A Personal Health Record (PHR) is a device or software that allows patients to keep track of and manage their health information. Many PHRs are contained on a USB thumb drive designed to be carried at all times. Some USB drives are built into bracelets, necklaces, or are shaped so they will fit into a wallet. Other PHRs might be web-based using a patient portal such as Microsoft Health Vault, or the now-defunct Google Health.

According to a brief by Deloitte, PHRs may provide the means for consumers to enhance self-care, which can help reduce the cost of health care. Despite the benefits offered by PHR, they have not been very popular. Several factors have limited their adoption, such as the lack of interoperability standards, the slow adoption rate of electronic health records (EHR), and privacy concerns. Many older patients are also reluctant to embrace technology.

However, another recent article states that nearly all web users have searched for medical information online, most of them after talking with their doctor. The Deloitte article also goes on to state that twice as many patients belonging to generations X and Y want PHRs compared to Baby Boomers and seniors. Personal health records seem to be gaining popularity.

Several of the final meaningful use requirements require patients to have electronic access to their health records. In case you are unfamiliar, the HITECH Act will reimburse physicians for purchasing EHR systems and using them according to established guidelines known as meaningful use. These requirements ensure a minimum level of use and create a standard set of features all EHRs must provide.

For example, providers are required to provide electronic copies of health information including test results, problem lists, medication lists, and medicinal allergy lists. PHRs can also help exchange clinical information between providers, which will help improve patient care and reduce the amount of paperwork required. PHRs can also store summary of care records, which are useful when patients transition to another provider or care setting.

Providers should consider offering their patients a PHR. They should find a PHR system that is flexible, and will help them qualify for meaningful use. PHRs have much more legitimacy in the eyes of the patient when they come recommended from physicians, compared to direct business-to-consumer sales. Providers may even be able to partner with a vendor to retail PHRs to their patient. In these days of ever-declining reimbursements, it helps to have legitimate additional revenue streams. In any case, PHRs will be a crucial part of qualifying for meaningful use.

Electronic Health Records (EHR) can be a vexing topic for physicians nearing the end of their careers. Many older physicians feel their paper charts work just fine, and they hope to retire before they are forced to adopt EHR. Should retiring physicians consider purchasing EHR?

The answer depends upon three factors. First, a physician must consider how long they will stay in practice. A physician who wants to retire in three to five years may come to a very different conclusion than a physician who wants to retire in five to ten years.

EHR systems can bring many benefits to a practice, both in terms of finance and patient care. Better documentation and built-in coding help can allow physicians to legitimately bill higher service levels for office visits. Practices generally enjoy a 20% increase in revenue due to appropriate coding. Electronic systems can also reduce the material and labor costs of managing paper. Drug-drug interaction checking, automated follow-up reminders for patients, and lab results integration can all help improve care. Interoperability lets you share critical information with other providers without the pain of faxing, photocopying, or mailing paper charts. Electronic records eliminates the pain of deciphering poor handwriting.

It may take up to a year to fully implement an EHR system, allowing for installation, training, and learning to use the system proficiently. This of course depends upon the complexity of the EHR, the technical proficiency of the staff, and the size of the practice in question. Once the practice is “settled in,” it should start seeing a return on investment due to the factors I’ve already mentioned. Short-timers may not be able to pay for a system and reap the benefits before they retire.

Second, a physician must consider if they want to sell the practice. An EHR that decreases operational costs, increases revenue, and leads to greater profitability could be a great asset. Conversely, a complex, clunky, difficult to use EHR could be a liability. If a practice has tons of paper charts, it might be worthwhile to purchase a scanning solution. Practices paying a premium for offsite storage should definitely consider scanning in their old records. Scanning can be done in addition to EHR adoption or instead of EHR for short-timers who wish to sell their practice. No one wants to inherit a massive collection of paper records.

Third, physicians should consider how HITECH will affect their practice. HITECH promotes EHR adoption by reimbursing physicians up to $44,000 under Medicare or up to $64,000 under Medicaid. In addition to the carrot, HITECH also packs a stick. Starting in 2015, CMS will reduce Medicare reimbursements for physicians who are not meaningful users of EHR. The penalties start around 1% and increase to 5% over time. Even if a practice does not see many Medicare patients, they should be aware that private insurance companies may adopt similar incentives and penalties.

In conclusion, physicians looking to retire are faced with a complex decision. Physicians should consider their retirement time frame, whether or not they wish to sell their practice, and the expected financial impact of the HITECH act before they make an EHR purchase decision. Short-timers who do not wish to sell their practice have little incentive to purchase EHR. Physicians who expect to practice for at least five years, and short-timers who want to sell their practice should seriously consider purchasing an EHR.

The Centers for Medicare and Medicaid Services (CMS) will issue incentive payments to EPs and hospitals beginning in May 2011. In order to receive payments, providers will have to register in January. EPs and hospitals will need to use their EHR software according to the meaningful use guidelines for 90 days before they can attest. EPs and hospitals that wish to take advantage of the first payment period must have an EHR fully implemented and operational before January 1, 2011.

Those that already have an EHR should perform a self-audit to see if their system supports the final meaningful use requirements. Remember, the final meaningful use criteria consist of a core set of 15 mandatory requirements and a menu set, from which EPs must choose five options to implement. EPs who fear their existing system does not meet the requirements should contact their sales or service representative as soon as possible.

EPs who do not currently have an EHR in place need to move quickly if they wish to take advantage of the first payment period. There are several factors EPs must consider. First, no EHR software is currently certified for meaningful use compliance. HHS is working to approve independent bodies, such as CCHIT and the Drummond Group, to certify EHRs. HHS expects there to be approximately five or six certifying bodies, which could begin accepting EHR applications in late September or early October.

Most EPs seem to be waiting on certification, which could be a mistake. Right now many EHR vendors are offering great deals to encourage early adoption. Most analysts predict a huge surge in demand once certifications are in place. That means vendors will be backlogged and will probably have an installation waiting list. It also means that implementation and training teams are more likely to include new recruits rather than seasoned, experienced professionals. Simple economics suggests that a spike in demand will cause a price increase if EHR vendors maintain similar or slightly greater capacity.

EPs wanting to get in on the first payment period need to get busy. If they already have an EHR, they need to inspect their systems to see if they qualify. If they do not have an EHR, they need to look at purchasing a system in the next 30 to 60 days to remain ahead of the curve. Waiting on formal certification is a mistake. Any credible EHR vendor who does not want to go out of business will achieve certification.

The Certification Commission for Health Information Technology (CCHIT) just announced three new certification programs on its website today, Tuesday July 27, 2010. The new programs will certify electronic health record (EHR) software targeted towards behavioral health, dermatology, and long-term and post-acute care (LTPAC). The LTPAC program includes add-on certifications for EHRs used in skilled nursing and home health facilities.

Dr. Karen Bell, Commission chair, comments: “These certification programs represent the Commission’s ongoing commitment to increase the value of health IT for patients and providers by addressing the needs of individual medical specialties, care settings and patient populations.” Dr. Bell also stated that the new certifications “go beyond the current federal minimum requirements” to meet the long-term needs of healthcare providers in terms of functionality, interoperability, and security.

CCHIT consulted with a wide range of physicians, hospitals, payers, purchaser, and consumers. They also conducted pilot testing with several Health IT developers to help form and refine their certification requirements. Health IT vendors underwent a non-binding certification “pretest” to help CCHIT gauge what EHR features represent the current industry standard.

XLEMR is very excited to have been one of the eight health IT developers who participated in the pilot program. We focus on providing EHR systems that are simple, mobile, and efficient. Our mobile architecture allows LTPAC providers to see patients in facilities that lack internet and cell phone connectivity.

XLEMR has been working with the LTPAC community for many years. We feel it is an under-served, yet growing market. LTPAC will become increasingly important as the baby boomer generation ages. Providers will need more efficient ways to care for their patients. We believe EHR systems are an important tool that will allow providers to see more patients and improve their quality of care. To that end, we are very excited about CCHIT’s LTPAC certification.

HHS has revised the meaningful use rules proposed back in January to make them easier for practices to implement. They split the requirements into two groups: a core group, and an optional group. The core group includes 15 items practices must implement in order to qualify. The optional group includes 14 items; practice must choose five of these to implement in 2011 and 2012.

Required features include recording patient demographics; recording vital signs; maintaining an up-to-date problem list, an active medication list, and active medication allergy lists; recording smoking status for patients 13 years and older; providing patients with clinical summaries for each office visit; providing patients with an electronic copy of their health information; generate and transmit permissible prescriptions electronically; use computer provider order entry (CPOE); implement drug-drug and drug-allergy interaction checks; capability to electronically exchange key clinical information among providers; implement one decision support rule; implement systems to protect privacy and security of patient data; and reporting clinical quality measures to CMS.

Providers may choose five of the following: Implement drug formulary checks; incorporate clinical laboratory test results into the EHR; generate lists of patients by specific conditions to use for quality improvement; use EHR technology to identify patient-specific education resources and provide those to the patient; perform medication reconciliation between care settings; provide summary of care record for patients referred or transitioned to another provider or setting; submit electronic immunization data to immunization registries or immunization information systems; submit electronic syndromic surveillance data to public health agencies; send reminders to patients for preventative and follow up care; and provide patients with timely electronic access to their health information.

As you can see, the new rules give providers more latitude in meeting the meaningful use requirements. As you remember, providers could receive up to $44,000 under the Medicare program, or up to $64,000 under the Medicaid program if they meet the meaningful use guidelines. HHS will break up the payments over a five-year period. Most of the money comes in the first two years, so providers will need to act fast to qualify.

If you do not currently have an EHR, you need to act quickly in order to qualify for payments in 2011. If you currently have an EHR, you should evaluate your features to see if it will support meaningful use. Please feel free to contact us if you have any questions about meaningful use or the HITECH stimulus package.