Making the Transition The Ongoing Evolution of Electronic Health Records

Over the past few years, many developments have taken place in the area of Electronic Health Records (EHR). Those that are on the market have become more user-friendly, while also incorporating greater functionality and security. One fact still remains, however: Many physicians and medical practices in this region have been reluctant to make the switch.

This article will help to provide some insight into the benefits of making such a transition, as well as some of the recent developments in this area.

Impacting Legislation

While not fully known by many, Gov. Deval Patrick signed into law legislation requiring that all physicians become competent in using EHR and other health care IT by Jan. 1 of 2015. Accordingly, physicians will need to demonstrate such competence before their medical license will be renewed. The Board of Registration in Medicine is currently working on the criteria that will be necessary to demonstrate that they are competent for this renewal.

The other significant piece of legislation that all physicians should be aware of is the American Recovery and Reinvestment Act of 2009. This legislation includes a provision for providers who meet certain criteria to be eligible for up to $44,000 under the Medicare incentive program and for up to $63,750 under the Medicaid incentive program. To be eligible, users must ensure that their EHR system has been certified and that they meet various ‘meaningful use’ measures. Stage one of this incentive program began this fiscal year, with payments expected to begin as early as May of 2011.

Additionally, those practices and physicians that do not transition to using a certified EHR platform run the risk of having their Medicare and Medicaid funding cut beginning in 2015.

Pieces Coming Together

Many of the pieces of this complex incentive program puzzle are now starting to come together. As of Jan. 3, 2011, physicians were able to log in and register for this program on the Centers for Medicare and Medicaid Services (CMS) Web site. For those that plan to take advantage of this incentive program, the sooner that you are registered, the better. The reason for this is that as early as April 18, 2011, CMS will allow physicians to demonstrate ‘meaningful use’ through their “EHR Incentive Program Registration and Attestation System.”

Attestation for the first year of the program, 2011, will allow providers to respond to a series of ‘point and click’ inquiries. In 2012 and beyond, this will not be sufficient. Providers will then be required to submit documentation supporting that they have met each of the measures.

One concern that has been expressed by the medical industry as a whole is that physicians are currently required to register and administer this process on their own. In May, CMS is expecting to roll out an initiative allowing physicians to designate a third party to administer this process on their behalf. To do so, the physician will be required to log in initially, and once every year thereafter, to designate the third party that they wish to have administer the program. Until this is rolled out, however, it is not allowable for third parties to perform these tasks, because you would need to provide them with your user ID’s and passwords, which could constitute a breach of security.

Stage two of the ‘meaningful use’ provisions of the program is currently in process. While the final rule, which is expected by July of 2011, will likely tone down the requirements, the overall anticipated effect is that each of the measures will be more difficult to meet. Specifically, they do not anticipate adding new measures, but plan on increasing the requirement percentages to meet those existing measures and also moving some of those measures that are elective under stage one to core required measures in stage two, which is expected to be fully implemented by 2013, with the final stage-three measures to be implemented by 2015.


Since coming out in 2009, there have been a number of questions posed to CMS regarding the new incentive programs. These items have been accumulated, and as of March 18, 2011, were uploaded to the CMS Web site in the form of a ‘Frequently Asked Questions’ section. This has been broken down into different categories, such as eligibility, registration and attestation, certification, and meaningful use, among others, for ease of navigation.

Overall, the recommendation would be to not wait. Recent surveys, such as those performed by the Medical Group Management Association (MGMA) indicate that those trying to meet the initial requirements of the CMS incentive program are having difficulty meeting one or more of the core measures. Based on the results of this MGMA survey, the three most difficult to meet at this point include 1) “Implement Clinical Decision Support Rules,” 2) “Electronically exchange key clinical information,” and 3) “Report ambulatory clinical quality measures.” In each instance, less than 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of respondents believed that their current EHR system allowed them to meet the measure.

EHR appears here to stay. For those physicians that plan on remaining in practice beyond 2014, it is something that should be looked into as soon as possible. If not taken seriously, there is a risk of not being able to practice medicine or of having your Medicare and Medicaid reimbursements cut. For further information on those benefits that await you, should you begin the transition early, please refer to the CMS web site at

James Krupienski, CAP, is senior manager in the Audit and Accounting Division at Meyers Brothers Kalicka; (413) 536-8510.