QIO Support Accelerates Use of EHRs for Care Management

CMS and the U.S. Department of Health & Human Services’ Office of the National Coordinator for Health Information Technology (ONC) are targeting late 2009 to develop a proposed rule to implement Medicare and Medicaid electronic health records (EHR) incentive payment programs. The definition of HER meaningful use is a critical component of the criteria for incentive payments authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, a provision in the American Reinvestment and Recovery Act (ARRA). More information on the HIT provisions is available in this CMS fact sheet.

With an EHR system in place, physicians have better access to patient information, decision support and reference data. EHRs also enhance patient-physician communication, ultimately improving the safety and quality of care provided to Medicare beneficiaries. But while EHRs are rich in benefits, physicians and health care professionals often do not have the time or resources to fully integrate the systems into their practices.

The Indiana QIO, Health Care Excel (HCE), helped Southern Indiana Community Health Care (SICHC) move away from paper records during last QIO contract period. With HCE’s technical assistance, SICHC improved office efficiencies and patient care by implementing an EHR system. HCE staff worked with SICHC to assess its readiness to adopt an EHR, to select a system that met the non-profit family practice’s needs, and to make EHR use part of the clinical workflow.

As a result, said Janie Millspaugh, SICHC administrator, “We are on the cutting edge of technology. Here in Orange and Crawford Counties, we have an 89 percent EHR implementation rate—the state average is 25 percent.”

Now HCE, which provides a full spectrum of health care assessment and improvement services to healthcare providers, is assisting SICHC in maximizing its EHR system’s use for care management. HCE currently is helping automate electronic alerts for preventive services to identify patients who, for example, have not yet had their annual flu shot or mammogram.

The project is typical of the work that QIOs are performing under their current CMS contracts, which focus EHR support for primary care practices on improving rates of breast cancer and colorectal cancer screenings and influenza and pneumococcal vaccinations. Collaborative efforts like those of HCE and SICHE also have the benefit of preparing eligible professionals and hospitals to qualify for the Medicare incentive payments.

SICHC and HCE representatives recently met with a member of Senator Dick Lugar’s (R-IN) staff to communicate these and other positive outcomes of successful EHR use, including improved clinical documentation, better management of chronic illnesses, quality data reporting, and medication management.

“Our patients receive a list of their medications when they are in our waiting room and we ask them to update their list for us,” said Dr. Yolanda Yoder, a physician at SICHC’s Paoli location. “When the patient leaves, an updated printout of their medication list is given to them that include instructions on dosage, when to take the medication, and when to call the doctor if they need assistance. This process is very helpful to patients and caregivers—it allows patients to have a current list of medications to carry with them should they ever need it. It also informs any specialty physicians the patient may see.”