The Health Information Technology (HIT) Committee, a federal group working on the HITECH stimulus law, approved initial recommendations for data exchange and interoperability standards. Data exchange and interoperability is a requirement for meaningful use. Physicians must purchase and implement a certified system that supports the meaningful use requirements in order to qualify for reimbursement payments.

Meaningful use has four main functional requirements: computerized order entry, drug interaction checking, maintaining an updated problem list, and generation of transmissible prescriptions. A certified EMR system must provide these functions, and physicians must use them daily for all their patients. In addition, a certified EMR must be capable of sharing information and working with other systems.

Sharing information is one of the crucial requirements which physicians and vendors alike have been waiting for. Sharing information will help physicians work together when referring patients, or seeking information or advice on treatment plans, diagnosis issues, or other problems. Electronic information sharing will cut down on the amount of paperwork – specifically faxing, printing, filing, and mailing charts – that the office staff must do everyday. Eliminating the cost of managing paper can save a substantial amount of money for most practices.

The HIT Committee wisely chose existing data standards for their recommendations. Health Level 7 (HL7) is data standard based on the Extensible Markup Language (XML). HL7 was developed for earlier government programs, such as the Doctors Office Quality Information Technology (DOQIT) and Physicians Quality Reporting Initiative (PQRI). The HIT Committee also decided to use existing primary vocabulary standards, such as SNOMED, RxNorm, and others. This will ensure that all EMR systems measure and record data the same way.

Reusing existing standards is a wise decision because many vendors currently use them in their products. Developing new standards would take time and increase development costs, making it more difficult for physicians to participate in the stimulus program. Physicians will also benefit from using existing standards. Many are already familiar with SNOMED and RxNorm, which will reduce training time and allow physicians to implement and use their systems faster.

Interoperability requirements were one of the key things many physicians have been waiting on. Now that the initial recommendations have been approved, physicians should start transitioning from their current “wait and see” attitude into a more proactive shopping mode. Once the government starts their initial certifications in October, there won’t be any reason for physicians to delay. Getting started early is the key to successfully participating in the stimulus package and getting the highest reimbursement possible.

The federal advisory committee for electronic health records (EHR) approved a preliminary certification process on Friday, August 14th. The process will start in October, 2009 and allow EHR vendors to apply for HITECH stimulus package certification. The process is only preliminary because the meaningful use requirements have not yet been formally adopted by Health and Human Services (HHS).

The Certification Committee on Health Information Technology (CCHIT) was invited to submit proposals for the preliminary certification process. However, HHS would manage certifications, not CCHIT. Ultimately, multiple organizations will certify EHR vendors once the 2011 regulations are formally in place. HHS and the National Institute of Standards and Technology (NIST) will oversee the certifying organizations.

The preliminary certification process is an important step in the right direction. EHR vendors are already working to ensure their products will support meaningful use. Allowing vendors to apply for early certification will help them appeal to physicians who are still doing their market research. The heretofore lack of certification requirements and procedures has been one of the main road blocks to EHR adoption.

Most physicians do not want to risk purchasing a system that will not qualify for reimbursements. Preliminary certification will allow vendors to apply early before the meaningful use guidelines are officially adopted in January 2010. Preliminary certification will demonstrate that a product can support the meaningful use requirements. This should eliminate much of the uncertainty plaguing the EHR market and increase adoption rates.

Once preliminary certification begins in October, EHR demand should surge. Although the market is currently slow, many vendors have installation backlogs. Preliminary certification may cause those backlogs to increase. Physicians who are in the “wait and see” mode will need to make a decision quickly. Waiting could result in long delays that may jeopardize the ability to qualify for the first year of reimbursements.

One alternative is to purchase a simple system. Simple systems take much less time to install, so backlogs are not a problem. Simple systems are also easier to learn, meaning you do not use as much valuable time for training instead of seeing patients. Finally, simple systems are easy to use, giving you more time to qualify for meaningful use. Be sure to ask any EHR vendor if they have any backlogs, and how long it takes to implement their system. Their answer will tell you if their system is simple.

Although the HITECH Stimulus Act has created a flurry of interest in Electronic Medical Records (EMRs), physicians and hospitals are not spending their money just yet. The HITECH Stimulus Act encourages EMR adoption by reimbursing physicians up to $44,000 over several years. In order to qualify, eligible physicians must purchase a certified system and use it in a meaningful way.

Although many expected to see a sharp spike in EMR demand, it hasn’t happened just yet. Many factors combine to put the breaks on demand. First, physicians are taking their time and researching EMR vendors. They don’t want to risk purchasing a system that won’t qualify for the stimulus package, or worse yet, not work for their practice in the long run.

Undefined meaningful use and certification requirements cause many physicians to hold off on EMR purchases. The Office of the National Coordinator for Health Information Technology approved meaningful use recommendations in July. However, the recommendations won’t be official until the Centers for Medicare and Medicaid Services formally adopts them in January 2010. In addition, the “certified EMR” requirement has not been defined, and no certifying bodies have been appointed.

The EMR market itself is intimidating; there are hundreds of EMR vendors. It can be exceedingly difficult for physicians to cut through marketing rhetoric and determine which system fits their needs. Physicians have heard many horror stories about failed implementations, costing hundreds of thousands of dollars.

The Stimulus Act is a reimbursement program. However, many practices, both large and small, don’t have the liquid capital necessary to purchase an EMR system. The recession can also make it difficult to get a loan or otherwise obtain financing. If physicians can’t afford to purchase an EMR on their own, the Stimulus Act won’t help them.

All of these factors combine to slow down the decision process. Many feel the time table set out by the stimulus package is too aggressive. Once the requirements are officially adopted in January 2010, physicians will have a year to purchase, implement, and establish meaningful use of their EMR systems. 2011 is the first year for reimbursements, and also offers the highest payout. Physicians will need to move fast in order to qualify.

The solution is to purchase a simple, flexible, and inexpensive EMR system. Physicians should select the most basic system that will fulfill their needs and conform to meaningful use requirements. Flexible systems can adapt to new requirements, and may prevent physicians from being stuck with a system they don’t like. Avoiding unnecessary features will reduce prices and reduce implementation time to qualify for the 2011 payments.

The HIECH Stimulus Act is part of President Obama’s plan for full, nation-wide use of EMRs by 2014. The act promotes Electronic Medical Record (EMR) adoption by allocating funds to reimburse physicians for purchasing and using a qualified EMR system. In addition, physicians who fail to adopt an EMR will eventually face Medicare reimbursement penalties. Although the goal is lofty, Obama hopes the act’s carrot and stick approach will encourage physicians to adopt EMRs.

However, a recent report by HealthLeaders-InterStudy indicates that Phoenix, Arizona is experiencing a high rate of Electronic Health Records (EHR) uninstalls. According to the report, the trend is due to training, functionality, or affordability issues. Both top-level hospitals and smaller providers struggle with the financial constraints of purchasing and implementing EHR systems. Arizona rapidly adopted EMR systems due to a 2005 executive order by Governor Janet Napolitano, which required that all healthcare providers install an EHR by 2010.

Does this uninstallation trend provide us a glimpse into the future? Will the U.S. share Arizona’s experience at the national level? Arizona’s executive order is similar to the HITECH stimulus act because both seek to rapidly drive EMR adoption to meet an arbitrary deadline. In both cases, physicians feel pressured to make a very important and potentially very expensive decision. Although EMRs provide many benefits, selecting the wrong system, or rushing the implementation process could lead to many problems. It seems that Arizona physicians are scrambling to remove unusable systems due to poor selection or botched implementations.

This does not necessarily mean the HITECH Act will fail. Rather, it means that physicians need to be careful and not rush into a decision they may regret. EMR system prices can reach $100,000 or more. In contrast, the stimulus act will only pay about $44,000 in reimbursements. Physicians should focus on their needs, not wants or superfluous features, and select the simplest system that fulfills their requirements. Simple systems are easy to install, easy to learn, and easy to use. Ease of use is critical; complex and difficult systems can lead to spiraling maintenance and training costs, and may ultimately be discarded.

The uninstallation trend in Arizona is a clear warning. Although well-intentioned, the HITECH Stimulus Act may encourage physicians to rashly purchase a system that will not work well in the long run. Physicians must resist the temptation throw in a system just to qualify for reimbursement payments. Instead, they should take their time to find a simple, user-friendly system that meets their needs. After all, $44,000 sounds like a lot of money, but it will probably not cover the more expensive EMR systems with monthly maintenance fees.