Q: What is the difference between an electronic medical record and an electronic health record?
A: The two acronyms are often used in-terchangeably, but information technology consultants indicate differences do exist. The EHR contains information from a variety of contributors (i.e., providers, hospitals, pharmacies). It is a repository for patient information that follows the patient regardless of where care is provided. Patients have access to their EHR and can add information to it.


The EMR is managed by a provider (i.e., physician, hospital, pharmacy) and documents the care rendered. This is a legal record and is the property of the provider. Patients have limited or no access to their EMR. In this light, EHR is dependent on the adoption of EMR.


The Office of the National Co-ordinator for Health Information Technology prefers the acronym EHR and suggests using it as the standard abbreviation.


Q: What percentage of office-based physicians use a full EMR system?

A: The National Center for Health Statistics states in its October 2007 report that, "In 2006, 29.2 percent of office-based physicians reported using full or partial EMR systems." A subsequ-ent report based on a 2008 mail survey published in December 2008 indicated that 38.4 percent were using full or partial EMR systems.


Q: Is there a financial incentive for implementing EMR?

A: Yes. The Health Information Tech-nology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Rein-vestment Act signed into law in February 2009, contains two incentive programs for the adoption and use of an EHR. One program is through Medicare and the other through Medicaid. Eligible professionals may only participate in one incentive program, however, not both.


Q: Who or what qualifies as eligible for these incentive programs?

A: The incentives described in current legislation benefit hospitals and office-based physicians. The Medi-care incentive program provides for eligible professionals, which are physicians defined in the Social Security Act who are office-based. Hospital-based physicians do not qualify. Physician assistants and nurse practitioners do not qualify for the Medicare incentive but do qualify for the Medicaid incentive.


Q: What other criteria exist in order to qualify for the programs?

A: Both programs require the eligible professional to demonstrate "meaningful use" of a certified EHR. The Medicare program requires that the provider submit Part B claims of at least 133 percent of the maximum incentive for the program year. For example, if the maximum incentive for the year is $18,000, the provider must submit at least $24,000 in Part B charges. The Medicaid incentive is available to those that have at least 30 percent of their patient population receiving medical assistance.


Q: What is considered "meaningful use"?

A: The Secretary of Health and Human Services is charged with finalizing the definition.
The proposed definition requires satisfying a series of objectives and measures with a timeline. The proposal indicates meaningful use supports specific goals:

   • Improve quality, safety and efficiency.

   • Engage patients and their families.

   • Improve care coordination.

   • Improve population and public health; reduce disparities.

   • Ensure privacy and security protections.


Public comments on the definition were due by June 26, 2009. This definition will continue to develop.


Q: If I already have an EMR system, can I receive the bonus now?

A: No. Until the final regulation is published, existing EMR users will not know if their current system qualifies for the program. Incentive program dollars will not be distributed to any qualifying professional until 2011.


Q: If I qualify for the bonus, what payments will be available to me?

A: The chart above describes the  structure for the Medicare bonus. Physicians practicing in a health professional shortage area may secure an additional 10 percent to their annual bonus payment.


The bonus is available to each provider who satisfies the eligibility criteria. So, in a group practice, each physician is eligible for a bonus.


Systems must be certified to qualify. Certification criteria continue to evolve. Additional information about certification can be found at the website for the Certification Com-mission of Health Information Tec-hnology (www.cchit.org).


Q: Will I be penalized if I do not adopt EMR?

A: Yes, but not right away. Phy-sicians who do not adopt a qualified EMR system by 2015 will realize a reduction in their Medicare payments of 1 percent in 2015, 2 percent in 2016, 3 percent in 2017 and beyond. In 2018, if the Secretary of HHS determines that less than 75 percent of eligible professionals utilize EMR, an additional 1 percent and then 2 percent reduction could occur. The reduction is capped at 5 percent.


Q: Once I begin receiving  the health information technology bonus, will I still be able to qualify for the e-prescribing bonus program?

A: No. Because this program contains a provision for e-prescribing capability, the e-prescribing bonus disappears for those seeking the health information technology bonus. This avoids double-dipping.


Q: What government agency will be in charge of this legislation?

A: The Office of the National Coordinator for Health Information Technology will administer the HITECH Act. The HHS secretary appoints the national coordinator, who in turn reports directly to the secretary.


Q: Does the HITECH Act address security issues?

A: Yes. You can expect additional requirements for security relating to Protected Health Info-rmation.


Q: Will there be a public listing of who received the incentive bonus?

A: Yes, the Centers for Medicare and Medicaid Services will publish and post online the names of those receiving the Medicare incentive bonus.


Ms. McCune is vice president of Corcoran Consulting Group. Contact her at DMcCune@corcoran ccg.com.