CEO SUMMARY: The federal government will spend $20 billion over the next four years to encourage every physician to use an electronic medical record (EMR) system. For labs, this increase in connectivity represents a significant marketing opportunity. However, the new federal rules on meaningful use of EMRs released last month may complicate the situation for clinical labs and pathology groups. One EMR expert says that’s because some EMR systems will do a poor job of interfacing lab test orders and lab test reporting with the lab’s LIS.
LONG-AWAITED RULES for “meaningful use” of electronic medical record (EMR) systems by physicians were announced last month by federal officials. Clinical laboratories and pathology groups will want to be ready to help physicians with their EMR projects.
“For physicians, the new rules are less burdensome,” observed Pat Wolfram, Vice President Marketing and Customer Services for Ignis Systems Corporation, in Portland, Oregon. “It had been proposed that physicians would need to meet 25 criteria relating to EMR use before they would be eligible for the federal incentives authorized under the HITECH Act of 2009.”
Wolfram has been involved with EMR systems for more than 15 years. As a consultant to physicians and labs on EMR systems, Wolfram has extensive experience in helping to create interfaces that allow EMRs to handle lab test orders and accept electronic reporting of lab test results.
“The new rules published on July 13 won’t be as favorable for labs because the requirement for computerized physician order entry (CPOE) of laboratory test orders has been removed,” explained Wolfram. “Also, a requirement that the EMR accept the import of structured laboratory test results was trimmed from 50% to 40%.
“In practical terms, the new rules lower the bar for EMR functionality,” he continued. “It allows EMR vendors to provide very limited lab integration capabilities, yet still pass the meaningful use criteria. That alone promises to be troublesome for the nation’s clinical laboratories and pathology groups, for a very good reason.
“Physicians consider it important that their EMR system integrate well with their choice of a clinical laboratory,” said Wolfram. “However, physicians often assume that the EMR system they intend to purchase works well in allowing full integration of laboratory test ordering and lab- oratory test results reporting. That is why physicians tend to not look closely at these functions during their EMR evaluation.
“In addition, as pathologists and lab directors know, orders to laboratories can be less complete or ‘clean’ from those EMRs that do not integrate well,” he added. “It also means the EMR’s ability to retrieve and display lab test results could be less than ideal.”
Wolfram believes that the earlier draft of meaningful use criteria would have forced stronger integration capabilities on the EMRs. That is because the earlier draft required the meaningful use of an EMR system to include laboratory test ordering capabilities and a higher percentage of structured lab test result reporting.
Certified EMRs Are Key
“Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for $20 billion in Medicare and Medicaid incentive payments when they adopt certified EMRs,” noted Wolfram.
“Starting in 2011 and going forward four years, physicians can be rewarded for adoption and use of qualified EMR systems,” he explained. “In year five of this program, physicians not using a qualified EMR system will be paid less by the Medicare program than those physicians who do.
“The new meaningful use rules announced by DHHS on July 13 make up phase 1 of the federal program to reimburse physicians for investing in EMRs,” observed Wolfram. “A revision to the meaningful use rules is expected as part of phase 2.”
Federal incentives for physicians will be paid over several years. “Each physician who invests in an EMR system and follows the meaningful use rules can get up to $44,000 from Medicare,” noted Wolfram.
Incentives To Motivate Docs
“It is believed these incentives will motivate physicians to select an EMR system and begin using it during 2011,” he stated. “As that happens, laboratories should be prepared to provide their referring physicians with as much guidance as possible to help them achieve effective integration of the lab test ordering and lab test reporting functions between their LIS and the referring physicians’ EMR system.”
The revised rules on meaningful use released on July 13 are a direct result of public comment that followed the publication of a draft of the meaningful use criteria earlier this year. It was this draft that listed 25 criteria. In response to the public comment, the EMR meaningful use requirements were reduced in number.
“After considering the feedback and public comment, the Office of the National Coordinator (ONC) looked at which criteria could be eliminated without watering down the effectiveness of the meaningful use rules,” observed Wolfram. “The new rule established just 15 required criteria, along with a list of 10 more criteria, of which the physician can choose to defer five during the years 2011 and 2012.
Incentives To Motivate Docs
“There are two criteria in the new meaningful use rule which deal specifically with ambulatory lab orders and laboratory test results,” he added. “That is a changed from the previous rules, which required 80% of all clinical orders to be electronically captured in the EMR,” he said. “Under the former rules, qualifying clinical orders was defined to include medications, lab tests, images such as radiology, and other diagnostic procedures. Each type of clinical order had to be documented within the EMR.
“The rules issued on July 13 now only require medication orders, and these only under certain circumstances,” he noted. “Thus, one consequence of the new meaningful use rules is that physicians won’t be required to change the way they order lab tests in order to qualify for the Medicare incentives related to EMR adoption and use.
“In such situations, under the new meaningful use rules, it is possible for a physician to set up an EMR and meet enough criteria to qualify for the Medicare financial incentives, while still using paper requisitions to order laboratory tests,” stated Wolfram. “For this reason, it may not be until the phase 2 meaningful rules are issued in coming years that paper lab test requisitions finally disappear.
“The new meaningful use rules were also relaxed on the results side,” Wolfram added. “It’s still required that a percentage of laboratory test results must be structured and codified. But it used to be that 50% of the laboratory test results needed to be structured and now it’s only 40%.
“Labs need to understand the definition of ‘structured results’,” he said. “Structured results allow the EMR to display trends, trigger protocols, and report across populations.
400% Growth In EMR Use
Wolfram predicts that there will be four-fold increase in the number of physicians using an EMR system between now and 2015. Currently there are 120,000 physicians using an EMR and that number may grow to 480,000 physicians by 2015.
If the rate of physician adoption and implementation reaches the level predicted by Wolfram and other experts, then double to quadruple the number of physicians will be in the market shopping for EMR systems, compared to past years. In turn, these same physicians will want their laboratory to step up and support integration of either or both lab test ordering and lab test results reporting.
That means laboratory administrators and pathologists should be preparing their laboratory organization to accommodate a much larger number of EMR–to–LIS integration projects. However, this added expense can produce a benefit.
Each time a laboratory develops an electronic interface for lab test orders and lab test reporting between the physician’s EMR and the lab, this interface will act as an anchor that helps maintain both the clinical and business relationship with that office-based physician.
When Physicians Consider Purchasing an EMR, Labs Should Provide Their Own EMR Report Card
WITH TENS OF THOUSANDS OF PHYSICIANS about to implement an EMR system, the next few years will be very busy for clinical laboratories and pathology groups because of the need to build the integrated interfaces required to support lab test ordering from the EMR as well as reporting of lab test results.
“Laboratories have both an opportunity and a responsibility to explain the complex connectivity issues that physicians face with linking an electronic medical record (EMR) system to a laboratory,” declared Pat Wolfram, Vice President Marketing and Customer Services for Ignis Systems Corporation, in Portland, Oregon. Ignis specializes in helping physicians and labs develop interfaces between EMRs and laboratory information systems (LISs).
“In my experience, one of the most effective things a laboratory can do when helping physicians during their EMR implementation is to produce a report card based on their own EMR integration experience,” said Wolfram. “This report card should identify those EMR products with which your laboratory has already integrated. It should also state the specific order/result functionality that is expected of that EMR.
“Include two checklists on the report card,” he continued. One checklist is for the user features that the physicians and nurses experience during everyday use. The second checklist is for the setup and maintenance of the lab ordering/resulting modules.
“If you can provide this report card and checklist during the time when the client physicians are evaluating different EMR products, it can help them understand which EMR products may best fit the specific needs of their medical practice,” he added.
Goal of EMR Report Card
“Your goal is to encourage them to purchase and use a known EMR that handles lab test orders and lab test results with ease,” added Wolfram. “Consider this report card to be a good complement to the EMR product’s cer- tification by CCHIT (Certification Commission for Health Information Technology).
“As the agency that certifies EMRs, CCHIT has certified over 70 different EMR vendors for physician use,” he explained. “But the CCHIT certificate for a specific EMR product won’t tell the whole story.
“No EMR vendor is going to tell a physician that its product does not efficiently handle laboratory test orders and lab test results,” added Wolfram. “That is why it is helpful for a clinical laboratory to create its own EMR report card that details the strengths and weaknesses of different EMR products to which it has built the electronic interfaces on behalf of client physicians.”
Meaningful Use Criteria Are in Two Categories
For the first round of Medicare and Medicaid EMR bonuses in 2011-12, physicians must meet 15 core objectives and at least five of 10 “menu set” items. Each objective has a measure to determine if an EMR was used to perform the function for an appropriate number of opportunities:
Core Set Criteria
(must meet all criteria)
- Record patient demographics
- Record vital signs/chart changes
- Maintain current and active diagnoses
- Maintain active medication list
- Maintain active allergy list
- Record adult smoking status
- Provide patient clinical summaries
- Provide electronic health information copy on demand
- Generate and transmit prescriptions electronically
- Use computerized physician order entry for drug orders
- Implement drug-drug/drug-allergy interaction checks
- Be capable of electronic clinical information exchange
- Implement one clinical decision support rule
- Protect patient data privacy and security
- Report clinical quality measures to CMS or states
Menu Set Criteria
(can defer up to five criteria for 2011-12)
- Implement drug formulary checks
- Incorporate clinical lab test results
- Generate patient lists by condition
- Identify patient-specific education resources
- Perform medication reconciliation between care settings
- Provide summary of care for transferred patients
- Submit electronic immunization data to registries
- Submit electronic epidemiology data to public health agencies
- Send care reminders to patients
- Provide timely patient electronic access to health information
Source: Centers for Medicare & Medicaid Services