The HITECH stimulus program reimburses physicians up to $44,000 under the Medicare program and up to $64,000 under the Medicaid programs for purchasing and implementing Electronic Health Records (EHR). Meaningful Use (MU) is a set of standards that applies to the use of EHR software. Eligible professionals (EPs) must meet MU standards in stage one of the Medicare program and stage two of the Medicaid program.

MU standards guarantee EPs must actually use their EHR software instead of just buying it and shelving it in order to obtain stimulus funds. EPs have 25 objectives, 15 core which they must meet in stage one, and ten menu objectives, of which they can choose five. They range from simple tasks, like capturing race, ethnicity, and preferred language, to more complicated items like computerized provider order entry (CPOE), electronic prescribing, and submitting electronic data to immunization registries.

The objectives have two parts: a function and a measure. Some of the requirements are calculated as a percentage. For instance, the CPOE measure requires the EP to enter medications for more than 30% of all their unique patients. The percentage is calculated based on a numerator and denominator. The denominator consists of the number of unique patients with at least one medication in their medication list during the reporting period. The numerator is the number of patients in the denominator which have at least one medication entered by CPOE.

Does this sound confusing? It certainly can be. 16 of the 25 measures compute using a numerator, denominator, and resulting percentage. The remaining measures compute using a simple yes/no response. Medicare participants must use their EHR according to the measures for a period of 90 days. EPs must comply with all of the measures in order to receive payment. The incentive reimbursements are all-or-nothing. EPs that fail even one of the measures will have to restart their 90 day reporting period and try again.

It is critical to track compliance with the measures. We recommend a one-week MU pretest. If your practice can fulfill the requirements for one week, there should be no problem with the 90 day reporting period. Certified EHRs are required report your MU measure compliance. We strongly recommend reviewing your reports on a daily basis. That way, if you notice that one of your providers is slipping, you should have ample time to correct the issue.

XLEMR produces a daily score card that lists each provider and their compliance with the 16 calculated measures. Our EHR software creates the report automatically and emails it to the practice manager along with each of the providers. You can view an example of our MU score card at: http://www.xlemr.com/content/mu_scorecard.pdf. Please let us know if you have any questions about meaningful use measures or compliance.

If your practice is like most of our clients, your finances follow a strict budget. It is no secret that implementing Electronic Health Records (EHR) can be a short term strain on your budget. Although there are many different kinds of EHR systems, they all require a solid foundation of workstations, local area wireless and wired networking, routers, servers, and other gadgets. Collectively, this is known as Information Technology (IT) infrastructure.

Chances are you have at least some IT infrastructure in place already. If you have a billing service or practice management software, you will most likely have a couple of workstations, a local network, and an internet connection. Most practices moving to an EHR for the first time need to purchase more workstations. You can go with mobile devices like tablets or laptops for each staff member, or have a workstation in each exam room. You may also need to purchase a server and backup systems.

Even if you choose a web-based EHR with a monthly service fee, you can’t neglect your IT infrastructure. Although web-based or Software-as-a-Service (SaaS) EHR vendors love to claim that their system does not require a substantial hardware investment, at a minimum you will need a workstation for each staff member or exam room. You also may need to upgrade your internet connection to commercial cable, as well as purchase more robust routers and related equipment.

Be sure to allow room in your budget for IT infrastructure, not just the EHR software. Many practices who spend hundreds or thousands a month on EHR software are tempted to skimp on their IT infrastructure. This is like purchasing an expensive house, only to find out later that the foundation is sub-standard once the walls start cracking.

Many EHR implementations are delayed or scrapped because of poor IT infrastructure. Chances are, end users will not know the difference between issues caused by the EHR software, the workstation, the local network, the internet, or the server. All they know is that something is not working. Frustration builds quickly in a busy practice.

How can you know your IT infrastructure is sound? Does your practice need to spend thousands, or tens-of-thousands on the latest cutting-edge gear and equipment? Not necessarily, but it always makes sense to purchase good-quality equipment. Our clients have had good success with refurbished or used equipment. Although there are some risks, refurbished goods retail at a fraction of the price of new gear.

Look carefully at your system requirements. For instance, If your system is web or client-server based, you do not need to splurge on workstations with large hard drives. In some cases, it may make more sense to let your infrastructure grow organically and acquire items as needed, rather than splurging on an expensive set up that will last you for the next ten years. Whatever your purchasing strategy, make sure your IT infrastructure will be a firm foundation for your EHR.