I f you’re a chiropractor, chances are you’ve heard mention of Medicare’s Electronic Health Records incentive program. The wealth of information about Meaningful Use (MU) can be overwhelming: state associations, advertisements, solicitations, webinars––you name it. And the new lingo for EHR standardization is becoming something we all deal with daily: quality measures, numerators, denominators, certifications, decision support, electronic prescription, patient reminders, exclusions, etc. There’s a lot going on out there, and with new regulatory requirements comes demand for expert services. This new field of expertise is called Health Information Technology (HIT), and its goal is not just to help navigate the paper pile, but to send it the way of the Dodo bird through computerized automation.
In the coming years HIT services will inevitably supplement your current IT infrastructure. IT focuses on hardware and software configuration, things like passwords and security, routers and networking. An HIT professional, on the other hand, provides consulting for office workflow, meaningful use requirements, staff training and software interoperability; HIT takes IT to the clinical level.
In addition to the EHR incentive program, the Office of the National Coordinator (ONC) has started HIT training programs across the country. From what we've seen already, the diversity of the technical expertise among the first wave of HIT professionals is impressive. I've talked to graduates from these programs that have backgrounds in database administration, technical sales, IT consulting, medical billing, and programming. To a person they’ve gone through months of in-depth meaningful use and HIT training, which speaks to the level of importance being placed on HIT development moving forward.
The ONC has identified six areas that HIT professionals will be able to serve MU practitioners: Clinician/Practitioner Consultant, Implementation Manager, Implementation Support Specialist, Practice Workflow & Information Management Redesign Specialist, Technical/Software Support Staff, and Trainer. These are the basic roles required to successfully implement an EHR. Large hospitals may assign each HIT role to a team of individuals and a smaller clinic will likely enlist the services of someone that can take on most or all of these tasks.
Successful EHR implementation is complimented by HIT services. I’d even go so far as saying that getting software fully certified for meaningful use is easy part. The real ingenuity comes with designing a training program that HIT professionals can use to assist each clinic in showing MU. If you plan on demonstrating the meaningful use of an EHR you’ll receive HIT services from professionals who will translate meaningful use requirements and help your practice implement MU. Meaningful use brings many new requirements to your practice, but with the proper training and guidance, you and your staff will be able to understand and demonstrate MU with ease.
What is full certification?
The biggest buzzword around the Medicare incentive program is “Full Certification.” When considering an EHR experts are advising consumers to only entertain “fully certified” systems. Medicare offers two types of certification for EHR: Full, and Modular. Certification of an EHR is done in sections referred to as “modules.” The testing procedure for each module is well documented and the order of certification of each module has a precise workflow and expected result. The testing procedure happens like a giant, multi-layered checklist. To receive full certification qualified EHR software must demonstrate, measure, report, and pass 100% of the modules that make up meaningful use. If an EHR is missing a certification for just one module then that EHR only will only receive modular certification. Fully certified systems have a significant advantage because they have demonstrated every module for MU and will have documented procedures to accomplish each one.
The process of getting our EHR fully certified was straightforward. Our test proctor started with the very first module, we walked him through the process, and moved onto the next module. We went through every module, one-by-one, and demonstrated meaningful use of our EHR for every applicable measure. Thankfully for them, Eligible Providers (EPs) will not have to be as thorough as we were. EPs will have a number of exclusions they can make and measures that they can selectively demonstrate. We’ve created instructions for how each module is demonstrated and measured to make it easier on our user base. Successfully completing the certification allowed us to design an HIT training program that meets or exceeds any and all testing requirements.
What makes “meaningful use” meaningful?
Creating a reliable method of medical information exchange is one primary goal of meaningful use. Other goals are the “pay for performance” model that Medicare has been pursuing for years, and providing decision support and educational materials at the point-of-care with reliability and consistency. Ultimately, meaningful use is a broad set of rules that helps gather, analyze, and share medical information, and it establishes guidelines for future flexibility of electronic health records.
When we outlined the meaningful use requirements for Chart Talk, we were able to classify every measure into three basic categories: Patient Information, Interoperability, and Quality Measures. MU measures that fall into the same group share common features such as required percentage reporting, file type and structure, alerting capability, and other factors. Your HIT providers will be able to clearly define each of these measures and how your clinic will apply or exclude them when demonstrating meaningful use.
From the distance the task can look as insurmountable as the High Sierras, but don’t stop now, ‘cause there’s gold in them there hills. Keep from getting your back to a wall with the assistance that’s available to you. The new HIT programs are beginning to put trained professionals into the work place, your local regional extension center (REC) is set up to help EPs implement MU, and your EHR vendor should have HIT services available. Use whatever resources you have at your disposal; with the right HIT partner, teamwork in your clinic, a willingness to modify some of your workflow, and a 49er attitude, you will be able to demonstrate meaningful use and keep your clinic running smoothly.
Matthew Richard is Vice President of Mighty Oak Technology, Inc. Matt championed the “50 Days ‘Til Friday” initiative, a plan that saw Chart Talk receive full meaningful use certification in 50 days. Matt received his BS in Physics from Southern Oregon University and now lives in Minneapolis, MN.
» Six areas for MU professionals
» CMS FAQ 17