As the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act evolves forward, physicians practicing in different specialties face diverse situations, challenges, and questions. One specialty in which questions have been particularly heightened has been that of radiology. Many radiologists interact primarily with referring physicians, and thus their patient contact is limited compared to the vast majority of specialties; what’s more, radiologists’ workflow is in some ways quite unique; what’s more, until recently, most radiologists did not use electronic health records (EHRs) in their fullest sense. All that said, the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS) have made it clear that they expect virtually all physicians in private practice to participate in the meaningful use program—not only that, but also that radiologists are liable for reimbursement penalties under the program’s guidelines, as well as for its funding rewards.
One radiology group practice that has been striving forward on meaningful use is East River Medical Imaging, which has been participating in Stage 1 of meaningful use, and is simultaneously planning for Stage 2 participation. Its leaders have been partnering with the Fort Lauderdale-based IDS, which provides the group with its core electronic health record (EHR) solution, a product designed specifically with radiologists and orthopedic surgeons in mind.
Andy Wuertele, East River Medical Imaging’s chief administrative officer, and David Vazquez, its systems administrator, spoke recently with HCI Editor-in-Chief Mark Hagland. Below are excerpts from Wuertele’s comments to HCI.
Tell me about your participation in Stages 1 and 2 of meaningful use? Did you attest for all 12 radiologists for Stage 1?
That’s correct, yes; all 12 radiologists submitted their attestations in March 2013, and received their incentive payments at the end of March.
And can you share about Stage 2?
We’re in the midst of our second year of Stage 1 data-gathering and participation for this October-December quarter, and are preparing for Stage 2. We are still finalizing our plans and watching very closely what CMS is guiding the field to do, and are awaiting some further clarification on their expectations for 2015.
When are you thinking of attesting to Stage 2?
We believe we will need to begin as of January 1, so it will be a 365-day Stage 2 attestation process. We would be quite supportive of the discussion to transition that to a 90-day process.
Will it be a significant burden to do a 365-day period for a medical group your size?
Yes, if only because vendor preparedness has taken this much time. If we were attesting to Stage 1 for 365 days, that would not be a problem; it’s adding in the new technology right now that is challenging for so many.
You’d have to be doing that right now, correct?
Yes, that’s right, and very few vendors have implemented their 2014-approved technology. And one requirement is for patient participation. We’re very excited to develop a patient portal, but we need for it to be very patient-friendly to support it and meet the high expectations for service that are essential in our practice. And so to have so many question marks still in the atmosphere about what’s expected and for it to e this late in the game to have the 2014 versions of the EMR systems being approved, we’re still in a bit of a standby mode.
Your core solution is from IDS?
Yes, the Abbadox solution from IDS. It’s a cloud-based solution.
Is it particularly good for specialists?
It’s supportive of specialists’ workflow. I believe their client base supports radiologists and orthopedic surgeons; they have the capability of adapting it to the needs of other specialties as well.
What have been the special elements of meaningful use for radiology practices?
First and foremost, our conversion to a comprehensive electronic workflow had already happened more than ten years ago, driven by the efficiencies around PACS [picture archiving and communications system] use, and the large amount of data we’ve had to manage and turn into further information. So the vendors in radiology have legacy products and systems tailored to those sets of challenges, and their willingness to reinvent their products to add meaningful use capability has been limited. And the incentives that the government has put in place don’t recognize that radiology is a leader in accomplishing what they’re incentivizing. So we need to do even more than we have already done; we need to make technology investments on top of those made over the prior decade, so it’s a very unique situation. And in radiology, therefore, there has been skepticism about the impact of the meaningful use requirements. So all that is a historical note. But when you start to look at what we think the definition of meaningful use is, relative to driving better results and higher quality with each encounter, we recognize that a patient’s flow through radiology is different.
For one thing, the patient often doesn’t have direct contact with the radiologist.