive the information electronically

QUESTION: How do I qualify for the payment incentives? 

ANSWER: You must enroll through the online registration system and you may attest to your meaningful use of certified EHR technology in 2011 and 2012.  If you begin participation in either 2011 or 2012, you are eligible to qualify for up to $44,000 per physician in incentive payments, distributed over a five year period. If you choose to begin participating in 2013, the most you will be eligible for is $39,000 and $24,000 in 2014.  If you choose to not participate, you will be subject to payment penalties beginning in 2015.

Physicians who do not comply with the Meaningful Use criteria will be subject to the following penalties:

QUESTION: What should I be doing now? 

ANSWER: Hospital-based radiologists should know that hospitals are also eligible through the eligible hospital (“EH”) program.  Find out if your hospital is going to participate and if so, are they going to facilitate compliance by the physicians in their institution who are eligible for the EP version of the program.  There is some overlap between the EH and the EP meaningful use criteria and technology, but also several differences so the hospital will need to make specific accommodations for EPs if they are going to include EPs.  Non-hospital-based radiologists should be conferring with their technology vendors about the vendors’ plans and timelines for both certification and training.  Vendors are largely responsible at this point for developing and presenting their technology for certification and will also need to train providers in how to utilize their technology in a meaningful way.  There is sufficient time at this point so beyond participating in CMS’ online registration process in January, doing the appropriate due diligence needed to assess your options is the best course of action today! 

QUESTION: Where can I find more information? 

ANSWER: You may find useful information at the following website:

http://www.acr.org/SecondaryMainMenuCategories/GR_Econ/FeaturedCategories/federal/hhs/ACR-Summary-CMS-and-ONC-Stage-1-Meaningful-Use-Final-Rules.aspx 

Also, below are some links to the primary source information for verification purposes:

ONC final rule on HIT standards, certification criteria, and implementation specifications: http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf 

CHPL List:   http://onc-chpl.force.com/ehrcert/EHRProductSearch 

CMS - EHR Incentive Programs: http://www.cms.gov/ehrincentiveprograms/ 

CMS Fact Sheet on MU Measures: https://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC-Core-and-MenuSet-Objectives.pdf 

ONC - Meaningful Use: http://healthit.hhs.gov/meaningfuluse 

ACR Comment to DHHS:
http://www.acr.org/SecondaryMainMenuCategories/GR_Econ/FeaturedCategories/federal/hhs/ACR-ASA-and-CAP-Letter-to-HHS-Meaningful-Use-Considerations.aspx 

Physicians have until October 1, 2012 to attest to meaningful use of certified EHR technology and be eligible for the full payment incentive amount.  If you are hospital-based, find out what your hospital is doing and get yourself a seat at the hospital’s table.

Ask these questions:

• What is the hospital’s strategy for satisfying the EH criteria?
• Does the hospital intend to include EPs in their strategy?
• If not and if you rely upon the hospital’s technology (RIS, PACS, HIS), how will the hospital accommodate any EHR modules you intend to invest in unilaterally?

If you are not hospital-based, speak with your technology vendors about their plans and timelines for certification and training.

Statement from the RBMA Technology Task Force:   

There are still many unanswered questions about the meaningful use of EHR technology and the RBMA Board of Directors has formed the Technology Task Force to serve as a resource for its members.  A primary objective of the Technology Task Force is to educate the RBMA membership about the meaningful use of certified EHR technology and the Task Force will continue to monitor and provide updates as they become available.