Veltri is hoping a smoother workflow will boost patient care and drive bigger Medicaid financial reimbursements by ensuring that forms are properly filled out.
Sue Reber, marketing director for the nonprofit Certification Commission for Health Information Technology (CCHIT), said that in some ways the EHR legislation creates a pinch-point. That's because HHS agencies are allowing time for deliberative rule-making, but reimbursements for EHR technology will begin this October, when the government's fiscal 2011 starts. That doesn't allow for enough time to digest the rules, roll out the technology properly and seek federal money to pay for it.
Reber noted that while reimbursements for the completion of Phase 1 of an EHR implementation can start as late as 2014, "the later you start, the less money you'll get -- and the bigger hurdle you'll have to get over in 2015 and 2016 to avoid penalties."
EHR implementations are far more complicated for hospitals than for doctor's offices, because they aren't all-inclusive bundled systems. Hospitals use piecemeal technology that's rolled out department by department and requires integration. And since many hospitals won't just rip and replace their existing IT infrastructures, they'll be forced to integrate new physician and nurse documentation systems, computerized order-entry systems and relational databases with their existing systems.
Most hospitals began using health information technology far earlier than smaller health care operations, but they purchased that technology by department. For example, a hospital might have implemented a patient admission system for its front office; a patient transfer system for its departments; separate administration systems for its emergency room, laboratory, pharmacy and radiology departments; and a separate physician order-entry system. All those systems may have come from different vendors and, on top of that, many hospitals customize their own software.
The CCHIT is currently the only organization accredited by HHS to certify EHR systems for meaningful use, although federal health officials are working on new rules for accrediting organizations that can certify EHR systems.
According to Reber, physicians who have never purchased EHRs are looking at a 12-to-18-month period after deployment before they'll have enough data to meet meaningful use requirements for reimbursement.
"If you aren't at least evaluating some EHR products and talking to your peers about this, you're going to have a difficult time getting all of your reimbursement payments," Reber said. "And you may even get yourself into the penalty phase."