Like many people, Chris Tirabassi has watched the political parties duke it out over the relative merits of the Health Information Technology for Economic and Clinical Health (HITECH) Act. As practice administrator for CNY Diagnostic Imaging Associates LLC (Liverpool, New York), however, he has little time for philosophical discussion. Instead, Tirabassi is knee-deep in the meaningful-use mandates of the HITECH Act, as they apply to CNY’s Syracuse-area private practice of six radiologists.
Five years after widely embracing PACS, the four-location, radiologist-owned practice decided to pursue stage 1 of the meaningful-use provision. Avoiding penalties, Tirabassi, says, was certainly part of the rationale.
“Meaningful use is a pure carrot-and-stick program. It’s better to take the carrot than to get punished by the stick.”
—Chris Tirabassi, CNY Diagnostic Imaging Associates
The decision to pursue the carrot took shape in early 2013. At that time, Tirabassi began assembling the pieces needed to collect the appropriate data for a government-mandated 90 consecutive days. CNY planned to attest to stage 1 meaningful use prior to the end of 2012.
Getting to the brink of attestation has been neither easy nor inexpensive. Tirabassi estimates that software, support, and operational costs of preparation have probably cut into about half of the anticipated incentive payment. “From an administrative standpoint, we’ve consumed about 160 hours of administrative time to meet and to develop the policies and procedures,” he says. “For training time, we’re in the range of 60 to 80 hours, across the company.”
Beginning the Journey
In stage 1, the government’s goal is to foster the capture of additional data to promote better health-care utilization. It’s a tall order, and Tirabassi hopes that the result will be greater practice efficiency.
The journey started with the naming of a lead team consisting of Tirabassi, the practice’s assistant administrator (a workflow expert), and two people from FUJIFILM Medical Systems USA, the software provider that powers most of CNY’s electronic health record (EHR) solution. CNY uses the Fujifilm Synapse® RIS (version 6.x), its integrated billing module, and its meaningful-use module; it interfaces with the local regional health-information organization and MEDENT, a regional EHR vendor—enabling the practice to communicate directly with several referring offices.
An outside consultant familiar with the Fujifilm RIS also joined the team. The consultant, the Fujifilm people, and the internal team started working together in early spring 2013 to begin the planning process.
Tirabassi purchased a module from Fujifilm that included additional software and a five-year maintenance agreement. “Internally, we had to consume additional resources for office managers to be involved,” Tirabassi says. “We had to get more input from our internal IT department, as well as our outside IT support system. Everything we needed to comply with the meaningful-use requirement was part of the Fujifilm system. The other resource was the time needed to train staff in how to capture the data.”
Doing the Homework
After the team had been assembled, each member pored over the fine print on the CMS website, which included the instructions and guidelines needed to comply with meaningful use. “The first steps (after we formed the team), which really drove the entire process, were to decide which core items we would measure and which we would exclude—and to decide which menu items were most related to our practice,” Tirabassi explains.
He adds, “There are 14 core items you have to account for; you have to deal with each of the 14, but you have the latitude to decide which ones you can measure and which ones can be excluded, based on the specific nature of your practice.” CNY chose to be excluded from using computerized provider order entry (CPOE) for medication orders, from prescribing electronically, from recording and charting vital signs, from providing patients with an electronic copy of their health information, and from providing clinical summaries for each office visit.
Stage 1 meaningful use essentially relates to primary care and patient-centered services—and not as much to “ancillary radiology, pathology, anesthesiology, and the types of practices that are more exam oriented,” Tirabassi reports. Of the 10 menu-set objectives in stage 1, CNY team members picked the five that were most relevant to