certified ehr vendor attrition
TRANSCRIPT
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Abstract
The Health Information Technology for Economic and Clinical
Health (HITECH) Act, which passed under the American Recovery
and Reinvestment Act (ARRA) in 2009, provided incentive money to
healthcare providers to adopt and use Electronic Health Record
systems (EHRs) in a way the government deemed meaningful.2
These “Meaningful Use”(MU) requirements were established by the
Center of Medicaid and Medicare Services (CMS)3 .Currently, there
are two stages of MU. Stage 2 requirements began to be enforced
in 2014 for all providers who had met stage 1 requirements for at
least two years 3. Not all EHR vendors have been able to upgrade
their EHR system sufficiently for it to be certified for stage 2 of MU
because of stage 2’s high demands for interoperability. As a result,
many providers who were able to attest to MU stage 1 have EHR
systems that cannot operate at a stage 2 level4. Providers who do
not meet stage 2 requirements will no longer receive incentive
money, and will begin to receive a penalty to their Medicare
reimbursement in 2015.
The purpose of this research was three fold: 1) to determine the
percent of Medicare eligible providers who purchased an EHR from
a vendor certified for MU 2 in 2014; 2) to investigate which EHR
systems Medicare eligible providers are switching in order to meet
MU2 requirements; and 3) create an original model that can
predict if a Medicare eligible provide is likely to switch EHR
systems.
Introduction
Results
References
Acknowledgements
We would like to thank the faculty and staff of the UT Austin
Health Informatics and Health IT certificate program, and
specifically Mr. Bob Ligon, Ms. Julia Martin and Dr. Leanne Field
for their guidance, support and feedback in the creation of this
poster.
This project was completed under the guidance of Mr. Bob Ligon.
The CMS provides the public a list of all the eligible providers and
hospitals who attested for Meaningful Use stage 1 and stage 2, the
year they attested for MU, the name of the EHR vendor and the
software version that was installed at the time. Using the
statistical software R, we restructured the data and looked for
meaningful patterns through logistic regressions and partitioning
trees. We also used R and excel to determine how many providers
had switched to a new EHR, and what EHRs they switched to.
Components Percent improvement from using a CDSS
Diagnostics Drug
prescribing and dosing
Prevention Patient
outcome
Overall or clinician
performance
Jaspers et al.
1 20% 75% 67% 30% 63%
2 20% 60% 74% 39% 66%
3 64% - 75% 4%
4 57% 14% 43% 86%
5 40% 66% 76% 18% 59%
6 - 100% 0% 50%
7 100% 50% 100%
8 - - 50%
9 61% - 22% 61%
Eberhardt et al. 40% 66% 64%
Average 30% 60% 55% 41% 61%
Components Percent improvement from using a CDSS
Diagnostics Drug
prescribing and dosing
Prevention Patient
outcome
Overall or clinician
performance
Jaspers et al.
1 20% 75% 67% 30% 63%
2 20% 60% 74% 39% 66%
3 64% - 75% 4%
4 57% 14% 43% 86%
5 40% 66% 76% 18% 59%
6 - 100% 0% 50%
7 100% 50% 100%
8 - - 50%
9 61% - 22% 61%
Eberhardt et al. 40% 66% 64%
Average 30% 60% 55% 41% 61%
Necessary Features Percent success with feature
Workflow EHR
Integration Specificity
Automatic provision of
DS
Provision of DS at point
of care
Computer based
generation of DS
Recommendation rather than assessment
The high demand for interoperability in Meaningful Use stage 2
made it difficult for many vendors to get their EHRs certified. As a
result, many physicians were left with an EHR that that was not
certified, making it impossible for them to claim Meaningful Use
incentive money. If their EHR is not replaced, it
will eventually lead to them receiving reduced Medicare
reimbursement. Using the data from the Center of Medicaid and
Medicare Services (CMS) about physicians enrolled in the Medicare
program, we discovered a few trends. Modular EHR system were
more much more likely to be stage 2 certified than complete EHR
systems. Of the providers that switched from an uncertified HER to
a certified one, approximately 85% switched to a cloud based EHR.
The University of Texas at Austin, Health Informatics and Health IT Certificate Program, Fall 2014
Pablo Alvarez B.S., B.A. and Jonathan Engelhardt B.S.
Certified EHR Vendor Attrition: Effect on Eligible Providers’ Attestation to MU2
Methods
Contact Information
(1)CMS.gov (2014) “Data and Program Reports” Retrieved from
http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html
ePrograms/DataAndReports.html
(2)HealthIT.gov(2014); “Health IT Legislation and Regulations’, Retrieved
from http://www.healthit.gov/policy-researchers-implementers/health-it-legislation
(3)Center for Medicare and Medicaid Services (2014); “EHR Incentive Programs”,
Retrieved from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprogr
ams/
(4)The Office of the National Coordinator for Health Information Technology (2014);
“Data
Analytics Update”, Retrieved from
http://www.healthit.gov/FACAS/sites/faca/files/HITPC_DataAnalyticsUpdate_011414
(5)athenahealth (2014) “The Power of Cloud Intelligence”, Retrieved from
http://www.athenahealth.com/
(6)Acumen Physician Solutions (2014) “Acumen nEHR” Retrieved from
http://www.acumenmd.com/products/nehr/
(7)MEDENT EMR/EHR (2014) “MEDENT EMR/EHR” Retrieved from
http://www.medent.com/
(8)Practice Fusion (2014) “Products” Retrieved from
http://www.practicefusion.com/electronic-health-record-ehr/
42%
58%
Provider's with uncertified Vendors
Provider's with certified Vendors
n=272,909
42% of Medicare eligible providers purchased an EHR from a
vendor that was certified for meaningful use stage 2
athenahealth Inc 50%
Acumen Physician Solutions
22%
Other 11%
MEDENT - Community
Computer Service Inc 9%
Practice Fusion 4%
Epic Systems Corporation
4%
n=166
Figure 2 presents the vendors that Medicare Providers are
switching toas of 2014. All of the vendors shown are certified for
MU2. 85% of the providers chose a MU2 certified vendor that
hosted their produce in thecloud: athenahealth Inc, Acumen
Physician Solutions, MEDENT –Community Computer Service and
Practice Fusion .
Conclusion
We drew the following conclusions from our external data
analysis.
• 42% of Medicare eligible providers who are currently
participating in the meaningful use incentive program
purchased EHRs from vendors that were certified for MU2.
• Over 85% of the Medicare eligible providers who have
switched from an uncertified product to a product certified
for MU2 moved to athenahealth inc, Acumen Physician
Solutions, MEDENT – Community Computer Service Inc, or
Practice Fusion. All of those vendors provide cloud based
EHRs.
• Using the predictive model, we determined that:
• All specialties were equally likely to have an EHR that
did not certify for stage 2.
• Providers with modular EHR system were much more
likely to have a system that is certified for MU2.
• Early adopters of EHRs tended to have an EHR system
that were not certified for MU2
• The state a provider practiced in had a large influence
on whether or not a provider would have a MU2 certified system.
In this partitioning tree, branches to the left signify that physicians in that category
were more likely to have an EHR certified for Meaningful Use stage 2. The model shows
providers with modular EHRs were more likely to have a certified product, early
adopters were less likely to have a certified product, and the state the provider is
located in has an effect on if the provider is likely to have a certified EHR. The lack of a
split for physician specialty shows that all specialties were equally likely to have an EHR
certified for MU2.The ROC curve has an area of 78.9% signifying our model has
significant predictive model.
FIGURE 3. PARTITIONING TREE OF PROVIDERS WITH A MU 2 UNCERTIFIED EHR
Jonathan Engelhardt
Pablo Alvarez
FIGURE 2. EHR VENDORS MEDICARE PROVIDERS ARE SWITCHING TO
FIGURE 1. MEDICARE PROVIDERS PURCHASING EHR SYSTEMS CERTIFIED FOR MU2 in 2014
ROC Curve of Partitioning Tree