Means to an End
How do radiologists stand to benefit from the next stage of meaningful use?
It's a common experience: a patient walks into a doctor's office for the first time. The assistant tells her to fill out medical forms before the physician can see her. Then the doctor refers her to a specialist's office, where she is met with reams of paperwork to complete.
Dissatisfied with the specialist's diagnosis, she seeks out a second opinion and, again, is required to submit documentation asking for the same information all over again.
These inefficiencies arise from, among other things, the fact that there is no commonly adhered-to, one-size-fits-all format for doctors to exchange health records. In addition, the interpretation of record formats and standard varies widely. Providers who use electronic health records (EHRs) often create documents written in different formats with different communication protocols that cannot be accessed by others along the health-care chain. In addition, most patients do not have access to their own health-care records, relying on providers to keep their records up-to-date for them.
In an effort to solve these problems, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act as a component of the American Recovery and Reinvestment Act of 2009. CMS and the Office of the National Coordinator for Health IT (ONC) administer the Medicare/Medicaid EHR Incentive Program, which is better known as meaningful use (MU). MU offers financial incentives to both eligible professionals (EPs) and hospitals to invest in and demonstrate that they can "meaningfully use" certified EHR technology (CEHRT) to improve patient care.
Changes from Stage 1
In MU Stage 1, CMS used these financial incentives to induce EPs and hospitals to invest in certified EHR technologies. Now, in Stage 2, the focus is on using CEHRT to facilitate the successful exchange of patient information among health-care providers. This emphasis on sharing information is intended to improve quality and efficiency. Keith J. Dreyer, DO, PhD, FACR, chairman of the ACR Informatics and IT Committee, vice chairman of radiology at Massachusetts General Hospital in Boston, and associate professor of radiology at Harvard Medical School, believes that the ultimate goal of MU is to create a more user-friendly experience for patients. "The MU program attempts to better define and regulate the EHRs and, as health-care providers, our use of them," he says.
In pursuit of this goal, a few Stage 1 objectives — requirements that must be satisfied in order to complete the stage — have been modified in Stage 2. The changes are designed to, as CMS puts it, encourage providers to "demonstrate meaningful use of their certified EHR technology for an even larger portion of their patient populations." For one of the modifications, CMS states that EPs must now use "secure electronic messaging to communicate with patients on relevant health information." The organization believes objectives like this will enhance patient care and safety as well as encourage patients to feel more invested in their own health care.
Michael Peters, director of legislative and regulatory affairs for ACR's Government Relations and Economic Policy Department, poings out that through MU, "policymakers and regulatros want to enable patients and their providers to have secure access to their health-care data, just like how many people electronically access their own finances, communications, and other data in today's connected world." The Stage 2 emphasis on ease of information sharing among providers and patients is intended to bring the health-care industry closer to this vision.
How Do Radiologists Fit In?
Since Stage 2 MU objectives were composed for all physicians regardless of specialty or subspecialty, many radiologists feel that the objectives do not have direct relevance to what they do on a day-to-day basis. This has led some in the specialty to feel they have been left out of the equation. Although providers can qualify for exclusions from several of the objectives if they have no way of satisfying them, the hefty costs involved with investing in certified EHR systems cause many professionals to wonder if MU is worth the trouble even if they do qualify.
One point of contention derives from the fact that for years, radiologists have been at the forefront of health information technology. But when it comes to MU, many providers do not see criteria that offer rewards for having been so forward-thinking. David E. Avrin, MD, PhD, FACR, vice chairman of informatics and professor of clinical radiology at the University of California San Francisco Medical Center, characterizes the sentiment like this: "Radiologists have been leading the pack in information technology for the last two or three decades. But now CMS is going to penalize the specialty for not being meaningful users of health information technology because we don't do things like weigh patients, counsel them on smoking, and do e-prescribing."
But where some providers see stumbling blocks, others, like Rasu B. Shrestha, MD, MBA, vice president of medical information technology at the University of Pittsburgh Medical Center, see opportunities. According to Shrestha, although MU should have addressed workflows more specific to radiology, most radiologists are indeed considered eligible providers under the MU program. He points out that "radiologists work hand-in-hand with technologists to set imaging protocols that include items like active medication allergy lists." In other words, employees within practices and hospitals are often already collecting data that can satisfy some MU objectives. However, he notes, many professionals don't think about these criteria as meeting MU requirements.
Curtis P. Langlotz, MD, PhD, vice chair for informatics in the radiology department at the University of Pennsylvania in Philadelphia, says that although it would have been ideal if CMS had included more criteria that were directly relevant to radiology, he understands where the agency is coming from. "The current MU regulations are targeted at physicians who see patients in a clinic," he says. "That is the logical place to start because the majority of physicians practice that way and CMS wants to maximize the overall quality improvement for their investment." The problem for many is that radiologists don't typically practice in what Langlotz calls "clinic mode."
Putting Patients First
One of the main objectives of the MU program is to encourage patients to take a more active role in their own health care. Dreyer points to patient portals as a way for radiologists to engage with this objective. "There are numerous patient portal solutions available for patients to access their medical records," he says. "These are mainly provided by health-care providers through their EHR vendors, while others come from entities such as Microsoft."
Avrin also supports the notion of patient portals as a positive step. Through his work with the RSNA Image Share project, a network that allows radiologists to share medical images with patients through personal health record (PHR) accounts, Avrin has urged patients to participate more in their own health care. "We're in favor of patient portals, as well as patients being able to schedule their own exams and receive reports on imaging studies over the Internet."
CMS and ONC agree that such portals are integral to positive patient care. For Stage 2, one of their priorities was patient engagement, says Peters. "One Stage 2 MU objective requires a certain percentage of physician's patients to have interaction with their data outside of the clinical environment. Another Stage 2 MU objective requires a certain percentage of patients to send secure messages to the physician. With these two examples, CMS clearly wants physicians to promote their EHR technology's online capabilities to their patients in the hope that patients will log in from home to access information and engage in secure messaging."
The meaningful use of CEHRT is also just one component of a wider effort within the health-care industry to lower costs. By reducing the number of duplicative medical reports and giving patients more ownership over their health, CMS and ONC are striving to make health care more affordable. Although it may not always be easy to connect the dots, many radiologists believe that they have an important role to play in this new paradigm.
By Chris Hobson