Electronic Health Records

NURSING NOTES

– Oncologists who switch from paper documentation to electronic health records (EHR) are eligible for cash incentives from the Center for Medicare and Medicaid Services (CMS).   

– Oncologists who fail to adopt the EHR will be penalized.

– The oncology specific EHR system adds additional value in the specific area of chemotherapy ordering, preparation, and administration and makes it easier to analyze and research clinical outcomes, enroll patients into clinical trials, and improve the billing process.

– The ultimate goal for EHR is to improve the quality of care, and create a more efficient “mobile healthcare” system.

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Oncologists who are smart enough to make the switch from paper documentation to electronic health records (EHR) now are eligible for cash incentives of up to $44,000 from the Center for Medicare and Medicaid Services (CMS). The board‑certified physician, including the oncology specialist, is included in the list of eligible providers, and even a small practice of just 3 physicians can receive more than $100,000 from the Health Information Technology for Economic and Clinical Health (HITECH) Act, a set of mandates that falls under the stimulus provisions of the American Recovery and Reinvestment Act (ARRA) of 2009.¹

The topic is very current since eligible providers need to qualify soon in order to receive the full incentives and avoid penalties.  Chantal Worzala, writing in the Journal of Oncology Practice, warns that, “The Medicare EHR incentives have the force of law and will be implemented on an aggressive timeline.”²    This means that oncology physicians who fail to jump on the bandwagon and adopt the EHR very soon will feel the pinch of the penalty provisions of the same HITECH Act, which reduces Medicare payments for practices, hospitals, and other health providers that do not adopt the EHR technologies.  For providers that fall behind, payments will be decreased by 1% in 2015, 2% in 2016, and 3% in 2017.³      

The oncologist and team are positioned well to participate in the adoption of an appropriate system that adds value and improves patient care.  The EHR technology adds additional value in the specific area of chemotherapy ordering, preparation, and administration.⁴  In a two-part review published in the Journal of Oncology Practice, Shulman and colleagues note that, “EHRs hold the promise of enhancing our ability to deliver safe and quality oncology care. However, as with any technology, integration into the clinic must be accompanied by a careful assessment of workflow and with great forethought.”⁵  Shulman and co-workers review some general principles important to the productive integration of the EHR into the oncology practice:

o   Accuracy

o   Standardization

o   Automation (eg, of calculations)

o   Decision Support (with tools such as dose ranges, thresholds, and interaction alerts)

o   Flexibility (to incorporate new medical technology)

o   Workflow Integration (with support, allied health and pharmacy staff)

o   Safety First (over convenience)

o   Efficiency (faster than paper)

An Office of the National Coordinator for Health Information Technology (ONCHIT) was established by the same legislation that set up the incentives and penalties for the adoption of EHR technology, and this body is charged with determining the certification standards and testing procedures for the various EHR systems to be designated as “certified EHR technology,” although the final nod of approval needs to come from the CMS.⁶