2011 ACC: EHRs Are Making an Impact

Meaningful use of electronic health records (EHR) is already happening, said Farzad Mostashari, MD, ScM, deputy national coordinator, programs and policy, Office of the National Coordinator for Health Information Technology (HIT). A poster presented Sunday reported a 24% drop in the heart attack rate across a single ZIP code.

The drop was a direct result of changes in care made possible by implementing an EHR covering 92% of residents in the study area, Dr Mostashari said during the annual James T. Dove Lecture, “Meaningful Use from the Perspective of the Office of the National Coordinator for Health IT.”

Clinicians could identify and monitor patients at risk for cardiovascular events and improve care with electronic decision support.

"Health information technology is in your service,” he said. “HIT is infrastructure and tools, health and information. Technology is last.”

EHRs address a key barrier to care: Cardiologists lack the information and the tools to apply their knowledge to all of their patients all of the time. Only about one-third of heart attack patients are getting aspirin. Fewer than half of appropriate patients are being treated for low density lipoproteins or hypertension. Less than 5% of patients who want to stop smoking get help from a physician.

“Without information, medicine is reduced to the level of a shoe store,” Dr Mostashari said. “The clerk asks ‘Can I help you?’ when you walk in. If you want to be able to do more than ask, ‘Can I help you?’ you have to know patients’ risk factors and history and be able to reach out to them. You have to make a registry and apply that registry to every patient at every visit. Meaningful use of an EHR is aligned with what you want to do and need to do to thrive and maybe even survive as reimbursement is increasingly tied to quality of service and not quantity. It is a way to prevent heart attacks and strokes.”

Meaningful use is also within reach. The initial criteria were published in April, and the fi rst physician reimbursement checks will be mailed in May, Dr. Mostashari said.

Future meaningful use requirements are still being designed, said Floyd Isenberg, MD, senior vice president, health information technology, National Quality Forum. But the outlines are clear.

“We have a lot of process measures,” he said. “We want to move forward to measure outcomes. In practice, you are going to want to use your EHR for 100% of your patients 100% of the time.”

James Tschang, MD, professor of medicine and informatics, Duke University, Durham, NC, agreed that meaningful use is not difficult to achieve. And meeting the criteria can pay.

Approximately $34 billion has been earmarked for providers who demonstrate meaningful use; up to $44,000 plus an additional $63,750 for some Medicare/Medicaid providers. Providers who do not demonstrate meaningful use by 2015 will start to see reductions in Medicare reimbursement.

“Get a certified EHR now and use it,” he recommended. “Implement those Stage 1 meaningful use requirements and register for the incentive at www.cms.gov/ehrincentiveprograms/20_registrationandattestation.asp? Three months later, go back online and complete the attestation. And then deposit your check.”

Source: EHR use already affecting CV patient outcomes. CardioSourceNews at ACC.11/i2 Summit. http://www.cardiosource.com. Accessed April 4, 2011.