For Dr. Jennifer Brull, the decision to implement electronic health records in her Plainville clinic was an easy one.
“It was just a desire,” she said. “I’d had an electronic health record in residency.”
Now, Brull and her colleagues at Plainville Medical Clinic are glad they made that decision. The technology — which allows patient charts to be kept digitally on a secure network — went live in 2008, putting the rural family physicians a bit ahead of a huge national push.
The American Recovery and Reinvestment Act of 2009 includes a massive $34 billion in incentives for medical providers to improve or implement the technology. To qualify for those funds, providers must comply with a new set of federal “meaningful use” criteria issued in July.
While some hospitals and health care providers in northwest Kansas — including Brull — are trying to bring their current technology up to par with the new standards to qualify for reimbursement, others are considering taking the technological leap.
Among them is Russell Regional Hospital, which is planning to add the technology and currently interviewing vendors. But for some of the area’s small, rural hospitals, the high price tag for start-up costs could be a bit prohibitive, said Chief Executive Officer Shelley Boden.
“Cost is a huge factor,” she said. “In order to meet meaningful use criteria, as with a lot of critical access hospitals or rural hospitals, the cost associated with implementing it is going to be very challenging.”
To be sure, this technology isn’t cheap. A ballpark figure would be about $30,000 per provider, said Brull, who sits on the state’s E-Health Advisory Council.
Beginning in 2015, providers who have not successfully demonstrated meaningful use will face cuts in the amount of Medicare reimbursement they receive. It will begin with 99-percent payment in 2015, and drop to 97 percent by 2017, according to information from the Centers for Medicare nd Medicaid Services.
“So if your practice has not implemented an EHR and have meaningful use, you’re going to get reimbursed less dollars for the same service as someone who does,” Brull said. “So ultimately, people are going to be pressured to do this.”
An aggressive time frame is another challenge facing start-up providers. Money is available through Medicare and Medicaid, and providers opting for the Medicare program must achieve the first phase of meaningful use by 2011 or 2012 for optimum reimbursement.
The first phase requires that 20 of the 25 provisions listed in the new meaningful use criteria must be met, said Michael Aldridge, director of the Kansas Health Information Technology Regional Extension Center.
The Kansas government in February designated the HITREC, under the umbrella of the Kansas Foundation for Medical Care, to help health care providers overcome these challenges, which seem especially prohibitive in smaller practices, he said.
“Capital is probably the biggest barrier … Those incentives are to help offset the capital that’s incurred,” Aldridge said. “The second highest barrier was difficulty selecting a product that the practice would feel confident investing the dollars in.”
The organization is preparing a list of vetted technology vendors, and working to assist both start-up providers and practices striving to obtain meaningful use.
All vendors must be certified for providers to qualify for meaningful use, which potentially could be a concern for providers who already have made the investment. It is expected, however, that most vendors will pursue this certification to stay in business, Aldridge said.
“People that maybe have chosen products and not done that type of research might find themselves having to repurchase a product, and certainly that’s very difficult for a lot of these practices that are already (financially) strapped to begin with,” he said. “I hope that doesn’t happen with much frequency.”
In northwest Kansas, those who have implemented the technology say they are reaping the benefits. Hays Medical Center’s medical staff went live with its EHR system in 2004, and has experienced cost savings and enhanced patient safety, said Chief Financial Officer Bill Overbey.
The system includes bedside safety features such as checking for allergies and possible drug reactions. Nurses also complete digital bedside medication verification, which ensures the correct dose is being given to the right person at the right time, Overbey said.
“There are several safety precautions, and from a patient care point of view … all of the information is in one spot,” Overbey said. “It shows lab results, it shows nursing notes, it shows drugs that have been ordered, it shows progress notes, and consults from other physicians — just anything that’s been created in the process of taking care of a patient.”
Hays Med is hoping to qualify for the incentives, which could be enough to cover almost all of the initial cost, Overbey said, noting several million dollars have been invested in the technology.
Efforts also are continuing to qualify for the incentives in various clinics, either by upgrading current technology or switching vendors to obtain additional features, he said.
“We’re literally about 90 percent of the way toward meeting all the requirements for the hospital that we need to meet a year from now,” Overbey said.
As for Brull, she said she would never want to go back to the days of paper records. One of the greatest advantages, she said, has to do with quality improvement.
“In the old days of paper, when you did quality improvement, you’d pull 30 charts,” she said. “In the day of electronic, we look at our entire population. So if I’ve got 400 people who qualify for pneumonia vaccinations, I’m looking at all 400 and how many had it done.”
While the system was costly, Brull said the investment has paid off for her small practice, Prairie Star Family Practice.
“Financially, even with paying for the electronic health record, the business has been more financially profitable over the past two years since we’ve had it,” she said. “It’s been good all the way around. We don’t have anybody who hates it. We don’t have anybody who would ever want to go back.”
By KALEY CONNER