Electronic Health Record

Learn about the Electronic Health Record (EHR), why it is critical for your practice or clinic to adopt, implement, or upgrade an EHR, and how the EHR can help practices and clinics achieve Person-Centered Medical Home (PCMH) recognition. Understand eligibility and requirements for the EHR Incentive Program, as well as Meaningful Use criteria.

What is the difference between an EMR and EHR?

Some people use the terms "electronic medical record" and "electronic health record" (or "EMR" and "EHR") interchangeably. However, the difference between the two terms is actually quite significant. Clinicians used early EMR’s mostly for diagnosis and treatment.

In contrast, "health" relates to "The condition of being sound in body, mind, or spirit; especially...freedom from physical disease or pain... the general condition of the body." The word "health" covers a lot more territory than the word "medical." And EHRs go a lot further than EMRs.

What’s the Difference?

Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:

  • Track data over time
  • Easily identify which patients are due for preventive screenings or checkups
  • Check how their patients are doing on certain parameters–such as blood pressure readings or vaccinations
  • Monitor and improve overall quality of care within the practice

But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.

Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. EHRs are designed to be accessed by all people involved in the patient's care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of "meaningful use" of EHRs.

Much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.

Benefits of EHRs

With fully functional EHRs, all members of the team have ready access to the latest information allowing for more coordinated, patient-centered care. With EHRs:

  • The information gathered by the primary care provider tells the emergency department clinician about the patient’s life threatening allergy, so that care can be adjusted appropriately, even if the patient is unconscious.
  • A patient can log on to his own record and see the trend of the lab results over the last year, which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers.
  • The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests.
  • The clinician’s notes from the patient’s hospital stay can help inform the discharge instructions and follow-up care and enable the patient to move from one care setting to another more smoothly.

So, yes, the difference between "electronic medical records" and "electronic health records" is just one word. But in that word there is a world of difference.

Source: www.healthit.gov

Connecticut Medicaid Electronic Health Record (EHR) Incentive Program

Financial Incentives for Electronic Health Record Adoption and Meaningful Use

Did you know that certain Medicaid health providers may receive up to $63,750 in incentive payments if they adopt, implement, or upgrade and meaningfully use certified Electronic Health Record (EHR) technology?

The Medicaid EHR Incentive Program provides financial incentive payments for certain Medicaid health care providers to adopt and use certified electronic (EHR) technology in ways that can positively affect patient care. The program is administered by the State of Connecticut Department of Social Services with federal support from the Centers for Medicare and Medicaid Services (CMS). As of November 2012, more than 800 eligible health professionals have been paid over $3.8 million in financial incentives statewide and more than 1,100 have registered for the program since its launch in 2011. Nationally, over 104,000 professionals and hospitals have registered with over $4 billion distributed under the Medicaid program.

Who is eligible for Medicaid EHR Incentive payments?

In Connecticut, eligible health professionals are Connecticut Medical Assistance Program (CMAP) enrolled physicians, dentists, nurse practitioners (APRN), Certified Nurse-midwives (CNM) who have 30% or more Medicaid patient volume* (or 20% or more Medicaid patient volume for pediatricians), are not hospital-based†, and are in good standing with the state and federal governmental agencies.

What is required?

Health professionals are required to apply and attest annually that they have met the requirements of the program as outlined here:

First incentive payment year Second and subsequent payment years
Providers can
  • Adopt
  • Implement
  • Upgrade to a certified electronic health record technology
  • Demonstrate meaningful use of certified EHR technology
Must show that you are using certified EHRs in a meaningful way by meeting thresholds for a number of objectives

How much are the incentive payments?

Eligible health professionals may be entitled up to $63,750 in EHR incentive payments over a 6 year period for participating in the program and meeting all the eligibility requirements for the program in each year. The incentive payment is a fixed amount each year with an initial payment amount of $21,500 in the first year for adoption, implementation or upgrading to a certified EHR technology system. Payments in subsequent years are $8,500. Providers can skip years and participation in the program does not have to take place across consecutive years. There are no penalties for not participating. Incentive payments are made to individual providers, not to practices or medical groups, however providers may assign their payments to the group practice organization which may be used to offset costs associated with the practice’s EHR system purchase. Group practices could earn up to $63,750 per eligible professional!

When can I apply?

Health professionals can attest to meeting the Medicaid EHR Incentive program requirements and request incentive payments annually on a calendar year basis. The last date to attest for a payment year is March 31 following the end of the calendar year. The last year to begin participating in the Medicaid EHR Incentive Program and receive the full payment amount is 2016. The Medicaid EHR Incentive program runs through the year 2021. Over 1100 providers have already enrolled!

How do I get started?

Providers must register with the CMS Registration and Attestation System at https://ehrincentives.cms.gov and choose Connecticut as the individual state program that they wish to participate under. Once registered, you will be contacted by email within 24 hours and provided a link to Connecticut’s Medical Assistance Provider Incentive Repository (MAPIR) system where you can begin attesting to fulfilling the program requirements. Register today!

For more information

To learn more about the Connecticut Medicaid EHR Incentive Program:

  • Call the dedicated CT Medicaid EHR Incentive Program call center toll free at 1.855.313.6638, Monday through Friday from 8:00 am to 5:00 pm EST

* Medicaid patients include individuals receiving services under Medicaid Fee-for-Service (FFS), Medicaid for Low Income Adults (MLIA) and the HUSKY A programs.

† An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place of Service code 21) or emergency room (Place of Service code 23) setting.

Connecticut Medicaid EHR Incentive Program — updated 1/9/2013

What is EHR?

An EHR is a systematic collection of electronic health information on individual patients. EHRs are patient health records in a digital format which includes a range of data in comprehensive or summary form, such as demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

1. What is an Electronic Health Record (EHR)?

An EHR is a systematic collection of electronic health information on individual patients. EHRs are patient health records in a digital format which includes a range of data in comprehensive or summary form, such as demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

The purpose of the EHR is to collect complete records of patient encounters, and allowing the automation and streamlining of the workflow in health care settings and increasing safety through evidence-based decision support, quality management, and outcomes reporting.

2. What is the EHR incentive program?

The EHR incentive program was established by the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery & Reinvestment Act (ARRA) of 2009. The program aims to transform the nation’s health care system and improve the quality, safety and efficiency of patient health care through the use of electronic health records. Effective July 13, 2010, the U.S. Department of Health Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) released the final rule providing the parameters and requirements for the Medicaid EHR incentive program under the HITECH Act. The ARRA authorizes states to provide for incentive payments to Medicaid providers for adopting, implementing, or upgrading certified EHR technology or for the meaningful use of such technology.

Registration for the CMS Medicare EHR Incentive Program is now open. Providers should refer to the Path to Payment page on the CMS EHR Incentive Program Web site to review eligibility information pertaining to the Medicare EHR Incentive Program. Some providers will be eligible for payments through Medicare and other providers will be eligible through Medicaid. Some hospitals may be eligible for both incentives.

The Department of Social Services (DSS) has developed a system to manage incentive payments for Connecticut’s eligible providers. The Medicaid EHR Incentive Program was launched with CMS on July 4, 2011. Providers begin by registering with the CMS EHR Incentive Program Registration and Attestation (R&A) System site.

3. What does Adopt, Implement or Upgrade mean?

    Adopt, Implement or Upgrade means:

    • Adopt - Acquire, purchase or install a certified EHR system.
    • Implement - Install or commence use of certified EHR technology and have started one of the following:
      • A training program for the certified EHR technology;
      • Data entry of patient demographic and administrative data into the EHR;
      • Establishment of data exchange agreements and a relationship between the provider’s certified EHR technology and other providers (such as laboratories, pharmacies, or health information exchanges).
  • Upgrade - Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the Office of the National Coordinator (ONC) EHR certification criteria. Some examples of upgrading the existing EHR technology are the addition of clinical decision support, e-prescribing functionality, and computerized physician order entry.

4. What is Meaningful Use?

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted under the ARRA, incentive payments are available to eligible professionals (EPs), critical access hospitals, and eligible hospitals that successfully demonstrate meaningful use of certified EHR technology. The Recovery Act specified three main components of meaningful use:

  1. The use of a certified EHR in a meaningful manner, such as e-prescribing
  2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care
  3. The use of certified EHR technology to submit clinical quality and other measures

To demonstrate meaningful use, providers need to show they are using certified EHR technology in ways that can be measured significantly in quality and in quantity. Eligible hospitals will need to demonstrate meaningful use in their second and third year of participation in the CT Medicaid Incentive program in order to receive additional incentive payments.

Eligible professionals are not required to meet meaningful use for each consecutive year after they have received their first incentive payment for adoption, implementation, and upgrade of certified EHR technology. However, incentive payments will only be made for the years that an eligible professional has demonstrated successful meaningful use of certified EHR technology.

Stage 1 Meaningful Use Criteria

  • 15 Core Objectives (examples: e-prescribing, record demographics, clinical quality measures, etc.)
  • Five Objectives out of 10 from menu set (examples: Drug-formulary checks, incorporate clinical lab tests as structured data, generate lists of patients by specific conditions, etc.)
  • Six total Clinical Quality Measures

Additional information is available at the following link: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2017ProgramRequirements.html

The Connecticut Department of Public Health (DPH) currently does not have the capacity to receive data electronically from electronic health records. Per the DPH, EPs in Connecticut are excluded from meeting the Public Health menu measures. To obtain a copy of the DPH Meaningful Use Exclusion Letter, click on the following link: http://www.ct.gov/dph/lib/dph/communications/pdf_ech/exceptions_letter_from_dph_for_public_health_reporting-_meaningful_use_7_19_12.pdf

5. How do I register for an EHR incentive?

CMS launched the Medicare and Medicaid EHR Incentive Program Registration and Attestation System in January 2011. Providers applying for either incentive payment program must begin by registering with CMS’ EHR Incentive Program Registration and Attestation System, which can be done by clicking the following link: https://ehrincentives.cms.gov/

6. Who Is Eligible for an EHR incentive?

Eligible professionals and hospitals must demonstrate adoption, implementation or upgrade of a certified EHR system and meaningful use of the technology in order to qualify for the Medicaid Incentive Program.

Under the Medicare program, physicians, dentists, podiatrists, optometrists and chiropractors are eligible for federal EHR incentives. Under the Medicaid program, physicians, dentists, certified nurse midwives, and nurse practitioners are eligible if they have a specified volume of Medicaid patients. Physician assistants are eligible under Medicaid if they practice at a federally qualified health center or rural health center led by a physician assistant. Hospital-based professionals are not eligible under either program. It is important to note that a professional cannot receive incentives from both Medicare and Medicaid.

7. What is the CT Medical Assistance Provider Incentive Repository (MAPIR) System?

MAPIR was developed in collaboration with 12 other Medicaid states by DXC Technology. MAPIR is a web-based application that interfaces with the CMS EHR Incentive Program Registration and Attestation System for the exchange of data regarding both EPs and eligible hospitals (EH) a state selection and subsequent provider payments.

MAPIR matches the data supplied by CMS to the EPs/EHs data in the MMIS. Once matched, the EP/EH will be able to register and attest to the EHR Certification Number for the EHR technology adopted, implemented or upgraded and Medicaid encounters and total patient encounters by logging into their secure provider portal.

EPs and EHs have been able to access MAPIR via the secure provider portal since September 1, 2011.

Effective August 1, 2012, Providers will be required to upload supporting documentation into MAPIR. Please refer to the "Professional Instructions" link in the EHR Incentive Program Provider Registration section above for a complete list of the required documentation.

If an EP does not have a logon ID to the secure provider portal and plans to apply the Medicaid incentive program please contact DXC Technology at nctmedicaid-ehr@hp.com.

8. How much are the Medicaid Incentives?

The Medicaid EHR incentive payment is a fixed payment amount and is made based on the calendar year. As indicated in the chart below, EPs can apply for the Incentive Payment Program beginning in 2011 through 2016.

For the first payment year, when EPs have adopted, implemented or upgraded certified EHR where the EP has met the 30% Medicaid patient volume, the incentive payment is $21,250.

In subsequent years, the EP would need to continue to meet Medicaid patient volume and demonstrate that s/he is meaningfully using certified EHR technology. The payment would be $8,500 for subsequent years. The maximum incentive payment over 6 years would not exceed $63,750.

For pediatricians that do not meet the 30% Medicaid patient volume but meet the 20% Medicaid patient volume the first payment year, the incentive payment would be $14,167, and in subsequent payment years would be $5,667. The maximum incentive payment amount for a pediatrician with 20% Medicaid patient volume over six years would not exceed $42,500.

Source: www.ctdssmap.com

This portion of the HUSKY Health website is managed by Community Health Network of Connecticut, Inc., the State of Connecticut’s Medical Administrative Services Organization for the HUSKY Health Program. For the general HUSKY website gateway, please visit www.ct.gov/husky. HUSKY Health includes Medicaid and the Children’s Health Insurance Program, and is administered by the Connecticut Department of Social Services.