NN&I - August 2010

Health Care Beat 14 Nephrology News & Issues August 2010Subscribe to our free eNewsletter at www.nephronline.comGovernment issues softer EMR standardsBy Thomas KeatingLife in the 2010s may not be full of fly-ing cars or silver jumpsuits like we all envisioned. But at least you can send an electronic letter instantaneously from Mount Fuji to your friend sitting in a Japanese food restaurant in Hollywood. And of course, we can play the harmon-ica by blowing on our iPhones. But soon, it's the hope of the gov-ernment that doctors will universally embrace electronic health records to curb errors and save lives. In new rules issued July 13, doctors and hospitals who engage in the "meaningful use" of electronic health records will be eligi -ble for some extra bucks. And by 2015, those who don't will be fined. The Department of Health and Human Services said doctors and hos-pitals could receive as much as $27 bil-lion over the next 10 years to buy equip-ment to computerize patients' medical records. A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size. Starting in 2015, hospitals and doc-tors will be subject to financial pen-alties under Medicare if they are not using electronic health records. Donald M. Berwick, MD, who was sworn in July 12 as administrator of the Centers for Medicare & Medicaid Services, said electronic health records would lead to "better, smoother care, more reliable care." Even though American health care is known for the use of advanced tech-nology in treating patients, doctors and hospitals have been slow to replace paper records with electronic records. And the rules significantly scale back proposed requirements that the health care industry had denounced as unrealistic. "Only 20% of doc-tors and 10% of hospitals use even basic electronic health records," said DHHS Kathleen Sebelius. Richard J. Umbdenstock, the president of the American Hospital Association, said the final rules were an improvement over the proposal. But he said he was still concerned that a majority of hos-pitals could not jump over the hurdles to get federal aid. Ralph G. Brindis, MD, president of the American College of Cardiology, applauded the rules, telling The New York Times that they promised to "increase the quality of care while reducing cost." Cardiologists have been "early adopters" of electronic records, he said. David Blumenthal, MD, the nation -al coordinator for health information technology, told The Times that doc -tors and hospitals would be defaulting on their "professional responsibilities" if they did not use electronic medical records. Such technology can reduce medical errors, including mistakes that kill people, he said. The main criticism of the rules pro-posed by the Obama administration in January was that they took an "all or nothing" approach. Doctors could not have received any federal bonus pay-ments unless they met 25 criteria, or objectives, and hospitals would have been required to meet 23. Standards in the new rules are less demanding and more flexible. Doctors will have to meet 15 specific require-ments, plus 5 chosen from a list of 10 objectives. Hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals. Doctors, for example, will have to use electronic systems to record patients' demographic data (sex, race, date of birth); their height, weight and blood pressure; their medications; and their smoking behavior. To meet the new standards, doctors will have to transmit 40% of prescrip- tions electronically. Under the propos -al, 75% of prescriptions had to be sent electronically. "We are delaying some of the more ambitious requirements," Blumenthal said. He described the new standards as "ambitious but achievable" and said they would put doctors "on an escala-tor" toward full adoption of electronic records. Even pioneers in the use of elec-tronic records, like Kaiser Permanente, Intermountain Healthcare in Utah and the Partners HealthCare System in Boston had said they could not meet all the proposed standards. The final rules do not guarantee that doctors and hospitals can electroni -cally exchange clinical information on patients, but the rules do require health care providers to work toward that goalwidely seen as a way to improve the coordination of care and avoid the duplication of tests. Mr. Keating is NN&I's managing editor. HealthCareBeat_NN&I_0810_3.indd 14 7/15/10 2:54:10 PM