(Editor’s Note: The following is a response to a July 15, 2010 posting by Leslie Kane about the ease of demonstration of “EHR Meaningful Use — So Easy, Even a Caveman Could Do It?”. The Kane Scrutiny blog on Medscape.)

As President of Geriatric Practice Management, Inc., I have more than 30 years’ experience running regional Medicare Part A and Part B providers. Complying with these rules will be a monumental systems-engineering challenge for us — and we have an information technology department with 2 full-time programmers.

We face an additional investment of $150,000 or more to upgrade our current electronic medical record (EMR) to the compliant electronic health record (EHR) version. Then we have to determine whether our providers can actually use the new version and in a manner that does not decrease their productivity (a significant challenge).

We need to identify how many new “interfaces” (at $1000 to $10,000) we have to purchase; an interface is needed for each laboratory and probably each facility. Our providers practice in nursing homes (about 100 facilities).

This means that we have to arrange interfaces with 10 to 30 laboratories and a similar number of pharmacies (we admit approximately 1000 new patients per month with in excess of 10,000 active prescriptions). For the pharmacy information, there is the Surescripts hub, but someone has to enter the drugs into the system when the patient is first admitted. No system-wide clearinghouses for the laboratory information exist.

We are supposed to give a summary of each office visit to each patient within 3 business days. Whom do we sent the summary to when 70% of our patients are afflicted with some degree of cognitive impairment? Those are the kinds of questions that are above the pay grade of the average caveman.

I’m giving you the perspective of a single niche practice (but one that serves one of the frailest and most costly Medicare/Medicaid populations) — and we already use EMR. The challenges to many other groups are significantly greater.

Because we have nearly 40 physicians who are theoretically eligible for Medicare Meaningful Use ($1.76 million) and a dozen extenders who may be covered by the Medicaid incentive (up to $700,000), we can’t dismiss the program out of hand.

However, because many of the standards are poorly worded, buried in an 864-page document, and nearly impossible to translate into compliant clinical policies or procedures, our plan is to prepare but watch and wait. The complexity of this program exceeds the Physician Quality Reporting Initiative (PQRI), which barely functions, and the Medicare Provider Enrollment, Chain, and Ownership System (PECOS), which does not function.

Both of these programs punished most of the early adopters with systems failures and repeated data loss. I predict little chance of a stampede by physicians except where success is certain. The government will clarify (and simplify) the regulations. Health information technology (HIT) vendors will sweeten their terms if customers balk.

For 2011, we’ll continue participating in PQRI (about $5000 per provider per year for 30 patient records) and e-prescribing (about $2500 for 25 patients) because the money is certain, it requires a measured amount of administration, and you are still eligible for 100% of the EHR incentive if you start in 2012.

If the improbable happens — the Centers for Medicare & Medicaid Services clarifies the rules before the next regulatory year begins, and HIT vendors get serious about competing on price — we may take a plunge by October 2011. But don’t bet on it.

Source: medscape.com