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April 2008
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Centers for Medicare and Medicaid Services
Push Initiative for Electronic Health Records
The Centers for Medicare and Medicaid Services (CMS) are pushing an initiative to help physician practices nationwide to transition from paper records to electronic health records (EHR) to improve patient care and reduce medical errors.
Acting CMS Administrator, Kerry Weems and Nevada Medical Association, Executive Director, Larry Matheis (right) talk to physicians about Electronic Health Records. Photo-Connie McMullen
Acting CMS Administrator, Kerry Weems, visited with physicians and educators on March 12, at the University of Nevada, School of Medicine, to explain a five-year demonstration that will be launched in 12 communities in the U.S. The demonstration project will encourage small to medium sized primary care physician practices to transition to EHRs. The goal is to revolutionize the way health care information is managed, producing better health outcomes and greater patient satisfaction.
According to the National Academy of Sciences' Institute of Medicine, as many as 98,000 Americans die each year as a result of medical errors. Nevada State Medical Association, Executive Director, Larry Matheis, said “If you haven't been able to quite figure out why electronic health care is something that needs to be looked at carefully and integrated into the health care system, what's going on in Nevada right now is a case in point. In Southern Nevada there's an effort right now to locate 40,000 patients from one endoscopy center over a period of 4 years, and all there are is paper records of their time spent in that clinic. Imagine the difficulty in tracking them to be found.”
The project is a major step toward the President's goal of most Americans having access to a secure, interoperable EHR system by 2014. Weems explained the demonstration project will encourage a project from a group of physician stakeholders either from the North, South, or both to collaborate on the project. Over the five-year period, the project will provide financial incentives to as many as 1,200 physician practices that use certified EHRs to improve quality as measured by their performance on specific clinical quality measures. Physicians have until May to opt into the program, however, for many the challenge to convert from paper records will be difficult.
(left) Bill Welsh,Nevada Hospital Association and Richard Scher,M.D.,Reno Heart physicians.
Richard P. Scher, M.D., F.A.C.C., Reno Heart Physicians, ran into difficulty when his office began to develop an EHR system. Scher said it was a huge hit on the practice. “We had to stop doing business to convert the business,” he said. “It was expensive and frustrating.” Scher said most of the physicians practicing were over age 60 and faced a huge learning curve working with computers. He said training required time and took physicians away from the practice. “It cut productivity in half and we had large cuts in cash flow.” Adding, “implementation was very slow and painful.”
Much of the difficulty in transitioning to an all electronic system may boil down to a generation divide. Ron VanHooser, Business Manager, of The Corner Doc, in Reno had a different experience. VanHooser, who had information technology (IT) experience, said “the idea of having an all EHR practice took about a year.”
“What it has allowed us to do, from the standard of care, is to slow down our practice,” he said. “We went from 10-20 minute time slots with patients to 15-30 minutes. It allowed us to spend more time with each of our patients. By the time the doctor is finished with a patient and walks out of the exam room, the chart gets done, the prescriptions required are at the pharmacy, and the billing is sent to the front office. We were able to bring our billing back in-house which saved us immediately 7 percent.” VanHooser said the space which once housed charts was freed up, remodeled, and is now used to generate revenue as another exam room. “Everything about it has helped us to be more efficient and provide better patient care.”
Acting CMS Administrator, Kerry Weems talks with reporters about EHRs.
Photo-Connie McMullen
“Some communities are going to be more ready to do this than others,” Weems admitted, but some physicians have already begun.” Nevada Hospital Association, Executive Director, Bill Welsh said two hospitals in Clark County are moving towards systems that are interoperable. However, he cautioned that at some point in time the federal government will need to come up with standards.
CMS is moving in that direction. Weems said all participating practices will be required to comply with standards of the Certification Commission for Healthcare Information Technology (CCHIT) by the end of the second year in order to remain eligible for the demonstration.
“The benefit goes to the patient and the insurer,” Weems said. “The doctor gets the benefit in administrative costs, and better practice efficiency.”
Health Information Technology and Privacy
Many health care professionals recognize that the benefits of Health Information Technology (HIT) will be huge heading into the aging tsunami. The Sanford Center for Aging, Elder's Count, reported that between 1990 and 2000, Nevada's elder population age 65 and older increased 72 percent, and those age 85 and older increased 128 percent.
Nevada's aging population is projected to increase substantially with the graying of the baby boomer's from 11.2 percent of the population in 2004, to 18.6 percent in 2030.
HIT will assist in quality of care provided to this swelling population, however, patient privacy rights and sensitive information being sold to marketers, or worse identity theft scam artists remains a concern.
“The system of standards will have built-in safeguards for privacy and security,” explained Weems. “Like any other practice, it's going to be up to people who participate in the system to make sure they guard privacy and security.” Weems adds CMS will only certify those software systems that meet the CCHIT standards. “People have made this leap already,” he explained.
The Regenstrief Institute for Health Care at the Indiana University School of Medicine developed the first electronic health record (EHR), the Regenstrief Medical Record System (RMRS), which was installed in 1972 at Wishard Memorial Hospital. Other states have since followed in the EHR pursuit.
Weems says the situation in the Las Vegas medical clinics were people were exposed to hepatitis C or HIV was a 100 percent preventable, human error. “EHR can provide safety alerts and reminders for individual practitioners. It may also have helped locate those 40,000 patients. There would be records at the medical clinic; one would just go through and pull the record of the person by procedure type.”
To learn more about the EHR demonstration project or to locate the application form, e-mail to: EHI_DemoCommunitySelections@ cms.hhs.gov.