Here’s the rules of the game

By Rosemarie Nelson | April 20, 2011

The EHR incentives are here, but how do you ensure that both you and your staff know the rules of the game? First and most important, the initiative needs to be practice-wide, not just something your providers are required to do. Involving your support staff is essential to achieving meaningful use of a certified EHR. Indeed, staff will play a significant role in your practice’s successful adoption of EHR technology. So, what are the steps involved and how do you get your staff informed, involved, and in the game?

Give them the background

Certified EHR technology used in a meaningful way is one piece of a broader health IT infrastructure intended to reform the healthcare system and improve healthcare quality, efficiency, and patient safety. Under the HITECH Act, the Medicare EHR incentive program provides incentive payments up to $44,000 paid out over five years to eligible professionals (those professionals who are not hospital-based and who are: a physician, dentist, podiatrist, optometrist, or chiropractor) who are meaningful users of certified EHRs.

The Medicaid EHR incentive program provides incentive payments up to $63,750 paid out over five years to eligible professionals (those professionals who have 30 percent or greater Medicaid patient volume: includes physician, dentist, certified nurse mid-wife, nurse practitioner, or pediatrician with at least 20 percent Medicaid patient volume) for efforts to adopt, implement, or upgrade certified EHR technology and meet meaningful-use criteria over the next five years.

Each eligible professional (EP) must meet all 15 required CORE set objectives from Table 1. In addition to these, they must also select four of eight MENU set objectives from Table 2, plus one of two MENU set objectives from Table 3 — for a total of five MENU set objectives.

What can your staff do to contribute to your effort to qualify?

Tables 1 through 3 specify each objective and its required measure, as well as recommendations for staff support to meet each measure. The last columns of Tables 1 through 3 identify how you and your staff can use your EHR system to facilitate data collection, reporting, and/or data submission for eligible professionals. It is not necessary for all eligible professionals in a group practice to qualify for meaningful use; a single eligible professional in a group practice can qualify on her own merits.

It is likely that your staff is already completing several tasks that will contribute to meeting the required objectives for meaningful use. Your staff is registering patients and capturing their date of birth and gender — if you instruct them to also capture race, ethnicity, and the patient’s preferred language, one objective is met. The next logical step in patient flow is intake and rooming. Clinical support team members probably capture patients’ weight, height, and blood pressure. They can use that data to calculate BMI and plot growth charts for patients age 2 to 20. While performing intake, your staff can interview each patient regarding their smoking status, allergies, and any medications they are currently taking. Five of the fifteen required core set objectives are complete and you haven’t even seen the patient yet! The added bonus is that patients’ blood pressure, weight, and smoking status also meet the clinical quality measures requirement (Table 4 or alternate Table 5), so that’s six CORE objectives completed.

What happens after your encounter with your patient?

Use your EHR to automatically generate a clinical summary (for example: the problem list, medication list, medication allergies, and diagnostic test results) and your nurse or checkout specialist can provide that to each patient. There’s the seventh objective.

The most successful EHR implementations have a designated super-user on staff. She typically is the go-to-person in the practice who analyzes work flow and applies system functionality for maximum efficiency, solves immediate problems on a day-to-day basis, and interfaces with the EHR software vendor. Your super-user is considered the subject matter expert (SME) when it comes to any questions about your practice’s EHR. The SME can develop clinical decision support rules and track compliance for meaningful-use reporting (you must select three clinical quality measures from Table 6 to meet the reporting objectives). The SME will perform a test of clinical information exchange and most likely will be the person to perform a security risk analysis. That’s three more CORE objectives completed, making a total of ten (out of the required fifteen objectives) — all completed by support staff!

Browse the MENU set of objectives and you’ll find that it is easy to see where your staff can satisfy five of those options. (Table 1, Table 2, Table 3, Table 4 or alternate Table 5, and Table 6.)

Game, set, and match!

*For more guidance on meeting meaningful use, see our Meaningful Use Stage 1 Crib Sheet,” with additional input from Rosemarie Nelson on how to cut through all the legalese and find out what the government is saying and what it really means for your practice.

Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.

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