Electronic Medical Records (EMR) Incentive Reimbursement - Who Qualifies?

There are many pros and cons to converting to electronic health records; depending on the point of view, it may have more pros or more cons.

The American Recovery and Reinvestment Act is planning to give billion to physicians as an incentive to encourage physicians to use electronic medical records. This money will be given to physicians and practices over the duration of five years to invest in electronic medical records. Unfortunately, this incentive is not going to be given to just any practice that purchases the system. A practice must qualify in order to receive the reimbursement. The hard truth is that not everyone who applies for an incentive reimbursement is going to get it.

Who Qualifies for EMR Reimbursement?

Electronic Medical Records (EMR) Incentive Reimbursement - Who Qualifies?

In order to qualify for an incentive reimbursement, practices must pass a few things on the list. The incentive money is meant to use the electronic system in a meaningful way. This can mean several things. The electronic medical records system must be able to communicate with other systems from different vendors and have advanced features, such as the clinical decision support feature. In addition, you must be a meaningful user, meaning you prescribe electronically, exchange data with different providers, and generate reports on how well you do compared to the unspecified clinical quality measures. These measures may resemble what you would find in the Quality Reporting Initiative.

The qualification list does not stop there. In addition to the qualifications listed above, electronic medical records must also be certified. The American Recovery and Reimbursement Act has yet to specify who can certify electronic health records; however, the federal government will most likely choose the Certification Commission on Healthcare Information Technology (CCHIT). In order to receive the full disbursement of ,000 over the course of five years, physicians must also qualify as a meaningful electronic health record user beginning by 2011 or 2012. The later physicians choose to wait to qualify, the less they will receive in incentive payments.

There is another catch as well. Many physicians are eligible to receive incentive reimbursements, but not all physicians. Dentists, physicians, nurse practitioners, nurse midwives, and some physician assistants are included. Physicians who are not eligible are hospital-based professionals, such as radiologists, emergency physicians, pathologists, and anesthesiologists. Practices that choose not to use electronic health records will be penalized a 1% reduction in 2015 in their Medicare fee schedule and it can continue up to 5% as the years pass. Many physicians disagree with the federal government's plan to give incentive reimbursements. Many feel it is just one way the government can control how healthcare is administered, and as a way to push national healthcare coverage.

Electronic Medical Records (EMR) Incentive Reimbursement - Who Qualifies?
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History Of Electronic Medical Records

In the 1960s, a physician named Lawrence L. Weed first described the concept of computerized or electronic medical records. Weed described a system to automate and reorganize patient medical records to enhance their utilization and thereby lead to improved patient care.

Weed's work formed the basis of the PROMIS project at the University of Vermont, a collaborative effort between physicians and information technology experts started in 1967 to develop an automated electronic medical record system. The project's objectives were to develop a system that would provide timely and sequential patient data to the physician, and enable the rapid collection of data for epidemiological studies, medical audits and business audits. The group's efforts led to the development of the problem-oriented medical record, or POMR. Also, in the 1960s, the Mayo Clinic began developing electronic medical record systems.

New Electronic

In 1970, the POMR was used in a medical ward of the Medical Center Hospital of Vermont for the first time. At this time, touchscreen technology had been incorporated into data entry procedures. Over the next few years, drug information elements were added to the core program, allowing physicians to check for drug actions, dosages, side effects, allergies and interactions. At the same time, diagnostic and treatment plans for over 600 common medical problems were devised.

History Of Electronic Medical Records

During the 1970s and 1980s, several electronic medical record systems were developed and further refined by various academic and research institutions. The Technicon system was hospital-based, and Harvard's COSTAR system had records for ambulatory care. The HELP system and Duke's 'The Medical Record' are examples of early in-patient care systems. Indiana's Regenstrief record was one of the earliest combined in-patient and outpatient systems.

With advancements in computer and diagnostic applications during the 1990s, electronic medical record systems became increasingly complex and more widely used by practices. In the 21st century, more and more practices are implementing electronic medical records.

History Of Electronic Medical Records

Electronic Medical Records provides detailed information on Electronic Medical Records, Electronic Medical Record Software, Electronic Medical Record Systems, Electronic Medical Record Companies and more. Electronic Medical Records is affiliated with HIPAA Laws.

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Electronic Medical Records - The Pros and Cons

In this digital age, more and more bulks of information which used to be paper-based, from library catalogs to telephone books, are digitized and stored in a central location for easy access. The idea of EMRs started about 40 years ago.

The main proponents of EMRs cite the following advantages:

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(1) The use of EHRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable.

Electronic Medical Records - The Pros and Cons

(2) Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications.

(3) EMRs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization. EMRs translates into better treatment for patients. Take the example of one asthma center's experience with EMR: "A major benefit associated with EMR implementation was the increase in the number of children who were hospitalized with an asthma exacerbation and received an asthma action plan upon discharge. Prior to the EMR system, [only] 4% received an asthma action plan upon discharge. After implementation of the EMR system, 58% received an asthma action plan upon discharge."

(4) EMRs can save lives. VeriChip, developed by VeriChip Corporation is the first one of its kind ever approved by the US FDA. It enables rapid identification of at-risk patients and access to their medical history, thereby enabling rapid diagnosis and treatment especially in emergency situations. Classic examples are people with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also useful in vehicular accidents and other trauma incidents where the victims aren't capable of answering questions. In cases of large-scale catastrophes, VeriChip facilitates tracking and identification of victims. According to a coroner in Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.

Earlier this year, Google Health was launched, an online personalized health records service. Google Health is based on the principle that since it's the patient's medical record, the patient should control it, decide what should be in it, and who gets access to it. One of the features of the service includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google Health partners.

The HealthVault is another online health information storage service offered by Microsoft with features similar to Google Health. Keith Toussaint, senior program manager with Microsoft HealthVault recently stated " leading hospitals like Beth Israel Deaconess Medical Center are actually integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing."

What are the disadvantages of EMRs? Not surprisingly, privacy rights advocacy groups are the main opponent of EMRs. Here is what they have to say:

(1) EMRs threaten our privacy. In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient relationship is still sacrosanct. Besides, medical data can be used against a person in some cases - be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people's fear of incursion into their private sphere.

(2) EMRs can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. EMR is simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not that efficient. Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.

(4) EMRs are not safe and secure. Google Health and HealthVault are quick in assuring patients of the safety of their online health accounts. Access to the patient's account is only possible using log ins and password. In addition, HealthVault assures that "all health information transmitted between HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of security to safeguard consumer health information from theft, loss, or damage."

However, there are cases wherein passwords and encryptions do not seem to be adequate as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high security databases such as those run by banks and credit institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below:

November 26, 2007, Canada. Hackers accessed medical information on HIV and hepatitis from a Canadian health agency computer. - September 22, 2008, UK. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. - September 30, 2008, US. The company Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, there is criticism over Google Health not being a "covered entity under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (HIPAA)" under its terms and conditions and is therefore not subject to HIPAA privacy of individually identifiable health information. The HealthVault terms and conditions do not mention HIPAA privacy laws so it is not clear what its status is regarding this issue.

(5) VeriChip is not for humans. It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the US FDA says. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. Another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of concentration camp detainees. Popular Hollywood films on privacy incursions (e.g. The Net, Public Enemy No. 1) increased further people's paranoia about personal data.

Where do we go from here? Without doubt, we have the technology to make EMRs standardized and efficient. Google Health, Microsoft HealthVault and similar online personalized health information accounts are enabling patients to take control of their medical records. The main issues that need to be overcome are data security, protection of privacy and gaining the confidence of the patients. It doesn't seem evident that the use of RFID and similar tagging chips will become acceptable or popular anytime soon. However, we live in a digital world and we cannot hold back progress indefinitely. With improved technology and data protection tools, let us hope the EMR issue will be resolved soon.

Electronic Medical Records - The Pros and Cons

The article Electronic Medical Records - The Pros and Cons may be found in its entirety with references and links on http://HealthWorldNet.com

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