As of 01 Oct, 2013, primary care physicians in the United States will be required to adhere to a new standard of Health Information Technology. These standards go far beyond individual diagnoses in that each diagnosis recorded in an Electronic Health Record, (EHR), will be just one small part of that patient’s cumulative Electronic Medical Record, (EMR). Coding of all diagnoses and procedures will be per the new ICD-10 guidelines, (which go into effect simultaneously).

For many of us, these guidelines are a mixed blessing. On the one hand, they require us to evolve away from traditional paper-based records, (recognized as a significant factor in skyrocketing healthcare costs in the US),and  into the digital realm; the security involved in the transmission of patient records will be enhanced; researchers nationwide will even have increased access to statistical data in real-time. In the words of chief administrator Dr. Donald Berwick, MD, "With the start of registration, these landmark programs get under way, and patients, providers, and the nation can begin to enjoy the benefits of widespread adoption of electronic health records.”.

On the other hand, there are significant downsides. There will be a learning curve, and that will apply to your entire staff. You will need to design a strategy to transition into the new environment without disrupting daily duties. And, it certainly sounds like getting all of that up and running would be expensive, complicated, and time-consuming.

All HIPAA "covered entities" must make the change.

Congress enacted the Health Insurance Portability and Accountability Act, (HIPAA), in 1996, and, Title II of HIPAA requires “the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.”  These provisions also address the security and privacy of health data. (These standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange, (currently EDI/4010), in the U.S. health care system).

Fast-forward to the Health Information Technology for Economic and Clinical Health, (HITECH) Act of 2009, (itself a part of the American Recovery and Reinvestment Act of 2009). This Act scheduled- and established the new standards for- HIT in general, as well as allocating $20Billion in the form of incentive payments to physicians. For Medicare providers, these payments are to be spread out over a 5-year period, and are maximized to $44,000 per provider, (with Medicaid spread out over six years and capped at $64,000 per provider).  So, (for example) a practice of 6 Medicare providers will be looking at about $264,000 in incentives. And, if that practice is in a “health professional shortage area”, you’ll be adding a 10% bonus, (~$26K), to that figure!

THERE ARE THREE THINGS YOU WILL WANT TO BEAR IN MIND CONCERNING THESE INCENTIVES:

• The amount you receive will be tied to how soon you successfully demonstrate “meaningful use” as defined by Congress. The scale is incremented annually, begins 01 Jan, 2012, and ends on 01 Oct, 2013. The greater bulk of payments are scheduled for disbursement during calendar year 2012.
• The reporting period is 90 days for the first year, and one year for the second year.
• To meet certain meaningful use objectives, 80 percent of the physician’s patients must have records in the certified EHR.

Further, a prerequisite to ICD-10 is the adoption of the Electronic Data Interchange, (EDI), Version 5010, by January 1, 2012.

Due largely to the fact that “trading partners”, (the EDI term for all parties that are approved to send or receive information packets), tend to use different protocols, the planning, implementation, and maintenance of your EDI/5010-compliant system will be most effectively administered by a “Value Added Network”, or “VAN”, usually a dedicated server which functions as both translator and gatekeeper between trading partners. Of necessity, this VAN will administrate all of your EHR/EMR requirements only. You will still need a different vendor to address all other I/T needs, such as email, website hosting, digital phones, and so on.

THE GOOD NEWS IS THIS: “An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment. Modularity in an EHR system facilitates this. Most, if not all, EHR companies employ vendors to provide customization”.  There are well over 900 EHR service providers that have been certified to date by the three entities named by the federal government for certifying EHR technology under this incentive program. The sooner you implement, the more you, (and your patients), will experience these benefits:

• Version 5010 corrects many of the flaws of the current 4010 version. Since Version 4010’s launch in 2003, software developers have tweaked and patched it to its limits. Version 5010 incorporates hundreds of changes the medical industry has asked for.
• You can begin to realize the administrative simplification and subsequent savings that HIPAA promised. For example, authorizations will be streamlined, saving time and hassle on the phone for you and your staff.
• Version 5010 is a vital component for true standardization and interoperability, smoothing the way for widespread use of electronic health records.
• It will facilitate reporting of clinical data for quality performance measures, which are poised to become a driving factor for payment of claims and performance bonuses.

The deadline for all of us to convert to HIPAA/5010 is 01 Jan, 2012. You should already be discussing your practice’s strategy to ensure this evolution occurs seamlessly with your IT director, as well as any 3rd party IT service providers you may use. Increasing bandwidth needs should be an integral part of these talks, as well as the more obvious hardware-related needs inherent to the increase in networking.

Again- you could wade through and do the research on the more than 900 EHR service providers available- if you have virtually unlimited time and resources. Remember, all of these services have already been certified by the federal government, and uniformity of protocol is the order of the day! That being said, there is still a somewhat broad range of both price and capabilities available, but there are four things I would be asking my network administrator.

• Which EHR should I choose?
• What type of training will my staff need?
• How do I install an EHR with minimal disruption to my practice?
• How do I make meaningful use of an EHR so it helps my patients and earns me a Medicare or     Medicaid incentive bonus?

Once you’ve upgraded to HIPAA/5010, you’ll be able to have an EHR platform installed to your specifications; layouts, workflow- every single detail customized to your satisfaction. Seamlessly.

After that, (of course)- you’ll want to go here to register and start that 3-month clock:
(CMS) registration and attestation web page.

Further reading: Travis Medical Society, as well as Bexar County Medical Society, and the Medical Society of Virginia, each helped to provide and/or clarify various points of fact. I would also strongly recommend reading any source document, (HIPAA, HITECH Act, etc.), referenced herein.