Hurricanes Delay EHR Program
The damage from hurricanes Gustav and Ike didn't stop at properties and coastal erosion. The storms also put a damper on efforts to recruit primary care physicians for a federally funded electronic health records demonstration project.

"There have been some applications in, but certainly we need a lot more," said Will J. Jackson, project manager for the Louisiana Health Care Quality Forum.

Jackson said the Qualify Forum has fielded lots of questions since launching the application process, but only around 50 applications came during the first four weeks of the program.

"We're not discouraged. We're just going to make sure that we continue recruiting them," Jackson said.

The forum is the community partner of the Centers for Medicare and Medicaid Services. CMS wants to get 200 small and medium-sized primary care physician practices to sign up for the project. The goal, according to CMS, is to revolutionize the way health care information is managed, producing better health outcomes and greater patient satisfaction.

"Physician use of HIT is critical to bringing transparency, evidenced based decision making and efficiency to health care," said Alan Levine, secretary of the Louisiana Department of Health and Hospitals.

While many hospitals and larger practices can afford the investments, and have made them, smaller physician practices often have a harder time, Levine said. Electronic health record system can reportedly cost as much as $50,000 for each physician in a practice.

In 2007, the Louisiana State Medical Society surveyed its members and found that 24 percent of those responding had converted to electronic health records or paperless recordkeeping systems.

Levine said the additional funding that the CMS program will bring to the state – potentially $29 million for physician practices -- in conjunction with Gov. Bobby Jindal's commitment and investment in health information technology, can help many of the smaller practices significantly defray the costs.

Although the hurricanes slowed the recruitment drive, the Louisiana Health Care Quality Forum has kept pace with other states in the initial demonstration phase, Levine said. Through the first week in October, Louisiana had submitted 14 applications, while Maryland/Washington D.C. had submitted 20, Pennsylvania 15 and South Dakota eight.

The other participants in the demonstration project are Alabama, Delaware, Jacksonville, FL; Georgia, Maine, Oklahoma, Virginia, and Madison, WI.

In order to apply, a practice must provide primary care services for at least 50 Medicare beneficiaries that are covered under the traditional fee for service program.

The electronic health records demonstration will reimburse up to 100 primary care physician practices as much as $290,000 over five years for taking part, Jackson said.

Jackson emphasized that this is not a grant program so physicians will not receive any money upfront to buy an electronic health records system.

The incentive payments cover the adoption and use of an electronic health record and for performance on 26 clinical quality measures related to the treatment of diabetes, congestive heart failure, coronary artery disease and for preventive health services.

CMS wants Louisiana to recruit 200 physician practices, Jackson said. The agency will randomly select 100 practices as a control group and 100 as the treatment group.

The control group members will not be eligible for the incentive payments, he said. These doctors will receive a small, yet-to-be-determined payment to fill out an office systems survey in years 2 and 5.

The survey will ask questions such as whether the physicians' have adopted an electronic health record and how they are using it, Jackson said.

Members of the treatment group will be asked to adopt a Certification Commission for Health Information Technology-certified electronic health record, if they have not already done so, by the end of the second year of the demonstration, he said. The certification means the system meets a certain level of functionality, privacy and security and can communicate with other electronic health record systems.

"It's an easy way for them to streamline the basic requirements for the electronic health record without telling the provider to go to this vendor, go to that vendor or pick this product, pick that product," Jackson said.

According to the Certification Commission, an electronic health record system must meet 219 criteria to be certified. The requirements include electronic prescribing features that give physicians access to a patient's medication history; the ability to view X-rays and other diagnostic images electronically; and using standard formats to exchange basic patient information, which improves continuity of care.

Physicians will be notified in March 2009 of whether their application was successful and into which group they've been placed, Jackson said.

For more information or to apply, go to www.lhcqf.org. The right side of the site includes the application, instructions, a fact sheet, frequently asked questions, and a summary of the project. If applicants have other questions, they can click on Jackson's e-mail (wjackson@lhcqf.org) or call (225) 334-9299.

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