By Gregory Stolhand, Director of Informatics, Pentax Medical
As part of the American Recovery and Reinvestment Act of 2009, it was required that as of January 1, 2014, all public and private healthcare providers and other eligible professionals were to have adopted and demonstrated “meaningful use” of electronic medical records (EMRs) in order to maintain their existing Medicaid and Medicare reimbursement levels. The Act also includes financial incentives for healthcare providers who prove meaningful use of electronic health records (EHRs), a more comprehensive digital record that is the ultimate end-goal of the federal mandate. Meaningful use, as defined by HealthIT.gov, should achieve the following goals:1
- improve the quality, safety, and efficiency of care
- reduce health disparities, because EMRs will provide more consistent and standardized care from patient to patient
- engage patients and family
- improve how we administer care through better coordination
- maintain the privacy and security of patient health information
Physicians who either failed to adopt certified EHR/EMR systems or could not demonstrate meaningful use by 2015 were subjected to a 1% reduction in their Medicare reimbursements. This penalty will continue to increase in subsequent years: 2% in 2016, 3% in 2017, 4% in 2018, and up to 5%, depending upon future adjustments.2
Given this information, how successful have endoscopists been to date in meeting these guidelines? How far have we come, and how far do we have left to go?
Currently, recording of patient data for endoscopy procedures is achieved via two primary workflows, namely dictation and transcription after each procedure or through the use of an electronic reporting solution to document the case. The norm today is that the reports created capture the information statically, which results in the accumulation of data that is self-contained and cannot be searched, shared, or otherwise accessed and manipulated in any meaningful way. Therefore, although the process of moving toward achieving the bare minimum requirements of the mandate has begun, I would argue that the current state of EMRs does not truly measure up against the definition of meaningful use, and that it has not reached its full potential for quality, efficiency, or physician-friendliness.
As software technology advances alongside the technological and research advances of the medical industry, we are speeding at an exponential rate toward quality reporting in endoscopy that is searchable, sharable, minable, reportable, customizable, and interactive. Much like the exponential advances in computer technology, as evidenced by the fact that your smartphone is more powerful than the computers used to land Neil Armstrong and his Apollo 11 colleagues on the moon, the current needs of physicians and the endoscopy solutions required to meet their needs are leagues ahead of the situation that existed in 2009, when the mandate was conceived.
What the endoscopy industry needs now, and what is just recently being made available, are comprehensive specialty specific software solutions that enable physicians to perform many functions. Using these software solutions, physicians can view and customize their daily workload and schedule, as well as obtain quick access to patient records that can be easily searched based upon criteria such as patient name, facility, or procedure date. They can also facilitate the organization, labeling, and annotation of endoscopic images and videos captured during procedure and streamline procedure documentation. Only with such all-inclusive software approaches can we really approach the intended goal of meaningful use. It’s also worth noting that reimbursement benefits are not the only advantage associated with these more forward-looking solutions, as this technology also has the potential to capture data that can be analyzed by clinical systems to make smarter purchasing decisions (e.g., determining the volumes of consumables used on a monthly basis), render the sharing of patient data between departments and/or physicians seamless, and reduce the risk of human error in reporting.
Without a doubt, the EMR/EHR evolution has begun, and it will continue to play an integral role in successfully managing the transition to the more comprehensive reporting requirements of the future. However, one of the largest hurdles that endoscopists face in reaching the goal of full electronic data accumulation and management is the natural human tendency to resist change. Forward-looking solutions like these will mean that the workflows used to create quality reports will also need to change. While it’s easy to defend the way things have been done all along, if we refuse to change, then the path to change will be both difficult and disruptive.
As the mandate deadlines rapidly approach and subsequently pass, those who refuse to change will wake up one day to discover that the way in which they gather and manage data will no longer be acceptable. The new way will be the requirement, and they won’t be prepared. This begs the question: How confident are you in the data that is collected at your organization right now? The advantage of using endoscopy specific software, from my perspective, is that it can offer a high degree of confidence in your data, and it will result in the generation of high-quality endoscopy reports that will be advantageous in all the ways that have previously been mentioned, while providing the added bonus of meeting the standards needed for full reimbursement. Physician engagement with software developers is the key element that results in as smooth a transition as possible for hospitals, providers, and patients.