In early May, the ACR® submitted comments to CMS and the Office of the National Coordinator (ONC) for Health IT on the proposed rules¹ for stage 2 of the meaningful-use incentive program. The proposal from the federal agencies, released March 7, is much more inclusive of radiology than the rules for stage 1 were, with new objectives that include making imaging results and information accessible through certified electronic health record (EHR) technology. In its comments, the ACR applauds the ONC and CMS for pushing for this level of access, while recommending that the ONC familiarize itself further with the Web Access to DICOM Persistent Objects part of the DICOM standard.
Vijay Ramanathan, president and CEO of RamSoft Inc, notes that adherence to standards is much more than a component of the meaningful-use program: It is the program’s overall goal. “The one real, solid objective of meaningful use is to establish certain common standards for all health-care software,” he says. “By establishing these common standards, with each future stage of the program, they’re going to increase the ease of communication between different systems. With strict standardization and certification, we could end up with a plug-and-play environment.”
Stage 2 and Beyond
Until the rules for stage 2 are finalized, Ramanathan says, the stage 2 timeframe is nebulous, but it will not include deadlines this year (or next year). “It’s going to take the better part of 2012 and 2013 for the majority of physicians to achieve stage 1,” he notes. “The goal of the meaningful-use program is not to get a small percentage of people qualifying through all the phases, but to get the majority of people moving forward, one phase at a time.”
By positioning the full spectrum of health-care providers, including physicians in outpatient offices, to exchange information in a standardized and secure fashion, the meaningful-use program sets the stage for emerging models of health-care delivery, Ramanathan adds. “What’s in place today means that hospitals end up with much more advanced infrastructures than outpatient offices have—because hospitals can dictate who uses what software program and database, and they can share information easily,” he says.
For now, he says, radiology practices should avoid the trap of worrying so much about the stage 2 requirements that they ignore their needs for stage 1. “Nobody really knows what stage 2 will look like yet,” he notes. “Stage 1 is what’s real today. People are receiving money right now for achieving it. To the professional associations, it’s important to get involved in drafts of future standards in order to help shape them, but radiology practices should avoid being so concerned over stage 2 that they are reluctant to implement stage 1.”
Radiology Needs
Ramanathan is not certain that radiology groups and departments fully understand their obligations, when it comes to meaningful use. “We’re much further along than we were a year ago, which is to say that many radiologists and radiology groups have now heard of meaningful use,” he says. There is some awareness, he explains, but how it applies to them is something about which many practices are still learning. He adds, “Meeting these standards will take some time.”
While RIS platforms can achieve modular certification through the ONC, enabling radiology groups to combine data aggregated by their RIS software with data aggregated in EHR software at hospitals or referring physicians’ offices, Ramanathan does not recommend this approach. “From a practical standpoint, unless you have a very savvy IT person, it is very difficult to cobble together products with modular certification and qualify for the funding,” he says. “For a typical radiology imaging center, there may be some in-house IT expertise, but many are using outsourced IT. For that reason, it’s very difficult to qualify for the incentives without a complete, certified EHR.”
With that in mind, Ramanathan says, RamSoft updated its RIS to meet all the criteria of a complete EHR and had it certified by the ONC as such. “We decided to create a solution with which the typical outpatient imaging center would be able to qualify for the incentive,” he says. “We can provide a single-platform solution that covers its core business needs—including RIS, PACS, report distribution, and billing—while qualifying for the government funding.”
The RamSoft RIS platform can record patients’ vital signs (including blood pressure), height, weight, and other health measurements not normally tracked in a radiology setting. “We had things to implement that we don’t expect anyone to use because radiologists can exempt themselves from tracking that information,” he says, “but we decided it was worth it to make the qualification process as easy as possible for our customers.”
Looking Forward
In the future, Ramanathan believes, radiology groups will need to be more IT savvy to survive than is currently typical. He notes, “The requirements and objectives of meaningful use are so technical and cryptic that I don’t see how somebody without an IT background could make heads or tails of them. With the direction in which all of this is headed, we’re really reaching a point where a CIO position is becoming a requirement for any radiology practice.”
For those groups without this level of IT expertise, Ramanathan notes, using hosted solutions is an alternate path to meeting the new standards. “We can deliver our software through a conventional model or a hosted model, and that is very conducive for a facility that lacks the in-house IT expertise (but wants the same caliber of infrastructure),” he says. “A lot of people don’t realize that meaningful use makes no distinction as to whether you purchase the software or rent it. All you have to do is make use of the software to get the incentives.”
By democratizing the ability to use this sophisticated infrastructure, meaningful use stands to make life much easier for radiology groups, Ramanathan concludes. “Realistically, an imaging center cannot build a custom HL7 interface with every referring physician’s office,” he says. “In the long run, if imaging centers are to be able to deliver reports that can end up in every referring physician’s EHR, there needs to be a plug-and-play standard, and that’s what meaningful use establishes.”
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.