The electronic health records fits seamlessly with a central cost-saving of health care reform: to shift U. S. health care from an expensive, pay-per-service system based on quantity to one that emphasizes quality. The goal now is to have medical payments reward good care — in a way that’s difficult to do with paper records. “You really can’t have accountable care without electronic records,” says Judy Hanover, a research director for IDC Health Insights, a health care research and marketing firm based in Framingham, Mass. “It provides the data and information foundation you need to implement accountable care.
Why should you care about how your doctor keeps records? Because, thanks to the technological push, you’ll soon have online access to your complete medical records for the first time. The government says not only can electronic health records reduce unnecessary tests and procedures, help your doctor coordinate your care with other providers and avert medical mistakes due to incomplete or incorrect information, but they also may save your life by enabling you to carry all of your own health records on your cell phone or mobile device.
Medicare and Veterans Affairs beneficiaries already can access their claims records through the federal “Blue Button” online service. “This is going to rock! ” says Dr. Farzad Mostashari, the national coordinator for health information technology and the captain of the federal electronic records initiative. “This is going to change things in a pretty fundamental way. ” Getting America’s health care providers to go digital has been no easy task. Mostashari notes that there are hundreds of medical software vendors of all sizes and more than 1,000 software systems in use, and few of them communicate with one another.
Some physicians continue to view electronic note-taking as time-wasting rather than time-saving. To ease the pain of transition, Congress allocated $27 billion for financial incentives, including Medicare and Medicaid bonuses to be doled out to hospitals and physicians able to demonstrate “meaningful use” of digital records and meet program milestones. Researchers found that only one in 10 doctors with an electronic health records system satisfied the U. S. government’s requirements of “meaningful use” by early 2012.
The ultimate goal… is a widespread adoption that results in broad interoperability so a lot of physicians are using systems and sharing data that result in better quality care,” said Catherine DesRoches, the study’s lead author from Mathematica Policy Research in Cambridge, Massachusetts. The Centers for Medicare and Medicaid Services (CMS) oversees the incentive program that pays individual doctors up to $44,000 through Medicare – the government-run insurance for the elderly and disabled – and up to $63,750 through Medicaid – the government insurance for the poor – to use electronic health records.
To receive a payment, doctors must meet 19 of 24 “meaningful use” objectives that include tracking patients’ medications and allergies, sending reminders, sharing lab test results and producing summaries of a patient’s office visit. More than 295,000 healthcare providers have received a total of $14. 3 billion in “meaningful use” incentive payments as of April, according the CMS website. “We’re making a tremendous public investment in electronic health record adoption… We want to be sure this public investment really pays off to benefit patients,” DesRoches said.
For the new study, which was funded by the Commonwealth Fund and Robert Wood Johnson Foundation, DesRoches and her colleagues sent surveys to about 3,000 family doctors and specialists around the U. S. between October 2011 and March 2012. About 44 percent of the 1,820 doctors who returned surveys met the requirements of having a basic electronic health records system, but only 10 percent met the first stage of criteria for “meaningful use. Those measures include the ability to encode a patient’s health information, track key conditions and share information for the purposes of coordinating medications and other aspects of treatment. They also include mechanisms for generating useful population-level data, including the ability to use common standards to assess the quality of healthcare being provided to all patients and the ability to cull from records to report on public health trends in the patient population.
Some of the most difficult objectives to meet, according to the new study published in the Annals of Internal Medicine, are the capacity to exchange data with other doctors, to generate reports on care quality and to provide patients with a summary of their visit. “If we want to see broad interoperability that improves care, we’re going to need some more focus on these usability issues,” DesRoches said.
Debora Goetz Goldberg, who has studied electronic health records but was not involved in the new research, told Reuters Health in an email that she’s not surprised y the findings because doctors face a number of challenges in meeting the criteria. “Meaningful use standards require physicians to make major transformations to the structure and functioning of their practice, which include considerable changes to care delivery processes, staffing, and reporting,” wrote Goldberg, from the George Washington University School of Public Health and Health Services in Washington, D. C.
Despite these challenges, DesRoches told Reuters Health that many doctors were close to meeting the requirements and she expects the number of basic electronic records and of meaningfully used records to increase next year. “I would expect that our next wave of data collection will see a big increase in that number,” she said. In May, CMS announced that more than half of eligible doctors and more than 80 percent of eligible hospitals had received payments for the adoption or meaningful use of electronic health records.
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