As the New Decade Begins, Change Your Mindset About Health IT

Just a few days from now, a new year -- and a new decade -- will begin. At the top of my wish list for our specialty in 2010 is this: I wish that more family physicians would adopt a forward-thinking mindset about health information technology -- a mindset that would position them for success as the new decade, and health reform, unfold.

Academy members know the days are limited for the current health care system, which pays physicians based on volume. They know momentum is building for a reformed system based on primary care and the patient-centered medical home, with payment that rewards quality and good outcomes, not volume. And they know what they need to do in their own practices to get ready, because the roadmap was laid out in the specialty's own Future of Family Medicine project back in 2004.

But if you're like many members, you might find yourself stuck in the present, doing your best to survive in this dying payment system and not doing enough to prepare for the new system.

I'd like to offer a few suggestions to help you prepare.

Perhaps you've already installed an electronic health record, or EHR, system in your practice. Congratulations on this important step, but do you use the EHR functions that will be critical in the reformed payment system? The results of a recent AAFP member survey suggest that many members don't.

The survey, conducted in 2008, showed that 42 percent of respondents had EHRs up and running in their practices, which is good news. But when those respondents were asked which EHR functions they used regularly, many reported that they did not use certain functions that will be essential in the future.

For example, only 28 percent of those with EHRs that could measure and analyze outcomes were doing so, while another 39 percent reported that this function wasn't even available on their EHRs. Only 42 percent of those who had a patient registry function were regularly using it, while another 32 percent said it wasn't available on their EHRs.

It's not surprising that a much higher percentage of respondents reported using functions that help in the current system, such as those that make documentation quicker, easier and more complete.

If this is the case in your practice, in the coming year, I hope you'll commit to thinking of your EHR as a bridge to the future, not just an essential tool for the present. And I hope you'll start using the functions the future will require.

Using those functions isn't just the right thing to do to boost the quality of care you provide. It also may help you get Medicare incentive payments of as much as $44,000 from 2011 through 2015 under the Health Information Technology for Economic and Clinical Health, or HITECH, Act.

As long as you participate in Medicare Part B and demonstrate "meaningful use" of a "qualified" EHR system, you will be eligible for the incentives. HHS will define these two terms in standards scheduled to be released by the end of this year. When the standards are available, you'll know which functions you need to use and whether you must upgrade your EHR or buy more products and services to obtain those functions.

If you don't have an EHR yet, you're not alone. The AAFP member survey found that 29 percent of respondents didn't have an EHR but planned to purchase one, while another 18 percent didn't plan to get one. Concern about cost was the top reason cited as a barrier to such a purchase.

It's important to get health IT in your office sooner rather than later, because in addition to the incentive carrot, the HITECH Act also wields a stick: Beginning in 2015, Medicare payment penalties will kick in for physicians who aren't using an EHR.

However, you might be able to get the functions you'll need without incurring the cost of a full-bore EHR. That's because the health IT industry is in the throes of a significant paradigm shift, moving from the traditional full EHR system that runs on a server in your office to less expensive modular applications, such as patient registries and e-prescribing applications, that run on Web platforms. These modular components eventually should be capable of integration through the Web platform, although such integration hasn't happened yet.

The AAFP has encouraged HHS to allow physicians who use modular components to qualify for the HITECH incentive payments, along with those who use full EHRs. If HHS says "yes" to modular components in the soon-to-be-released standards, you could use this less expensive option as your bridge to the future and still get the Medicare incentive payments.

The AAFP also played a role in drafting a bill recently passed by the House that could give you access to upfront capital for your health IT purchase. The Small Business Health Information Technology Act would establish a new lending program within the Small Business Administration to allow small and solo practices to obtain low-cost bank loans for the purchase of health IT. The loans would be limited to hardware and software products and services that would help physicians achieve meaningful use of health IT systems.

No matter what kind of system you ultimately decide to purchase, a good way to begin is to visit the AAFP's Center for Health IT. You'll find many helpful resources there: educational information, e-mail discussion lists and nearly 500 member-submitted reviews of EHR products. The center also can put you in touch with physicians in practices like yours who have experience with systems you're researching. Through the center, the AAFP stands ready to help you adopt that new IT mindset and put your practice on the path to success in the coming decade.