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Electronic records requirements vex health care groups

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Health care groups are generally unenthusiastic about the pending requirements for physicians' offices and hospital systems to begin meeting stricter standards for meaningful use of electronic health records under the Affordable Care Act reforms.

The largest concerns are that even as hospitals and doctors get up to speed on the first stage of electronic records requirements, stage two begins right around the corner in 2014.

"We think they're a pretty big step ahead of meaningful use that was required in step one," said Martin Ciccocioppo, vice president of research at the Swatara Township-based Hospital & Healthsystem Association of Pennsylvania.

For starters, only about 30 to 35 percent of hospitals have met meaningful use requirements under the first stage, he said. And many tech vendors have a backlog of software installation and training jobs.

Plus, hospitals will have to be ready to start stage two in 2013, even though rules and guidelines came out only in September, he said.

For example, stage one requires hospitals to use computerized medication orders for 30 percent of patients taking at least one medication who were admitted to inpatient or emergency departments, according to the Centers for Medicare & Medicaid Services.

Stage two requires hospitals to use electronic orders for 60 percent of medication orders and 30 percent each for laboratory and radiology orders.

Other requirements mandate more collection of health and demographic information about patients.

"Stage one is not a cake walk," Ciccocioppo said.

Patient portals, or websites where patients can access their medical records, are another large issue in the stage two requirements for EHRs, said Steven Roth, vice president of informatics and chief information officer for Harrisburg-based PinnacleHealth System.

The regulations mandate that hospitals show 5 percent of patients are using the portals, but even health systems that already have portals are showing much lower use rates.

Pinnacle has about between 1,800 and 1,900 patients signed up to use its portal, Roth said. That's about 2 percent of its total patient population, he said, but the question becomes this: How many people are actively using the portal?

"We'll have to really reach out to patients and help them understand why it's important for them to use it," Roth said.

The portals are best designed for patients with chronic conditions such as heart and lung disease or diabetes that require ongoing lifestyle management, he said.

"It'll be about the content," Roth said. "It won't be just about sharing the test results with (patients). It will have to be about helping them manage their lives."

Similar mandates are required of physicians' offices, too. However, many of them might be farther behind larger health care providers in meeting meaningful use of EHRs.

"You have to look at each practice separately," said Carol Bishop, associate director of practice economics and payer relations with the Pennsylvania Medical Society. "The size of a practice and the number of practitioners makes a difference."

Still, there's a lot of resistance from small physicians' offices to the bureaucracy involved with meeting meaningful use for electronic records, said Beverly Reider, owner of Cumberland County-based Medical Revenue Solutions, a billing and electronic medical records software company.

That's particularly true of small practices where doctors see the requirements as an intrusion or a complication, she said.

"They're so tired of dealing with bureaucracy and the government," she said. "They just want to care for their patients."

In other cases, practices may have started using electronic records years ago, but they feel they work fine and don't need to be updated, she said.

"It may not be the Cadillac version, but they just don't want to go through the headache again," Reider said.

Helping clients and potential clients understand how the software and services will help simplify some of their processes isn't always easy because of that, but there are long-term benefits, she said.

"That's what's so frustrating for me," Reider said. "I see that and can help them from an administrative standpoint, but I have to show them it's a good thing."

About 90 percent of Pinnacle's associated physicians are certifying for stage one meaningful use, and the vast majority of its staff are ahead of schedule, Roth said.

Yet there are still changes, particularly in the process that doctors, nurses, administrators and others use every day, he said. That workflow redesign will be a challenge at any stage.

"There's certainly work to be done," Roth said, "and we haven't really figured out how we're going to meet some guidelines yet."

Medical society to hold EHR webinars

The Lower Paxton Township-based Pennsylvania Medical Society is doing outreach through webinars with its partner organizations to help doctors’ office managers and physicians understand electronic medical records, requirement changes and how to meet meaningful use.

The society will hold its first webinar, “Are You Ready to Meet Meaningful Use Requirements and Earn an Incentive?” on Nov. 13.

The society is planning two more webinars, one in January on what doctors’ offices can expect for their first meaningful use certification, also called attestation, and another in March on future stages of meaningful use.

More information and webinar registration can be found on the multimedia page of the society’s website at

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