Meaningful Use: What About The Specialists?

By Ken Congdon, editor in chief, Health IT Outcomes

The more conversations I have with hospital CIOs, physicians, and vendor executives, the more I realize how challenging its going to be for many healthcare facilities to achieve EMR meaningful use. Most recently, Evan Steele, CEO of SRSsoft enlightened me to the plight of healthcare specialists in the meaningful use era.

Evidence suggests that the Stage 1 and Stage 2 quality measures for meaningful use largely overlook the needs of the specialist community. Every one of the six core clinical quality measures (and most of the 38 additional clinical quality measures) are focused on primary care. Moreover, the recently-formed, 24-member Quality Measures Workgroup (appointed by The HIT Policy Committee to analyze gaps in Stage 1 criteria) only includes two specialists — a hematologist and a psychiatrist.

Finally, in a recent position paper by Thomas C. Barber MD, EMR project team leader of the American Academy of Orthopaedic Surgeons (AAOS) stresses the problems specialist ambiguity in meaningful use criteria creates for the orthopaedic community:

"Orthopaedic surgeons will have great difficulty in meeting the current 25 Meaningful Use standards. Orthopaedics would derive greater benefits from standards promulgated by our medical specialty society rather than a set of generic requirements that mostly do not apply to musculoskeletal patient care."

So what makes specialty practices so different from primary care practices when it comes to leveraging EMR technology? And, what are the potential implications of not fully addressing the needs of the specialist community in current meaningful use definitions? I asked Mr. Steele these questions and got some interesting answers.

Specialists Have The Need For Speed
According to Steele, specialists differ from primary care physicians in three core areas — patient volume, patient mix, and revenue generation. "Most primary care facilities see 18 to 20 patients per day, many of which are follow-up visits," says Steele. "In fact, many primary care facilities close their practices to new patients to control volume. A typical specialty practice, on the other hand, sees an average of 50 to 60 patients per day, a large chunk of which are new patients."

Follow-up visits are typically easier to handle from an EMR perspective because patient data has already been entered into the system. New patients, on the other hand, require a new record to be created in the EMR system.

In addition to patient volume and mix differences, specialty practices also differ from primary care facilities in how they generate revenue. "Primary care physicians examine patients in their offices five days a week," says Steele. "What differentiates the economics of specialty practice is that their revenue is highly leveraged. They make most of their income in surgeries, procedures, and other tests—not in the office—but those procedures are generated from their office visits. The fact that they only spend limited time per week seeing patients in the office makes this time extremely valuable. Any reduction in the number of patients seen in the office reduces the number of procedures (and related revenue) in direct proportion."

According to Steele, most current EMR products being designed to meet the CCHIT's 467 largely primary care-focused criteria don't effectively address the unique demands of specialty practices. For example, many of these packages are note centric, requiring a fair amount of structured data entry from the physician.

"You'd be hard-pressed to find an ophthalmology or other specialty practice anywhere in the country where doctors in the practice are doing structured data entry," says Steele. "They just don't have the time."

Instead, specialists require EMR tools that focus on speeding up the data entry process through click minimization and features like chart review, e-prescribing, order creation and tracking, messaging, transcription sign on/off, and test result sign on/off.

Practice Efficiency & Productivity To Drive Specialty EMR Adoption
While Steele makes some excellent points regarding specialty oversights in current meaningful use legislation, I also can't fault the federal government for placing it's focus (for the time being) on primary care. Targeting incentives on this segment of the healthcare industry is arguably the fastest way to realize the desired cost-saving outcomes (i.e. improved chronic disease management, etc.). But, where does that leave the specialists?

According to Steele, rather than waiting on meaningful use incentives to be defined in line with specialty demands, specialists should begin evaluating specialty-focused EMR packages today — purely for the practice productivity and efficiency gains these technologies provide. "Any business that is run on paper is highly inefficient," says Steele. "When a specialist has access to a digital patient chart from anywhere at any time, they can start making real-time clinical decisions based on accurate and complete information, which improves the level of patient care while increasing productivity."

Effective EMR adoption can also translate to notable cost savings for specialists. Steele references an orthopaedic clinic in Central Florida that was able to cut 40 employees from its 260-person staff as a result of effective EMR adoption. These employees were employees that were formerly tasked with file management duties under the old paper system.

Effective EMR adoption for specialists means selecting a software package that addresses the unique demands of specialty physicians. Most EMR vendors will have a list of pre-cleared specialty references for you to call, but Steele warns that relying on these contacts may not provide you with a clear picture of an EMR package's true capabilities. Steele suggests calling other doctors within these reference sites to get comprehensive feedback on how an EMR package performs in a specialty environment. Better yet, specialists should do their own due diligence, asking their peers about the EMR software in use at their facilities and its effectiveness, rather than being led down a vendor's path.

Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at ken.congdon@jamesonpublishing.com.