Tales from the Trenches of Meaningful Use

CHICAGO-First the good news: 90 percent of radiology practices indeed can qualify for some of the $20 billion in federal stimulus funding set aside to stoke the “meaningful use” of health information technology. What’s more, meaningful use seems to change little the day-to-day work of radiologists, according to those whose practices have been through the meaningful-use wringer.

The bad news: getting to “meaningful” takes a whole lot of hard thinking, investment, and work, according to those with experience in the process speaking at RSNA 2011 on Tuesday.

The Center for Diagnostic Imaging, a Minneapolis, Minn.-based network of imaging providers with offices in several states, started with a cost-benefit analysis. Meaningful use would bring in about $2.1 million incentives over five years, said Steven Fischer, the company’s chief information officer. Getting there via requirements he described as “very onerous” would cost $889,000. Incentives weren’t the sole consideration, though.

“It’s really about that stick out there in 2015, when there’s a five-percent penalty on your dollars,” Fischer said, referring to the Centers for Medicare & Medicaid Services payment reduction slated for future meaningful-use scofflaws. His company started the work toward certification in January and won meaningful use certification on Nov. 14, he said.

The onerousness of qualifying for meaningful use certification has many roots, Fischer and others said. Broadly speaking, they include:
- Understanding the U.S. Department of Health and Human Services-derived requirements, spelled out in terms of objectives and core/clinical quality measures, which start with new information-gathering needs and stretch through reporting.
- Understanding the possible exceptions to those requirements (radiologists can thank American College of Radiology and other medical lobbying efforts for these) you may be able to take advantage of. Among the exceptions, for example, is one that lets radiology practices writing fewer than 100 prescriptions during a 90-day reporting period to avoid prescription-related requirements.
- Understanding what your RIS/PACS, speech reporting, practice management and other vendors’ systems are capable of, whether they’re fully certified or “modular” (partially) certified.

“You have to see what CQM (clinical quality measures) work for you, but you also have to see which ones your vendor has certified,” said Keith Dreyer, DO, PhD, a Massachusetts General Hospital radiologist and author of a new book, “The Radiologist’s Guide to Meaningful Use.”

If you find all this a bit confusing, you’re not alone. A KLAS-RSNA survey released at RSNA 2011 found that although 55 percent of about 200 radiologists surveyed were planning to qualify for meaningful use incentives or considering it, less than a quarter of them described them as familiar or very familiar with meaningful use.

Alberto Goldszal, PhD, MBA, who serves as CIO for University Radiology group in New Jersey, offered up some examples. His practice, which won meaningful use certification in October, found that more than 40 percent of the quality measures are taken care of by front-desk staff equipped with systems amenable to collecting patient information such as demographics, medications and medication allergies.

Recording vital signs such as height, weight, blood pressure, calculating and displaying body-mass index, and displaying growth charts for children ages 2-20 are other requirements his practice chooses to satisfy, although they may seem irrelevant to a radiology practice. One can also qualify if the PACS/RIS system is integrated into an electronic health record; if not, as long as your system itself is capable of recording such data, the radiology practice doesn’t actually have to use the data to get the credit for the purposes of meaningful use, Goldszal said.

Important is only that “the RIS is able to acquire data in a structured format,” he said.

Other capabilities, such as being able to provide a patient-requested electronic copy of the patient’s medical record in three business days, must actually happen, he said.

Goldszal and Fischer both emphasized the importance of being able to track and monitor your practice’s performance against meaningful-use criteria. Among other reasons, practices can expect to be audited at some point.

“You need a dashboard and reporting tool to monitor and support the effort,” Fischer said.

James Whitfill, MD, chief medical informatics officer of Southwest Diagnostic Imaging in Phoenix, Ariz., said his practice is assessing meaningful use but isn’t charging into the process.

Will having to measure blood pressure and take other vital signs impact workflow? Will it require more waiting room or clinical space? Even exceptions they might gain by saying blood pressure, height and weight have no bearing on a radiology practice might not be easy wins, Whitfill said: physicians asked to legally attest to such things – a prerequisite for winning the exceptions – might balk at it.

“So all of a sudden, easy excluding criteria become a whole lot harder,” he said.

Raymond Geis, MD, a radiologist at The Imaging Center in Fort Collins, Colo., said his practice is also taking a wait-and-see approach. His company covers two major, competing hospital systems, each with its own HIT and radiology IT offering – not to mention the 20 other sites they cover. He and colleagues are asking questions ranging from how they’re supposed to do follow-up for smoking assessment and counseling, as meaningful use dictates, to the possibility of using free Web-based electronic health records such as Practice Fusion for data they must collect but probably won’t use.

“We’re struggling with how these disparate pieces fit together,” he said.