Electronic Health Upgrade on Arkansas Medical News Inc.

Electronic Health Upgrade

By: LYNNE JETER

AFMC Helping Providers Meet Meaningful Use Requirements

Since mid-August, Jonathan Fuchs and the staff of HITArkansas—the Regional Extension Center (REC) for Arkansas and a division of the Arkansas Foundation for Medical Care (AFMC)—have traversed the state, hosting a dozen regional meetings for more than 500 providers and their office staff to discuss how AFMC and HITArkansas can help providers meet meaningful use requirements for electronic health records (EHRs) and receive funds from the ARRA stimulus program.

As of Sept. 10, 756 Arkansas primary care providers (PCPs) had submitted preliminary applications, representing about 260 individual practice locations. Fifty-eight providers had signed provider service agreements—the formal contract between the provider and the REC released earlier in the month. By mid-September, the REC staff had completed 88 provider visits to follow up with those agreements.

“By December 2011, we have an obligation to have 1,280 eligible providers signed, with certified EHRs installed or upgraded, and help eligible providers across the finish line to meet the meaningful use guidelines,” said Fuchs, COO of AFMC. “We’re on a roll and there’s a lot of excitement and interest—by all parties—as we go into providers’ offices.”

Medical News of Arkansas spoke with Fuchs about the daunting task ahead.

Share with us the different types of providers, as AFMC categorizes them for this task.

There are three different provider categories: those who have no experience in EHR or are just thinking about purchasing a system; those who already have a system and are learning to use it effectively; and those more experienced providers who have been using the system for many years. Each category of providers has different needs and the REC will offer the technical services to assist each of these provider categories.

Tell us about the certification process for vendors.

Many EHR vendors went through a previous certification process, but for purposes of this program, the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services (CMS) has a new certification program. CMS announced at the end of August the initial two organizations that are going to provide the new certification—The Drummond Group and the CCHIT group. By the end of September, at least CCHIT planned to make a preliminary announcement of vendors that are deemed certified. There may be three or four more organizations that provide this certification, but these are the first groups authorized to provide EHR vendor certification.

In July, the REC released a Request for Proposal (RFP) to EHR vendors. We’re in the process of reviewing responses and by the end of September will release the preferred, supported vendors, which we’ll post on our website: www.hitarkansas.com.

What is the significance of a preferred “supported” vendor?

‘Supported’ means our staff will be very knowledgeable about the selected vendors; there will be a vetted, master contract with protections for providers if the vendor does not meet certain installation milestones; and there will be a negotiated price. If the provider chooses a vendor not on the list instead of one of the vetted vendors, of course we’ll provide technical services, but there wouldn’t be a guaranteed price or a guaranteed vendor contract. The provider would be on their own for negotiations in that circumstance. For those providers with an existing EHR system that is upgraded to a certified EHR system, we’ll also provide the technical support to enable the provider to achieve meaningful use.

The formal RFP process was coordinated through the auspices of the Arkansas Medical Society (AMS), which nominated the majority of proposal reviewers and hosted the meetings for the review of the proposals. This provided an arm’s length perspective. It should be stated that neither AFMC, the REC or AMS have financial interest with any of the vendors, nor will we receive any remuneration upon selection by the REC or an eligible provider.

What specifically is—and is not—your role in the EHR transition process?

Very importantly, we aren’t in the business of selling or reselling EHRs. We’re not in the business of selling the hardware or software. We’re simply negotiating contracts between providers and vendors.

We are in the business of providing technical support and will augment vendor installation activities. We’ll be the project manager, if you will, of the vendor-provider implementation. We will be providing the preliminary implementation activity—the work/flow analysis and helping the provider get ready for the EHR implementation, for example. We’ll be working side by side with the vendor, making sure the steps are being met for the implementation timeline. We will also provide post-implementation support and assist providers to use these systems more effectively. At the end of the day, we want to get the provider across the finish line so that they can achieve the meaningful use requirements. Particularly for those providers with existing EHR systems needing upgrades, the post implementation support to achieve meaningful use would prove to be most helpful.

What exactly does being certified for meaningful use requirements represent?

First, providers must implement, adopt, or upgrade to a certified EHR system. Second, that the provider’s system has the ability to send and receive data. We recognize that regional health information exchanges (HIEs) don’t exist yet in many areas, and that it may be a year, possibly two, before a statewide HIE system is available. We also recognize there are a number of regional HIEs being used by some of the larger hospital systems so we can test these systems to communicate with these hospitals or with pharmacies, laboratories and such. Third, providers must meet meaningful use criteria. For an EHR system to be certified, the software has to produce a report on the 15 core provider-centric meaningful use criteria and additional quality components.

Regarding certification in general, initially Medicare and Medicaid will require the attestation by signature of the eligible provider that the provider has met the three components of the meaningful use criteria. Medicare has not defined formally (at press time) the actual process. Maybe it will be electronically or the doctor may have to send a report somewhere, perhaps to the REC for documentation.

With Medicaid, the state has submitted a State Medicaid Health Plan to CMS for approval. This plan supports the use of the REC to provide the validation for these criteria. Providers are not required to use the REC to be certified or validated. They can do that independently. However, providers may be subject to an external third-party audit, duplicative of the activities of the REC. The key point: while it’s not required to use the REC to get certified or validated, it’s strongly recommended, particularly with all the added technical support provided by the REC relating to meaningful use criteria.

What else will the provider need to do, regarding the certification process?

The provider will have to fill out information on a national Medicare database, which will be transferred to a state Medicaid database. The provider will need to answer a few additional questions there; Medicaid will then run the information through its systems and produce a report that says the provider meets the eligibility criteria for Medicaid. The REC will help the provider complete these documentation activities for Medicare and Medicaid.

When will providers have the ability to make information available to the Medicaid system?

Not until April 2011. Payments are expected to begin as early as May 2011, pending approval of the state’s Medicaid Incentive plan. I want to emphasize that I don’t speak for Arkansas Medicaid.

The first wave of certification for meaningful use criteria is for priority primary care providers (PPCPs) only, correct?

Actually both primary care and specialists are eligible for ARRA stimulus monies. The REC grant is to provide funding for the technical support of priority primary care providers. We are not given money by the federal government for technical support for specialists at this time. However, HITArkansas would be pleased to work with specialists on a separate consulting basis. Our priority activity, though, is directed to PPCPs. I would encourage providers to visit our website, www.HITArkansas.com, for the latest information and complete a preliminary application so that a no-obligation visit can be scheduled. This is a time-limited opportunity and funding support and/or maximum ARRA monies start to decrease after December 2011.