Guarantee vendor support prior to striving for Meaningful Use

Many providers assume that if their electronic health record system has been certified as being able to meet the EHR Incentive Program's Meaningful Use requirements, then receiving reimbursement dollars is all but guaranteed (assuming that they do their jobs and meet the clinical quality measures). But that's not necessarily according to attorney James Kalyvas, with Los Angeles-based law firm Foley & Lardner.

Some EHR systems simply don't measure up in the support department, and neither do their vendors, Kalyvas explained during a recent webinar. "Certification tells you part of the story, that the EHR system qualifies for Meaningful Use," he said. "But [that] doesn't necessarily give protections to the user [that the system will help the user meet the meaningful use criteria]."

Daniel Orenstein, counsel for EHR vendor athenahealth, who also spoke on the webinar, agreed, saying that some providers have had trouble meeting Meaningful Use because their EHR system doesn't deliver the functionality needed. That ultimately puts the providers' ability to earn the incentive payment at risk, according to Orenstein, since some systems' workflow and other designs are difficult to maneuver.

Orenstein identified four areas, in particular, where providers have run into difficulties meeting Meaningful Use because of system functionality issues, despite the surface appearance that the user was dropping the ball:

  • Providing clinical summaries for at least 50 percent of all office visits within three business days;
  • Recording demographic information;
  • Recording vital signs, especially for EHR systems geared to specialists, who historically didn't collect this data; 
  • Protecting the electronic health information from security risks, including conducting a risk assessment and implementing mitigating steps to eliminate vulnerabilities. 

Then there's the thorny issue of a currently certified EHR system staying certified for Meaningful Use beyond Stage 1. According to Kalyvas, the "evergreen nature of the technology staying certified" is vital. "The last thing you want is a big financial hit for the next stage of Meaningful Use," he said. "You need to make that bargain with the vendor."

Orenstein recommended that a provider shopping for an EHR system ask the vendor several questions about their system, and get the vendor to agree to as many requests as possible, as most requests are negotiable. Some of the questions include:

  • Is the EHR system currently qualified as certified for Meaningful Use?
  • Will the system always qualify for Meaningful Use, even during later stages, which may mean that it needs upgrading?
  • Will the vendor help the provider obtain its incentive payments?
  • What payments/guarantees will the vendor give to the provider if the EHR system does not meet the criteria for certified EHR technology?
  • What payments/guarantees will the vendor give to the provider if the Meaningful Use incentive payments are denied because of a problem with the EHR system, such as functionality, and not user error?

Getting assurances and assistance from the vendor to meet Meaningful Use and making the vendor accountable for its product is no different than keeping the vendor on the hook for patient safety issues arising from the EHR system. The time may be ripe for vendors to step up to the plate and stop trying to abdicate their responsibility for the products they're selling.

"There has to be an inherent fairness," Kalyvas said. - Marla

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