Today was a big day in health care information technology (HIT). There are so many acronyms in HIT that I probably should publish a list, not today though. The Office of the National Coordinator of HIT (ONC) of the Department of Health and Human Services (HHS) issued its final rule on meaningful use criteria. As we know, these are the requirements that ‘providers’ (mainly physicians) have to meet to receive incentive payments from the Centers for Medicare & Medicaid Services (CMS) for the use of electronic health records (EHR) and other specific information technology (such as electronic ordering, electronic prescribing & exchanging of health information). The incentive payments start as early as this year for Medicaid providers, the rub is that after 2015, if you haven’t qualified, you will receive smaller Medicare or Medicaid payments (you can only qualify for one). These criteria were first published early last year & have been in comment periods or under revision ever since.
Despite this long period of evolution (over 2000 comments were evaluated), the question for providers continues to be “Is it worth it to me or my practice to even try to qualify?” The incentives are supposed to be based on the cost to acquire & adopt the necessary technology, but the total incentive (paid over as much as five years) is well under $100K for Medicaid providers. This may be close to the actual cost of the technology, but that does not take into account the disruption in practice caused by training, workflow changes & differences in usage caused by the technology. Providers who have been used to talking to their patients (even in the small amounts of time that modern clinical workflows allow) must now also do data entry (into the EHR) & spend part of their time filling out electronic order & prescription forms. This disrupts the clinical visit for both the provider & the patient. I have had not a few people (it’s people who are patients after all) tell me that they refuse to allow their doctor to enter data & consult “the computer” during their visit. They feel it’s disrespectful, regardless of how productive it may potentially be.