For Academic Radiologists, Meaningful Use Takes Support

CHICAGO - Radiologists at academic medical centers must piggyback on their institution’s efforts to comply with a federal incentive program designed to promote use of electronic medical records, agreed speakers at the Radiological Society of North America annual meeting session, “Health IT Incentive Programs: Experience from Radiology Practices in Hospitals and Health Systems.”

Without strong institutional IT support and coordination, many departments simply will not be able to meet the meaningful use requirements set out in the 2009 economic stimulus law. The law lays out a series of carrots and sticks to accelerate the adoption of electronic medical records and ensure that the systems are used to improve medical care.

The law greatly accelerated the adoption of electronic medical records, increasing the number of physicians using the systems from 20%, when the law was passed, to 70% now, said Curtis Langlotz, MD, PhD, professor of radiology and biomedical informatics at Stanford University. Many radiologists support the goals of the program and wish to take advantage of its incentives, which were up to $44,000 per physician for those who began in 2012 and have declined each year since. But it has been difficult for some to meet the law’s requirements.

Many meaningful use requirements are not relevant to radiologists, so academic center radiologists must build off the meaningful use efforts of their institution and referring physicians in order to comply, explained session moderator Ramin Khorasani, DMD, associate professor of radiology at Harvard Medical School and director of information management systems at Brigham and Women’s Hospital in Boston.

“Leveraging the institutional electronic medical record system and meaningful use initiative is really the only way to do this,” Khorasani said.

Khorasani and his colleagues have piggybacked off Brigham and Women’s institutional meaningful use push, and have tapped into the institution’s electronic medical records system to extract data, like a patient’s smoking history, that are required to meet meaningful use standards but that are not routinely collected by radiologists.

It takes a substantial investment in IT to make it possible for radiologists to tap into their institution’s larger medical record system. For example, Khorasani’s department requested $300,000 (about 6% of the $1.8 million meaningful use incentive the department was eligible for) from Brigham and Women’s to make necessary IT upgrades. In addition to allowing the department to access data needed to meet meaningful use requirements, the upgrades allowed the radiologists to access more clinically useful information about patients.

“Radiologists now have access to  very detailed clinical information they didn’t have before,” Khorasani said. “It ended up being clinically useful.”

The radiologists and their staff had to be trained to enter other data, such as a list of patient’s medical concerns, or to ask patients to fill out forms for additional required information. But the radiologists have been pleased to receive incentives of about $14,000 each over 5 years in their pay, Khorasani said. The rest of the incentives went to the institution or department. So far, 92 of the department’s radiologists have qualified and the program has collected $1.7 million in incentives.

But some academic radiology departments may find that it is simply not feasible to meet meaningful use requirements. Keith Hentel, MD, MS, chief of the division of emergency/musculoskeletal radiology and executive vice chair of the department of radiology at New York-Presbyterian Hospital-Weill Cornell Medical Center, said his department tried and failed to comply with the meaningful use requirements.

“I was caught up in the excitement about becoming a meaningful user, but we failed,” he said.

He explained that his institution’s electronic medical records system and the electronic systems used by the radiology department didn’t communicate well enough to allow his department to piggyback on the hospital’s patient data. The cost for implementing the IT changes necessary to bridge this divide would have been substantial and much of the incentive funds would have gone to the institution and not the department.

“We are working with bridging the divide,” he said.

For those starting after 2014, there are no longer financial incentives to meet meaningful use requirements. Financial penalties for those physicians who don’t meet meaningful use requirements were set to begin in 2015. Hentel noted, however, that a hardship exemption has been created that applies to many radiologists. He also noted that a 2014 law created a new set of penalties that radiologists should be concerned about. The law requires documentation that an imaging decision support system has been used or the radiologist’s CMS claim won’t be paid. That new requirement is a major incentive for radiologists to make necessary electronic upgrades, Hentel noted.

Langlotz said he hoped that, going forward, federal incentives and penalties will be simplified into a single program. In the meantime, he encouraged radiologists to stay up-to-date.

“It’s highly relevant to our practice today and in the future,” Langlotz said.