Epic Update: Doctors make strides meeting meaningful use guidelines

The project team is working hard to help make compliance seamless

Matthew Ellman, MD, discusses implementation of the Epic system with Hillary Marino, his practice supervisor, in October 2011.

The 2009 American Recovery and Reinvestment Act earmarked almost $27 billion to help individual doctors and hospitals offset the cost of adopting an electronic medical record (EMR) such as the Epic system. The Yale School of Medicine (YSM) can get up to $44,000 to $64,000 per eligible physician over a 5-year period in incentive payments if faculty meet guidelines to demonstrate what is called “meaningful use.”

“Eligible faculty are required by the school to attain meaningful use within the prescribed timeline,” said David. J. Leffell, MD, deputy dean of clinical affairs for the YSM. “In budgeting for the Epic implementation, it was assumed that our faculty would achieve this goal.”

As of early this month, seven YMG doctors had fulfilled the 15 required meaningful use objectives, as well as five of 10 additional elements. The objectives include using the EMR for a certain percentage of medication orders, entering demographic information, recording vital signs, noting smoking status, and maintaining an active medication allergy list, among other things. (Stage 2 and 3 regulations have not yet been finalized.)

“Most of our doctors who are now using Epic are very close to meeting the Stage 1 objectives,” said Amber Patterson, the Epic project team’s meaningful use compliance coordinator. “We’re all working very hard to ensure that YMG providers will fulfill the guidelines for Stage 2 and Stage 3 seamlessly.”

Most physicians are almost there

This month, Gary Friedlaender, MD, in orthopedics, became the first department chair to achieve the meaningful use standard. Drs. Matthew Ellman, Peter Ellis, Lydia Dugdale and Katherine McKenzie—the physicians of Yale Internal Medicine Associates (YIMA)—have all qualified for Stage 1 payments, as has Jeffrey Topal, MD, of Yale Infectious Diseases, and Andrew Duffy, MD, of Gastrointestinal and Bariatric Surgery.

Out of the more than 100 YMG physicians who have gone electronic since last October, when YIMA became the first practice to go live, most are very close to what is known as attestation, the formal name for the milestone, Patterson said.

The work that goes into making it possible for each physician to qualify for incentive payments starts early in the Epic implementation sequence and continues long after his or her practice goes live. Early in 2011, during the collaborative build phase, Epic analysts used feedback from providers to fine-tune the Epic model system in such a way that all of the information required to demonstrate meaningful use could be captured, routinely and without extra steps, in what are known as structured fields.

“In a structured field, you can quickly and easily enter and pull out data, such as whether or not a patient smokes, to show that you’ve met this required objective,” said Patterson. “You can’t do this in a long sentence or a note.”

Providing ongoing education

Patterson and David Smith, implementation project director for YMG, meet with practice administrators and providers to introduce them to the meaningful use program and to the right way to use Epic to meet its objectives.

“We’re also getting more and more involved now in putting this information into the formal training program that takes place before go live,” Patterson said. Training continues after the implementation is complete, as Patterson and her colleagues troubleshoot with Steven Schlossberg, MD, chief medical information officer for the Yale School of Medicine and Yale New Haven Health System, and his enhanced clinical support team.

“Using an EMR is a new way of doing business, and like any federal program, there’s a lot of ongoing education that’s necessary to make sure everyone achieves the meaningful use objectives, qualifies for the incentive payments that run out in 2016, and avoids the non-compliance penalties that begin after 2015,” Dr. Schlossberg said.

Patterson, Dr. Schlossberg, and the other meaningful use watchdogs routinely analyze reports that Epic generates to determine how well providers are doing, and if there are problems, an Epic team member can be dispatched to address them. In addition, there’s a help desk, staffed 24/7. “If you have questions, just reach out,” said Patterson. “Dealing with change can be overwhelming, but we’re here to help.”