Tuesday, April 6, 2010

Achieving Meaningful Use – A Roadmap for a Small Practice

A few days ago, while reading one of my favorite EHR forums, I ran across a post from a typical Primary Care physician, practicing in a typical small practice, seeking advice on EHR adoption. There was nothing unusual about his post, except the last line:

“So confused.  All I want to do is see patients.  Any suggestions”

This may be the most succinct and accurate description of the situation out there. We the “experts” are reading hundreds of pages of legislation and rulemaking cropping up on a daily basis, participating in public meeting and public comments and writing heaps of articles and blog posts all over the Internet. However, the typical doc, in the typical small practice, does not have either the time or the inclination to become an expert. All these physicians have is incomplete and sometimes misguided information.

For the anonymous doc from my forum and for the hundreds of thousands of his/her colleagues, I committed to writing a guide to the times, or a simple guide for achieving the national goals for HIT, starting with Meaningful Use.  This is not another lofty guide to policy. It is a hands on (do this first, do that second, and so forth) guide to researching, deciding, selecting, buying, implementing and using EHR technology, in accordance to the newest regulations.

This is work in progress, and only the first Chapter and two appendices have full content.  I would normally wait until the paper was complete before posting anything. However, I think we’re running out of time and these doctors need answers. So I decided to build this guide in a public, as-you-go process. Below is a synopsis of the first Chapter and a link to the Draft document. I expect comments and questions and suggestions, which will be incorporated in the final version.
The buzz word is Meaningful Use. You go buy one of those CCHIT certified EMRs and the Government will send you a check for $44,000. Not sure what Meaningful Use is, but many vendors guarantee that you will get your check. There are two options here, trust the vendor and buy something. Trust no one and wait and see.
And then there is the prudent option. Start educating yourself so you can make an informed decision. This paper will provide a roadmap for a typical small practice with no special affiliations to a hospital and no other immediate source for freebies.

Part I – Pre Decision to Buy

Step 1: Estimate your incentive amount
That $44,000 figure is not for everybody. You could qualify for more and you could qualify for a lot less, maybe even nothing. . It all depends on how many Medicare or Medicaid patients you see on a regular basis. Where you see patients is also extremely important.

Step 2: Understand Healthcare Transformation
Whether you have seen EHRs in action and deeply disliked them, or haven’t experienced them at all, but heard all sorts of good/bad things from your colleagues, please be aware that the computerization of medical records is inevitable. We may not be certain of the shape or form it will take, but sooner or later paper will have to go away.

Step3: Survey the Landscape
There are literally hundreds of EHR options out there ranging from glorified word processors to super complex packages that will do everything short of actually examining the patient, or so they claim. The prices range from completely “free” to tens of thousands of dollars and everything in between. Some come with “warranties” and some are sold “as is”. Caveat emptor is the prime directive.

Full text draft of Part I, a synopsis for Part II and miscellaneous content are posted here [PDF].
This  documented will be updated frequently until complete (ETA - a couple of weeks).

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