Adoption and use of Electronic Health Records (EHRs) nationally and globally is becoming a reality. There can be little doubt that EHRs improve health care decision making, maximize patient outcomes and greatly ease the sharing and exchange of health care information and critical data by and among health care providers.
The national Health Information Technology for Economic and Clinical Health Act (HITECH), enacted as part of the 2009 American Recovery and Reinvestment Act (ARRA), mandates certain timelines for the adoption, implementation and “meaningful use” of EHRs by a large segment of the nation’s health care providers. The Act also sets forth significant and substantial monetary sanctions (among other penalties) for those covered providers who do not achieve the “meaningful use” benchmark by certain dates. It also seems clear that all health care payers (plans, HMOs, Carriers, IDSs and self-insureds) will require participating providers to achieve meaningful usage. In such a setting it is imperative that those practices and providers who have not yet done so, begin an EHR conversion and implementation program.
The HITECH act has set aside a pool of funds to subsidize, incentivize and facilitate conversion to EHR systems by medical providers. The Act also establishes a nationwide network of Regional Extension Centers to help health care providers and group practices convert to and operate EHR systems that are federally compliant. The federally designated Regional Extension Center for New Jersey medical providers is NJ-HITECH (New Jersey Health Information Technology Extension Center). NJ-HITECH is located on the campus of the New Jersey Institute of Technology (NJIT) in Newark, New Jersey.
NJ-HITECH is a “one-stop” resource and support center to be used by New Jersey health care providers in the planning, selection, design, implementation and “meaningful use” of EHR systems.
NJ-HITECH provides no-cost consultation, technical assistance and a platform of supportive services to health care providers and their staffs as they implement EHR systems for their practices. The goal is to accelerate provider adoption of EHR systems and help providers achieve “meaningful use” status as quickly as possible. Once achieved, “meaningful users” qualify for federal incentive payments — up to $44,000 for Medicare providers and $63,750 for Medicaid providers. There is a modest subscription fee of $500 per year/per practice/per location (regardless of the number of providers), which is not payable until 6 months after NJ-HITEC does the practice assessment. This fee is used to meet the 10% matching funds requirement mandated by HITECH and will usually occur when the provider is in receipt of incentive funds.
The following summary describes the range of services that NJ-HITECH furnishes to its participating providers and what the participating provider can expect from partnering with NJ-HITECH.
Agreement: at the heart of NJ-HITEC is the “Participation Agreement” between NJ-HITECH and the health care provider. The agreement allows the staff and contractors at NJ-HITECH to give the provider the following services: EHR education, vendor selection and group purchasing plans, EHR implementation and project management, practice and workflow redesign, privacy and security best practices, on-going and expert assistance in achieving “meaningful use” status and its application in the practice of medicine.
Education and Training: NJ-HITECH will share its knowledge with the provider about the selection and implementation of EHR technology and systems to optimize the quality and value of health care delivery and to achieve “meaningful use” status. NJ-HITECH will provide and furnish educational materials and conduct training workshops and seminars for its participating providers and their support staff. NJ-HITECH also makes available to its providers web-based tools and portals for ongoing support and assistance.
Practice Assessment and Vendor Selection: NJ-HITECH assists and consults with participating providers in assessing their EHR needs and in the selection of an appropriate and affordable NJ-HITECH Approved Vendor. If selected, the Vendor will provide and implement EHR technology and systems for the provider’s health care practice.
Workflow Assessment and Redesign: NJ-HITECH furnishes support and assistance to its participating providers and their Approved (EHR) Vendors to maintain ongoing EHR workflow assessment and redesign to continually and expeditiously move the practice toward achieving “meaningful use” status. NJ-HITECH helps the provider and its vendor move toward the achievement of the following: implementation and troubleshooting of EHR systems; consistent documentation of essential clinical information in structured formats; electronic administrative transactions, prescribing, laboratory ordering and tracking results and the sharing of key data across practice settings; providing patient access to their health care information; public health reporting; assuring the privacy and security of legally protected health care information.
Privacy and Security Best Practices: NJ-HITECH believes that the full potential of EHRs to improve health-care quality and reduce costs can only be mastered when patients and providers fully trust that EHR systems will protect and secure the privacy and confidentiality of their health care information and data. To that end, NJ-HITEC makes available to its participating providers a full range of supportive services to optimize the privacy and security compliance aspects of their EHR systems. These services include education, consultation and technical assistance for the following: compliance with applicable federal and state laws, rules and regulations; implementation and maintenance of physical network security, access controls, disaster recovery, encryption and storage by backup media and systems; staff training in privacy and security policy, practice and protocols; assuring the privacy and security of all medical information share and exchange media and related issues and services.
Project Management Services: NJ-HITEC can provide ongoing project management support throughout the entire EHR implementation process. Such services can include: individualized coaching, consultation and troubleshooting; assessing and achieving a health care practice’s “readiness” for EHR conversion; locating and remediating “gaps” in an EHR system infrastructure that impede smooth data flow and delivery; configuring EHR software to meet a particular practice’s needs; providing software training for a practice’s staff; monitoring adherence to project timelines for the achievement of “meaningful use” status. In certain instances, with the consent of the provider, NJ-HITEC can “general contract” the project and only dispense funds to vendors and consultants when these satisfy their contractual obligations.
“Go Live” status: “Go live” status is the first benchmark on the road to “meaningful use” status. A practice reaches “go live” status when its main and major health information collection, storage and exchange system is an approved EHR system that is up and operational. At this point, NJ-HITEC will continue to work with the practice staff in obtaining optimal efficiencies, quality and economies from their EHR systems and in insuring that health care services are delivered in an organized and professional manner. Simply stated, the provider must use the EHR system to improve the quality of health care delivery and to adequately record those facts so as to qualify for receipt of the incentive payments.
Consumer Protections: NJ-HITECH seeks to ensure that providers get all that they pay for from vendors and from consultants. To that end, NJ-HITEC is uniquely situated in the health care public and private marketplace to provide a “neutral” space for the efficient resolution of such disputes if they occur.
“Meaningful Use” status: The ultimate goal for a NJ-HITECH participating provider is the achievement of “meaningful use” status for their EHR system. Achievement of that status is required by the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) before any incentive funds can be paid. The Office of the National Coordinator (ONC) has promulgated a list of criteria to determine if a provider has achieved such status. Examples of such criteria are an EHR system’s ability to do the following electronically and on an “automated” basis: generate and track medication orders and prescriptions, conduct drug-interaction and allergy checks, record patient demographic data, list current diagnoses for each patient, maintain patient medication lists, record and chart changes in vital signs, record “smoking” statuses for patients, implement clinical decision protocols, report ambulatory quality measures to appropriate government agencies, provide patients with electronic copies of requested health information, electronically exchange and share clinical data among patient-authorized medical providers and other authorized entities, protect the privacy and security of health information and data, order and track laboratory tests and results, implement drug-formulary checks, generate patient lists by specific health conditions for quality improvement purposes, research, outreach and the reduction of disparities in care-levels, send patient reminders for preventative and follow-up care, provide data to authorized immunization registries and public health agencies. The nationwide Regional Extension Centers (RECs) are directly linked to CMS and ONC in a special network that is designed to position the RECs as the “meaningful use” information conduit in each State. Thus, NJ-HITECH is uniquely situated to oversee the process by which a provider’s EHR system develops the forgoing abilities and achieves “meaningful use” status for that provider in a timely and professional manner.
In addition to the above services, NJ-HITEC’s participating providers maintain 24-7 access to its website and website portals to other service and support resources. The website has continuously monitored and updated sections for education and training, practice assessment, workflow redesign, implementation services and meaningful use reporting. There are also sections for vendor selection, hardware and software financing and group-purchase programs, achieving discounts for malpractice insurance, privacy and security updates, recent EHR news and developments, and dates and locations for training and workshop events. The website also includes portals and links to regional and national health information technology consortiums and exchanges and “practice-specific” resources.
NJ-HITEC has already entered into partnership development agreements with some 540 health care providers and hospital-based medical practices. Additional agreements are being generated at a rapid and significant rate. Besides providing significant cost-savings over totally private vendors and consultants, the overall reality is that NJ-HITEC is in the best strategic position to move a provider toward full compliance with the EHR requirements of federal and state health care legislation, rules and regulations. As a federally designated and sponsored Regional Extension Center, NJ-HITEC is designed to be a medical provider’s first, last and only stop in EHR conversion, implementation and meaningful use.
Martin Perrotta is a consultant-writer for SpectraMD (www.SpectraMD.com) of Princeton, New Jersey; a firm that helps medical providers convert to Electronic Health Record systems. Mr. Perrotta is at firstname.lastname@example.org
NJ-HITEC (www.njhitec.org) can be reached at 973-642-4055. The website contains additional information on becoming a participating provider.