Meaningful Use and Radiology: Fully Certified Versus Modular Approaches
“Why make your RIS into an electronic health record (EHR) just to satisfy meaningful use?” David Avrin, MD, PhD, asks. It is a question that Avrin, professor of radiology and biomedical imaging at the University of California–San Francisco, has been asking (in one form or another) since the government’s program to provide incentives for the use of health IT launched. “There are people who have taken feeds from various systems into their modular-certified RIS platforms,” he continues, “and they have HL7 feeds coming in from every direction. Even though a RIS vendor may have the best intentions in creating a modular system, you’re still responsible for the other components.”
This approach poses multiple problems for the typical radiology practice, Avrin says, including cost and timeliness. Vijay Ramanathan, CEO of RamSoft, concurs. “We provide our solutions to all sizes of radiology settings,” he notes. “With all shapes and sizes of customers, you’re dealing with some people who have their own IT departments and some who don’t. When you’re dealing with a customer who is lacking in internal IT expertise, cobbling together multiple modular-certified solutions to meet the objectives of meaningful use becomes impossible.”
Time’s Running Short
With little time remaining to capitalize on the ever-shrinking incentives of the meaningful-use program, speed will be of the essence for radiology practices that want to get started without being penalized. “The clock is ticking,” Avrin says. “The incentives keep shrinking. What we are currently seeing is very little adoption of technology to get meaningful-use incentive payments by traditional radiology practices, and I don’t think the modular approach helps that.”
Ramanathan echoes Avrin’s sentiments, noting that the complexity, time commitment, and potential expense of combining modular-certified solutions might outweigh the financial benefits of program participation. “You have to factor in the labor involved to make this work,” he says. Ramanathan compares the issue to that of whether to purchase a separate RIS and PACS or a fully integrated solution: “Many facilities that are looking at acquiring a RIS and PACS are looking at acquiring a single platform, for the same reason,” he says. “Once you factor in the cost of supporting multiple products—getting them integrated and knowing whom to call when something needs troubleshooting—it kills any savings you would have had from purchasing them separately.”
Further, Ramanathan says, the complexity of the modular-certified approach might push currently nonparticipating practices past the point where they can receive incentive dollars. “A lot of radiology groups have delayed participating in meaningful use, and we’re getting to a point where it’s now or never,” he says. “If you’re going to do it, you need to do it now, and you don’t want to be delayed.”
Next Year’s Outlook
The need for radiology practices to participate might become more dire in just as a few months. As Avrin points out, the introduction of stage 2 of the meaningful-use program made sharing of information a key focus: “There was no significant implementation of sharing of data in stage 1, other than electronic prescribing,” he notes. “That means that the sharing of data drifted forward to stage 2.”
For that reason, radiology practices might not yet be feeling the pressure from their referring physicians to participate, but they will in 2014, Ramanathan predicts. “Imaging, as a key part of the interaction among referring physicians, laboratories, and imaging centers, was introduced in stage 2 and will probably be further entrenched in stage 3,” he says. “We’ll end up in a situation where referring physicians may start to refer patients to facilities that demonstrate meaningful use because it will make it that much easier for them to achieve it themselves. Ultimately, if they are going to get all the information into their EHRs, they will want to do business with imaging facilities that will give information back to them in the manner they need.”
The majority of participating facilities will hit stage 2 at the end of 2013 or the beginning of 2014, Ramanathan estimates—and that group includes hospitals and health systems. “The other consequence of this is that many hospitals have implemented meaningful use,” he says. “Outpatient imaging centers need to jump on board—or soon, they will be at a disadvantage, when compared with the local hospital.”
Base Versus Complete EHRs
There is one bright spot on the horizon for the modular-certified approach, according to Keith Dreyer, DO, PhD, vice chair of radiology at Massachusetts General Hospital in Boston and coauthor of The Radiologist’s Guide to Meaningful Use.¹ Dreyer notes that among the September 2012 changes to the meaningful-use program’s regulations was the distinction between a base EHR and a complete EHR. The criteria proposed for a base EHR include patients’ demographic and medical-history information, clinical decision support, computerized provider order entry, the ability to capture and query quality information, the ability to capture electronic health information from other sources, and the ability to maintain the privacy and security of health information.
“With these changes comes the ability for an eligible provider to use less than the complete technology, but still be compliant,” Dreyer says. The change will come too late, however, for eligible providers, including radiologists, to make the most of meaningful-use incentive dollars. “What’s the point of doing this if you’re going to do it too late to get the incentives?” Ramanathan asks. “There are other motivations for early participation, but the money is a big one. The program will take some time to trickle down into the referring and hospital communities—but not a lot of time. Radiology groups don’t want to be left alone when the number of organizations doing this tips over into the majority.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.
This approach poses multiple problems for the typical radiology practice, Avrin says, including cost and timeliness. Vijay Ramanathan, CEO of RamSoft, concurs. “We provide our solutions to all sizes of radiology settings,” he notes. “With all shapes and sizes of customers, you’re dealing with some people who have their own IT departments and some who don’t. When you’re dealing with a customer who is lacking in internal IT expertise, cobbling together multiple modular-certified solutions to meet the objectives of meaningful use becomes impossible.”
Time’s Running Short
With little time remaining to capitalize on the ever-shrinking incentives of the meaningful-use program, speed will be of the essence for radiology practices that want to get started without being penalized. “The clock is ticking,” Avrin says. “The incentives keep shrinking. What we are currently seeing is very little adoption of technology to get meaningful-use incentive payments by traditional radiology practices, and I don’t think the modular approach helps that.”
Ramanathan echoes Avrin’s sentiments, noting that the complexity, time commitment, and potential expense of combining modular-certified solutions might outweigh the financial benefits of program participation. “You have to factor in the labor involved to make this work,” he says. Ramanathan compares the issue to that of whether to purchase a separate RIS and PACS or a fully integrated solution: “Many facilities that are looking at acquiring a RIS and PACS are looking at acquiring a single platform, for the same reason,” he says. “Once you factor in the cost of supporting multiple products—getting them integrated and knowing whom to call when something needs troubleshooting—it kills any savings you would have had from purchasing them separately.”
Further, Ramanathan says, the complexity of the modular-certified approach might push currently nonparticipating practices past the point where they can receive incentive dollars. “A lot of radiology groups have delayed participating in meaningful use, and we’re getting to a point where it’s now or never,” he says. “If you’re going to do it, you need to do it now, and you don’t want to be delayed.”
Next Year’s Outlook
The need for radiology practices to participate might become more dire in just as a few months. As Avrin points out, the introduction of stage 2 of the meaningful-use program made sharing of information a key focus: “There was no significant implementation of sharing of data in stage 1, other than electronic prescribing,” he notes. “That means that the sharing of data drifted forward to stage 2.”
For that reason, radiology practices might not yet be feeling the pressure from their referring physicians to participate, but they will in 2014, Ramanathan predicts. “Imaging, as a key part of the interaction among referring physicians, laboratories, and imaging centers, was introduced in stage 2 and will probably be further entrenched in stage 3,” he says. “We’ll end up in a situation where referring physicians may start to refer patients to facilities that demonstrate meaningful use because it will make it that much easier for them to achieve it themselves. Ultimately, if they are going to get all the information into their EHRs, they will want to do business with imaging facilities that will give information back to them in the manner they need.”
The majority of participating facilities will hit stage 2 at the end of 2013 or the beginning of 2014, Ramanathan estimates—and that group includes hospitals and health systems. “The other consequence of this is that many hospitals have implemented meaningful use,” he says. “Outpatient imaging centers need to jump on board—or soon, they will be at a disadvantage, when compared with the local hospital.”
Base Versus Complete EHRs
There is one bright spot on the horizon for the modular-certified approach, according to Keith Dreyer, DO, PhD, vice chair of radiology at Massachusetts General Hospital in Boston and coauthor of The Radiologist’s Guide to Meaningful Use.¹ Dreyer notes that among the September 2012 changes to the meaningful-use program’s regulations was the distinction between a base EHR and a complete EHR. The criteria proposed for a base EHR include patients’ demographic and medical-history information, clinical decision support, computerized provider order entry, the ability to capture and query quality information, the ability to capture electronic health information from other sources, and the ability to maintain the privacy and security of health information.
“With these changes comes the ability for an eligible provider to use less than the complete technology, but still be compliant,” Dreyer says. The change will come too late, however, for eligible providers, including radiologists, to make the most of meaningful-use incentive dollars. “What’s the point of doing this if you’re going to do it too late to get the incentives?” Ramanathan asks. “There are other motivations for early participation, but the money is a big one. The program will take some time to trickle down into the referring and hospital communities—but not a lot of time. Radiology groups don’t want to be left alone when the number of organizations doing this tips over into the majority.”Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.