The American Recovery and Reinvestment Act of 2009, otherwise known as the Stimulus Act, authorizes the government to pay incentives totaling $44,000 per physician to encourage the adoption of Electronic Medical Records (EMRs). The incentives are coupled with penalties; physicians that don’t adopt an EMR will be penalized by a reduction in Medicare reimbursements. In order to qualify for the incentives and avoid the penalties, an “eligible professional” must use a “certified EMR” in a “meaningful way.”
The big question on everyone’s mind is “What is a certified EMR?” Physicians currently using EMRs want to be sure their systems are certified. Likewise, physicians shopping for an EMR don’t want to risk purchasing something that won’t meet the stimulus criteria. Unfortunately, the legislation did not specify certification criteria. We will have to wait for congress, various offices, and committees created by the legislation to agree on the requirements.
Right now, many people point to CCHIT as the certification criteria. However, only 8% of EMR vendors were CCHIT-certified in 2008. Does this mean that 92% of all the EMR systems on the market are garbage? Hardly. CCHIT is a hugely expensive endeavor that costs about $40,000 to complete, including registration and maintenance fees. This effectively locks out many smaller vendors that can’t afford to apply. In addition, many of the CCHIT requirements pertain to software with relational databases, or are otherwise unnecessary for a functional EMR system. Finally, CCHIT does not consider things like usability or ability to generate return on investment.
The government has a history of creating EMR standards that have suffered from poor participation. The now-defunct Doctor’s Office Quality – Information Technology (DOQ-IT) program was intended to promote EMR adoption and implement a pay-for-performance program. Since only a few EMR vendors were DOQ-IT certified, and only one vendor was able to submit regular production data, the government scrapped it in favor of PQRI. The Physicians Quality Reporting Initiative (PQRI) program was similar, but with less-stringent requirements. In 2007, only about 10% of physicians successfully received their 1.5% bonus.
Whatever the government decides will constitute a “certified,” EMR system, we can be sure that decision will go through a few revisions. It would not make sense for the government to adopt standards that rule out 92% of the EMR industry. Physicians contemplating an EMR purchase should not wait until the lengthy decision process is over. Purchase and install an EMR system now, that way your practice will have plenty of time to learn your system and use it in a “meaningful way.”