At last week’s massive RSNA imaging conference, I attended a session on a topic that does not often come up in imaging circles. Several panelists discussed their efforts to either participate in – or in some cases – avoid the “meaningful use” EHR incentive program. The program, which my colleague Joe Goedert has covered in depth since its inception two years ago, primarily has targeted rewarding EHR adoption by primary and some specialty physicians and hospitals.

But the program includes options for radiologists, who unlike their primary care peers, rarely see patients face to face. A number of radiology groups have successfully attested, and panelists at larger practices spoke of incentives in the multi-millions of dollars. Others, however, are basically hoping the program goes away—or at least hoping exemptions to the program for radiologists, which would enable them to avoid the eventual penalties for non-compliance that many other physicians face, will stay intact.  If they don’t, practices not attesting to meaningful use face some hefty Medicare reimbursement cuts down the line, perhaps as high as five percent.

Participating in the program for many radiology groups is not easy. James Whitfill, M.D., the CMIO at Southwest Diagnostic Imaging (Phoenix), described how his group has cobbled together two different clinical I.T. systems just to qualify. Its core radiology information system vendor apparently decided not to opt for Meaningful Use certification, meaning the practice had to put in a certified ambulatory system to participate. Whitfill described the workflow needed to use the two systems in harmony and make sure the correct radiologist gets credit for the correct patient. Radiology practices often don’t assign patient cases until after the order has been placed. And with 65 physicians in the group, I could imagine the influx of work. The center performs 1.2 million annual exams.

 Basically, patient demographics are captured in the practice management system, and the work order from the RIS flows into the EHR. If the patient is eligible for meaningful use, additional data is collected. Later, the EHR is updated with the correct provider who read the exam. It was the kind of presentation that left me both shaking my head in wonderment—why would such a complex chain of events even be required—and nodding in approval at the sheer innovation of it all. At heart, Southwest and the others who spoke were not going after MU dollars strictly for the money. The money helped, of course, but the investments in staff and technology required are substantial (usually outstripping any incentive money).  These practices have their eye on the future, and they talked of the importance of being able to connect with referring practices beyond their four walls.

However, when I hear physicians discussing whether or not inpatients should be counted in the qualifying patient denominator, or if outpatients only count, I can’t help but think this well-intentioned program of incentivizing EHR adoption has the unforeseen side effect of trivializing physician expertise. Maybe that’s why one of the panelists described how his health system has six full-time staff devoted to various aspects of meaningful use.


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