Questions from Physicians in the Field

During the 2012 ACP annual meeting in New Orleans, I had an opportunity to field and respond to member questions on health IT. A selection of most frequently asked questions and answers are provided for your reference below.

EHR Selection

I have tried to purchase an EHR system but none of the vendors are returning my calls. What else can I do? Will I be penalized?

We have heard this complaint from a number of our members both at ACP and through AmericanEHR Partners. The rush to adopt EHRs over the past few years is definitely straining vendor capacity to the breaking point. As such, many EHR vendors have long wait lists and are triaging the practices they take on. Vendors appear to prefer larger practices in geographic areas in which they have substantial penetration in order to optimize use of their resources. In turn, a lot of smaller practices and those in rural areas are left without many options. If you are in this situation, here are some recommendations:

  1. Ensure that you have really looked at all of your available vendor options. There are a lot of good EHR products being sold by smaller vendors who may have more bandwidth to implement in your practice.
  2. Don’t panic and purchase a product that you do not like just because you can install in quickly in order to get the incentive payment or avoid the penalties. If the product does not fit your practice you can easily lose more in lost productivity than the value of the incentive payment and penalty combined.
  3. Use time widely to get your practice ready for the installation. For instance, begin using standardized paper templates for your medication and problem lists, so that the information is easier to enter into the EHR.
  4. AmericanEHR Partners has a new Request for Proposal feature that allows you to contact participating EHR vendors through our site. This may get you connected to the right people faster.

The penalty component of the EHR Incentive program is still working its way through the regulatory process but it is likely that it will be based on your ability to meet the Meaningful Use requirements sometime in 2014, with the reduction in fees beginning in 2015. During the first year, the penalty will be 1% of your charges to Medicare. For most internal medicine practices this will be approximately $1,000 per provider. We are still uncertain about the exact details of exemptions to the penalty and whether they will take into account practices that are trying to implement systems.

What questions should I ask an EHR vendor?

The  Request for Proposal questions on AmericanEHR Partners are a great place to start. You should also understand what happens if you want to change EHRs or the company goes bankrupt. I encourage you to read the following article: Software as a Service (SaaS) and Application Service Providers (ASP) — What You Need to Know.

My EHR is not working out. What are my options?

Make sure you have exhausted all options with your existing EHR. Converting to a new system is likely  to be nearly as difficult as going from paper to your current EHR. One of the ways to become more proficient with your EHR is to arrange additional training with your vendor. Data we have collected through AmericanEHR clearly shows that additional training is strongly tied to EHR satisfaction levels, especially with respect to more advanced features. Once you make the decision to change, do your homework regarding different systems. Talk to your current vendor about which information can be transferred to the new EHR and the costs of this conversion. It may be cost-prohibitive to have all the information in your old system transferred as discrete structured data. You should prioritize the data that you wish to to transfer to the new system. A good place to begin is the data needed in order to attest to Meaningful Use.


I am still struggling with chart conversion and I have been working at it for more than 6 months. What can I do?

Try not to get caught up with perfection, especially when first converting from paper charts to an EHR. Try entering medication and problem lists during the first patient visit and additional information during subsequent encounters. Avoid entering/scanning the entire patient chart into the EHR; focus on information that is relevant to patient care. For further suggestions, listen to the recorded webinar Coping with Chart Conversion, Experiences and Techniques from a Small Practice. Converting to an EHR system is hard and it is easy to get caught up in the small details.

Government Incentive and Penalty Programs

What do I need to do to in order to achieve Meaningful Use this year?

If you have already attested to Meaningful Use in 2011, make sure that your levels don’t drop during 2012. After the first year you participate in the program, you will need to report for the entire year instead of 90 days. Stage 2 measures are currently going through the regulatory process and are not expected to be finalized for a few months yet. The Stage 2 requirements will not begin until 2014 so you have some time to work on Stage 1 requirements.

I was E-Prescribing last year but have been penalized this year. What is going on?

Many providers were caught off guard by the E-Prescribing penalty that started this year. For those unfamiliar with the program, I suggest reading Overview of the Medicare 2012 E-Prescribing Incentive (eRx) & 2013 Penalty Program. Unfortunately you cannot stop the penalty on this year’s claims but its not to late to avoid next year’s penalty.

When will I get penalized for not having an EHR?

The penalty component of the CMS EHR Incentive Program is still working its way through the regulation process as part of CMS’s Notice of Proposed Rule Making (NPRM) on Stage 2 Meaningful Use. It is most likely that the penalty will be based upon activity in 2014 in relation to claims submitted during 2015.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.

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