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Pagosa Springs Medical Center (PSMC) will soon implement an electronic health record (EHR) system.
The EHR allows healthcare providers to record patient information electronically rather than in bulky paper records.
On Feb. 13, 2009, Congress passed the American Recovery and Reinvestment Act (Recovery Act) of 2009. In order to shift the health industry into the digital age, the act provides incentives and deadlines for hospitals to adopt the use of EHR.
According to Sue Schmidt, clinical application specialist at PSMC, the five objectives of the implementation of the EHR include:
• Improved patient care and safety.
• Enhanced communication: The EHR not only assists with communication between provider and patient, but also back to the organization itself. An example of this is the use of a patient portal that will enable the hospital to post patient exams, what happened in the hospital, a patient’s medication and allergy list, and any instructions or education concerning the patient, such as recent lab work. The patient will also be able to communicate with the provider through secure e-mail via the patient portal.
• Potential to include revenue: EHC will help capture any missed charges in the system.
According to Schmidt, potential vendors of the EHR system did a department review for the medical center. They found that through the EHR the hospital could capture an estimated $80,000 a year in missed charges.
• Increased efficiency: The EHR system will allow the hospital to type in a key word or phrase into the system and conduct a search of the patient’s record. In this search, the EHC will pull up anything in the record that contains the word or phrase.
• Promote quality improvement.
Choosing a vendor
“We wanted not just to choose an EHR,” Schmidt explained, “we wanted to make sure it was the right one for our organization.”
When choosing an EHR vendor to work with, center officials focused on both the positive and negative points of each system. Points include vendor viability, the cost of purchase and support, and provider and user approval.
“We want to make sure we choose a vendor that is going to be there and viable in the marketplace for the long run,” Schmidt explained to the Upper San Juan Health Service board during its Feb. 26 meeting.
Companies that were reviewed as potential vendors were analyzed based on these points. The smaller companies were more affordable, but they did not have as strong of a presence in the marketplace.
Larger companies, such as Meditech and Cerner, were considered through cost analysis. Staff went through reference checks with other hospitals the same size as PSMC, as well as focusing on their implementation programs.
PSMC practiced what is called a “sandbox demonstration.” This was a hands-on demonstration of the vendors’ program conducted at the medical center.
“They got a chance to take real life scenarios, hands-on use with the systems, and got to go through and ask a lot of questions and then rate them as soon as they were done.” Schmidt explained, “After the ratings were all turned in, the top choice was Cerner.”
As a part of the Recovery Act, Medicare and Medicaid are providing hospitals with payment incentives to implement the EHR into the system. These payments can be received by the hospital between 2011-2014. If the hospital does not implement the EHR within four years, it will be assessed a penalty by 2015.
PSMC will not be receiving a reimbursement for the full amount; however, it will receive a significant portion from Medicare anywhere from 12 to 16 weeks after implementation.
The Medicaid payment can be expected in the same time period as Medicare, however, only 50 percent will come the first year, 40 percent the second year, and 10 percent the third.
If PSMC qualifies for Medicaid payment towards EHR, it will receive about $125,000, depending on the medical center’s inpatient acute Medicaid business.
PSMC anticipates that between 60 percent and 74 percent of the cost will be paid via Medicare and Medicaid EHR incentive payments, in a lump sum.
The EHR will be funded by the medical center on an interim basis until PSMC receives Medicare and Medicaid funding. The balance not paid after the lump sums are received will be financed over 36 to 48 months. The capital cost is $2.2 million.
“We anticipate financing the entire system, then repaying a significant portion when Medicare makes their lump sum payment.” Dennis Wilson, CFO, explained.
Currently, PSMC can only estimate the amount it will be paid. The final payment for the EHR will not be known until the cost report is finalized in 2015. All is negotiated with the Medicare Administration contract. At this time, there is still time for negotiation about what will be included and what will not be included in these costs.
“These are still estimates,” Wilson commented, “there are a lot of things that we do not know today, there are some things that we will not know until the year when we have the system in stalled.”
After the medical center signs the contract, it will take a month or two until the vendor, Cerner, starts implementing the program in the system. Orientation lasts another three months while staff works closely with the Cerner team.
The projected “Go Live” date for the project is Feb. 1, 2014. After this date, the medical center will gather data for 90 days. This data is submitted for Medicare and Medicaid attestation.
PSMC is one of the few medical centers that does not currently use an EHR system.
“We’re one of the last three in Colorado,” Wilson explained to the board.
The board concluded the discussion over whether or not to implement the EHR system with a unanimous, “yes.”