Electronic Health Records

States Setting High Standards for EHR Use

By Ken Terry

Requirements for EHRs, CPOE come on top of federal rules for meaningful use

Hospitals across the country are scrambling to show meaningful use of electronic health records in time to apply for federal incentives starting later this year. But in Massachusetts, they're also racing to beat deadlines that could determine whether they keep their doors open.

Massachusetts hospitals that don't have computerized provider order entry systems by 2012 and EHRs by 2015 face the revocation of their state certification. By the latter date, physicians must prove they know how to use an EHR; if they can't, they could lose their license to practice medicine in Massachusetts.

In Minnesota, all health care providers, including hospitals, physicians and post-acute facilities, must have interoperable EHRs by 2015. The law doesn't specify penalties for not meeting that goal. However, if a hospital does not have an EHR by 2015, "it would be in technical noncompliance, which is a misdemeanor, and nobody wants to be in that situation," says Mark Sonneborn, vice president of information services for the Minnesota Hospital Association.

No other states have yet adopted EHR mandates. But Maryland is requiring private insurers to build into their payment structure incentives for acquisition of EHRs and penalties for not adopting them. And some state Medicaid programs are expected to impose certain requirements—mostly for public-policy reasons—that exceed the federal criteria for meaningful use, notes Mickey Tripathi, president of the Massachusetts eHealth Collaborative.

Massachusetts hospitals must have CPOE by Oct. 1, 2012, and that's distinct from meaningful use rules imposed by the federal government. In addition, Blue Cross Blue Shield of Massachusetts requires CPOE as part of its alternative quality contract—a global risk contract with a quality bonus attached. The Blues' 2012 deadline may have had more impact than the state's in spurring hospitals into action, Tripathi says. Roughly 40 percent, of Massachusetts hospitals already have CPOE systems, and another third are in the planning stages, according the Massachusetts eHealth Institute.

David Smith, senior director of health data analysis and research for the state hospital association, says hospitals are less focused on the EHR mandate because it's five years away. But he doubts the state will actually yank a hospital's license if it fails to meet either deadline.

Bill Shikolovich, vice president and CIO of Tufts Medical Center in Boston, notes that his organization will complete its CPOE deployment by 2011—but not because of the state mandate. Tufts started planning for CPOE in 2005, three years before the state law was passed. The health system's goals for clinical IT, he says, are to deliver higher quality at lower cost while maintaining its network.

Similarly, South Shore Hospital in Weymouth, Mass., will finish implementing CPOE in September, notes Dell Dixon, the hospital's CIO. At that point, South Shore will be only a few modules short of having a complete EHR. Dixon, who has regular contact with colleagues around the state, says he believes Massachusetts has reached a tipping point, noting, "Everybody's on board, everybody wants to get it done."

A similar mindset prevails in Minnesota. In 2008, 30 percent of hospitals there had CPOE, 19 percent had full EHRs, and 61 percent had partial systems, according to the Minnesota Hospital Association. All the numbers exceed the national average.

Sue Severson, director of health IT services for Stratis Health, a Minneapolis research organization, notes that the large, integrated delivery systems that dominate Minnesotan health care are accelerating computerization of hospitals and physician practices. That factor, plus the state's emphasis on quality improvement and the federal EHR incentives, "will continue to propel us forward," she says.

Minnesota providers say the state mandate is a minor factor in their thinking. St. Mary's Duluth Clinic Health System has had an EHR in its ambulatory clinics for six years, says Rocky Chapin, executive vice president of the hospital division. By Jan. 30, 2011, SMDC will complete implementation of the EHR in its acute care hospitals. Chapin says the hospital started planning the rollout long before there was a state mandate.

Similarly, Kanabec Hospital, a critical-access facility in rural Mora, is a HIMSS Level 6 facility that has had an inpatient EHR for several years. But Sue Belford, revenue cycle manager, acknowledges that some other rural hospitals might have difficulty meeting the deadline for the state mandate.

This article 1st appeared in the July 2010 issue of HHN Magazine.

To respond to this article, please click here.