Is there still time for EHR adoption and 2011 Meaningful Use?

The HITECH portion of the American Recovery and Reinvestment Act (ARRA) earmarks up to $44,000 to each physician who is able to demonstrate “meaningful use” of a “certified” EHR by 2011. The Office of the National Coordinator (ONC) for Healthcare IT has received input from two primary committees, the HIT Policy Committee and the HIT Standards Committee, which have been developing the definitions of Meaningful Use, and a process for developing HHS Certification (a new term, not previously in existence). Also in-process is the method by which a physician using an EHR reports Meaningful Use in order to receive the HITECH bonuses.

To many, 2011 is “right around the corner” and implementing a system now is essential in order to be ready for bonus payouts. The common belief is that EHR implementation may take 1-2 years – and it is this belief that has prompted CCHIT (the only certifying agency for EHRs in the past, though will be one-of-many going forward with HHS Certification) to second-guess what the HHS Certification requirements will be, and establish a “provisional certification” process now.

Is the 1-2 year timeline for EHR implementation and achievement of Meaningful Use realistic? According to an article published in 2008, EHR implementation can be broken down into several phases: (1) Preparation (90-150 days); (2) System Selection (60-120 days); (3) Implementation (45-180 days); (4) Post-implementation (6-12 months). Are these timelines still valid? It depends on the kinds of systems being considered.

Traditional “big vendor” client/server EHRs, which are quite expensive and require local server setup and installation, including hiring/consulting IT expertise, will quite likely follow this pattern. Given the cost, the selection process puts considerable money at risk, and the “evaluation of cost-benefits realization” (phase 4, above) is daunting. Kaiser Permanente, with perhaps the largest non-government EHR implementation in the country, spent approximately $4 billion on their system, and rolled out their EHR in 10 of its 30 California hospitals by 2008, with the remaining hoping to go online over the subsequent year or two.

However, new developments in EHR technology have emerged, with web-based, software-as-a-service (SaaS) offerings now available – Practice Fusion is a leading example of such a “new paradigm.” Without the cost and need for local server infrastructure, the risk drops significantly and selection process can be very quick – since there is nothing to set up (other than internet-connected computers with a web browser), the time to implementation is immediate. Getting data (like legacy patient demographic data from prior sources, like billing systems) into the system can be accomplished in about a day. The main issue, then, is training and workflow redesign – and the ease of this is a function of system usability. Training, in fact, is essential to EHR success, and this can be carried out step-wise. However, with good, usable design, the learning curve for physicians using Practice Fusion has been measured in days-to-weeks (not weeks-to-months).

Over the next few weeks, we will report on “user experiences” from physicians who have used Practice Fusion in their office practices. The kind of SaaS-based model utilized by Practice Fusion completely changes and challenges the assumptions of “traditional EHR dogma” (which is based on legacy client/server technology) – we will show examples of how, by using Practice Fusion, achievement of Meaningful Use of HHS-Certified EHRs can be accomplished in a very short time.

Robert Rowley, MD – Chief Medical Officer, Practice Fusion, Inc.