HIT Disruptions and Your Practice

Vital Signs: December 2013/ January 2014

Next 3 Years will Bring More, Costly Changes

Electronic health records (EHRs) were just the beginning.

EHRs and all accompanying health information technology (HIT) are now viewed as the engine that will power ACOs and medical homes.

Physicians have seen an explosion in HIT growth over the past several years. In 2009, just 10 to 20% of Massachusetts practices were using EHRs. In August 2013, the MMS Committee on Information Technology surveyed several thousand MMS members and found that 79% were using EHRs, indicating Massachusetts is one of the top states in EHR adoption nationwide.

Extrapolated to the estimated 18,000 clinical physicians in Massachusetts, that leaves fewer than 3,500 local clinicians not using EHRs. But that is not a permanent state of being; by January 2017 all providers will be required to use an EHR connected to a health information exchange (HIE).

Although EHRs have seemed a singular focus for physicians and practice managers for many years, there are several additional technology-driven practice changes on the horizon.

Here are some crucial upcoming HIT events and deadlines expected to affect Massachusetts physicians and medical practices, as well as some of the associated costs.

January 2014

EHR Stage 2 Upgrades. As Meaningful Use moves to additional stages, EHRs are required to add significant new features and they will charge for additional functionality and interfaces to various services, patient portals, lab feeds, government entities, billing clearing houses, and quality reporting. Cost: System-support contracts required to obtain these upgrades typically cost 18 to 20% of the purchase price of the system on an annual basis.

October 2014

ICD-10 Conversion Deadline. (Editor's note: On March 31, 2014, Congress extended the ICD-10 deadline to Oct. 1, 2015.) Already delayed once by a year, this change to documentation and critical billing information is unlikely to be postponed again. It will essentially require all practices to adopt some sort of electronic system in order to bill within the complex rules of ICD-10 coding. Cost: United Healthcare estimates a total cost of $83,000 to $252,000 to accommodate the conversion for a 1- to 3-physician practice, depending on whether the practice has an EHR or not.

January 2017

Deadline for HIE Participation. Massachusetts will mandate that all physicians use an interoperable, connected EHR. Cost: Although the Massachusetts state HIE, called The HIway, is subsidized, there will be costs to build and install interfaces in addition to monthly usage fees. An interface can cost upwards of $10,000 — and in some cases additional usage charges for larger practices.

Ongoing

The change from paper records to electronic documentation brings a host of additional ongoing technology requirements. Cost: Very dependent on individual practice needs and requirements.

  • Analytical and reporting systems/services to support new quality and payment models
  • Data conversion associated with EHR change — practices joining larger organizations and ACOs, may incur significant data movement and conversion efforts and fees as they merge their patient records into the new system
  • IT Training, IT Services, and project management for both
  • Encryption, backup, intrusion protection, and disaster recovery/system failover systems for on-site EHRs
  • Cost of providing for more stringent HIPAA protections,audits, and documentation

—Leon Barzin
MMS HIT Director

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