In 2015, Medicare providers must begin demonstrating meaningful use of Electronic Health Records (EHR) technology. As of this writing, that's six months away. Nowhere is there any hint that this will be postponed, as was the ICD10 conversion date. Failure to make meaningful use of EHR records triggers a 1% reduction in reimbursement each successive year through 2017.
EHR Meaningful Use Defined
In 2015, CMS requires Stage Two Meaningful Use compliance by providers who've fulfilled Stage One requirements within the last two to three years. The core requirements for Stage Two compliance are dependent upon successful installation and mastery of sophisticated information systems that can support EHR exchange between providers and patients and between providers and other providers. Some of these are:
- Computerized provider order entry of medication, laboratory and radiology orders
- Prescriptions originated and sent electronically
- Use of clinical decision support systems
- Online patient access to their health records
- Online availability of lab results to patient and provide
- Secure electronic messaging capability between provider and patient
EHR Stage Two Implementation
Stage Two implementation is wholly dependent upon successful installation and operations of EHR software and hardware to support meaningful use (MU) attestation. There's a great deal of money to be made from the installation and management of EHR systems.
Ambulatory and Hospital Inpatient comprise the two types of EHR implementation. As of 2013, according to a report by research firm Software Advice 209,000 practices had attested to full meaningful use of an EHR in ambulatory setting, almost double the figure for 2012. In 2012, 107,000 ambulatory practices had attested to complete EHR use. By the end of 2013, this had increased by 95% to 209,000. The groundswell would seem to signal that practitioners are fully cognizant of the approaching EHR Stage Two requirements and are moving to comply.
In 2012, Ambulatory EHR implementations were served by 437 vendors. One might think the market for EHR systems' vendors saturated at that point, but in 2013, another 119 vendors appeared, an increase of 25%, bringing the total of EHR vendors supporting ambulatory to 556. Of these, ten had 64.2% of the market, with an astounding 456 vendors serving the remaining 35.8%, or 82,555 practices, equating to one vendor for each 181 practices. Whatever the long term effects of EHR on health care, it's certainly fostered a booming cottage industry of systems' vendors. It's also spawned speculation about the inevitability of consolidation, as market forces come into play, post implementation.
Hospital EHR implementations are served by far few vendors, hospitals being far few in number and having much larger and more complex requirements. These installations can run into the hundreds of millions of dollars and threaten the financial stability of the impacted health care systems, even as they boost the profits of major EHR vendors: ten of them designed and installed the EHR systems for 90 percent of attested hospitals, with three firms accounting for half of the hospital attestations.
Is EHR Conversion Worth It?
Health information systems are modernizing as fortunes are spent and fortunes made. The final bill for EHR conversion isn't yet available, but will surely run into the tens of billions. Concerns have been raised: “Evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services,” noted The New York Times.
It will be years before all the metrics of EHR conversion are available, its ultimate success determined by patient outcomes.