Some Radiologists Embrace Meaningful Use, Others Wait

CHICAGO - As many as 90 percent of radiologists are eligible for financial incentives provided by CMS for the adoption and meaningful use of certified EHR technologies, and some radiology practices have already qualified for incentives, say experts speaking this week at RSNA 2013.

“Some practices are in Stage 1, and others are transitioning into Stage 2,” said Alberto F. Goldszal, PhD, director of Medical Informatics for the University of Pennsylvania Health System’s Department of Radiology.

Yet, others are taking a wait-and-see strategy, opting out of the program until larger systems can establish qualified patient informatics systems they can adopt without an often substantial administrative burden. Transitioning to “robust” EHR systems, it is hoped, will streamline information exchange, thereby enhancing diagnosis speed and improving care coordination across a spectrum of practitioners.

Each stage of the program takes about two years to complete once a practice opts in. In Stage 1, the goal is to collect patient data in 24 areas including information on demographics, medications, allergies, and smoking status. Stage 2 asks practices to introduce additional data points and quality measures, and Stage 3 will attempt to use all information collected to improve clinical outcomes. Goldszal, for example, has shepherded his system through Stage 1 certification and is well on the way to Stage 2.

Up to 10 percent of those attempting to qualify will be audited, Goldszal said; based on his own experience, an audit can take about five months and involve multiple requests for information.

“The initial request asked for a core measures dashboard and proof of CEHRT [Certified Electronic Health Record Technology],” he said. “On the second request, the audit board wanted more information on records, risk analysis, patient lists and the immunization registry. Once that was justified, they asked for a third round of information.”

Primary care practices are likely better equipped to handle the administrative burden, admitted Alan D. Kaye, MD, chairman of the Department of Radiology at Bridgeport (Conn.) Hospital and president and CEO of Advanced Radiology Consultants in Shelton, Conn., but radiology practices should “get on this bus” as soon as possible regardless. “Radiology should lead the way in EHR,” he said. “We’re an IT business. We want good information. We made it an organizational imperative, [and] the incentives gave us capital to pursue other projects.”

Having launched into its first year of data acquisition on the way to Phase 1 certification, Phoenix, Ariz.-based Southwest Diagnostic Imaging has found qualifying for incentives to be anything but smooth sailing, said James Whitfill, MD, chief medical informatics officer. The program’s “definition of patient encounters is murky” for radiologists who don’t see patients face-to-face on a regular basis, he said, and “these programs are fairly expensive to implement and maintain. I share Albert’s concern that the ongoing costs are going to become non-trivial.”

Seeing these challenges, practices such as Advanced Medical Imaging Consultants in Fort Collins, Colo., have chosen the program’s “hardship option,” which allows up to five years to implement a qualifying EHR strategy before penalties kick in. “When we assessed this, we felt that we would have to have our own compliant EHR, and it would have to interface to a large variety of other systems over which we have no control,” said J. Raymond Geis, MD, a radiologist with the firm. “We’re going to wait and watch for better software.”  

Geis’ hope is that the two large hospital systems in the area will adopt a system, and the clinic can “piggyback” off the information they collect for most patients. “That’s going to make our lives easier.”