CHICAGO – At RSNA 2011 in Chicago on Tuesday, a packed roomful of curious radiologists sought to educate themselves – trying to decide whether it was worth their while to take the meaningful use plunge.
A joint RSNA/KLAS survey, released this week at the conference, revealed some interesting numbers concerning meaningful use education and adoption. As many as 60 percent of radiologists surveyed said they're at least considering attesting for meaningful use. A quarter of them said they're "very involved" in decision-making about the incentive program. But just 6 percent said they consider themselves to be fully educated about the ins and outs of MU.
It also found that nearly 40 percent of radiologists are either concerned about opaqueness in meaningful use guidelines or fear decreased efficiency as a result of adopting those guidelines.
[See also: Radiologists need MU education.]
In a session at RSNA titled "Meaningful Use: Experience from Radiology Practices," experts sought to enlighten those who may have assumed the attestation process wasn't worth their while.
Conventional wisdom for many specialists, of course, is that Stage 1 rules are "onerous," and "really written for general practice" said Steve Fischer, CIO of Minneapolis-based Center for Diagnostic Imaging.
He'd once assumed so himself – and had to think hard about whether going after the federal largesse made sense for his radiology practice: "Does it make sense?" he wondered. "Will radiologists even qualify?"
Even though it represented a substantial investment, he said, it soon became apparent that it "made sense for us to play."
But it wasn't just the $44,000 that motivated him. The "real why" was "ultimately not the carrot, but the stick." If penalties are set to hit the stragglers by 2015, he reasoned, if it would have to happen anyway, "we might as well go for the incentives."
Having started the multi-stage process in earnest in January 2011, his practice plans to start collecting data for attestation in January 2012.
There were challenges along the way, of course, as there will be for other radiologists planning to follow Fischer's lead – chief among them understanding the requirements for certification (especially for integrating capabilities such as e-prescribing) and understanding reporting requirements.
Fischer reminded the audience, for instance, that "attestation and meeting the metrics is by radiologist, not by practice," so one would "definitely need to have a dashboard to monitor and support that."
But while Stage 1 meaningful use may not make financial or operational sense for some radiologists, for many more it may be well worth their while, he said.
Meanwhile, requirements for Stages 2 and 3 are yet to be defined – "so any lobbying you can do to get to CMS to understand that criteria for two and three really need to be specialized, to be specialty-focused, we encourage everyone to do that," said Fischer. "We can make a difference."
[See also: Radiologists shouldn't shy away from meaningful use.]
Keith Dreyer, DO, vice chairman of radiology computing and information sciences at Massachusetts General Hospital, let the audience know that HITECH largesse is "already being rapidly spent," with nearly a billion dollars already paid out – his not-so-subtle subtext being that it might be smart to get on board while the getting's good, before the Oct. 1, 2012 deadline, to be eligible for the full $44,000.
Dreyer said there's going to be "a lot of discussion" at ONC and CMS this coming December about "what's going to happen with imaging" in Stages 2 and 3.
In the meantime, he said, radiologists are almost all eligible to qualify as part of the eligible provider (EP) program.
The "challenge," he said, "is most of us work at hospitals." The MU eligible hospital program "may not serve your needs in the EP program," he said. It's important then for hospital-based radiologists to "talk to your CIO," said Dreyer, and ensure their RIS is certified specifically for the EP program."
"If you're outside a hospital, or work in an imaging center, and you're on your own buying technology, it's a little bit easier, because you can control your own destiny and look for a RIS that's certified for the EP program," he said.
[See also: Radiologists worried about meaningful use .]
Still, it's crucial to "know what to ask your vendors," said Dreyer. "Certified technology will solve a lot of challenges for you." There are 25 measures – and vendors have to provide certified technology for each one.
Specialists such as radiologists have a bit more leeway. Of the meaningful use core measures and menu set objectives, the number items that can be opted out of or are eligible for exclusion means "you can get pretty close to chipping [them] all away" – to a point "that makes life a lot simpler."
That won't change what one will need to have in terms of certified technology, but it will assuage what a radiology practice will need to do operationally.
Due diligence
The good news is that eligible provider certification from RIS vendors has grown by leaps since just last year, when very few had that distinction. Even better, "a year from now, nearly everybody is going to have certification," said Dreyer.
Ultimately, whether or not – and, if so, how – to take the MU plunge comes down to a simple checklist, he said: consideration, preparation, execution and compliance.
"Understand fundamentals," said Dreyer. Determine your eligibility and the financial impact, and "run the numbers to see if it's worth it for you and your group to do." Then, "take measure of the requirements – see what it would take." Meet with other practice stakeholders, too, talking to other specialists, or the CIO or CMIO.
Next, "plan technology and operations strategy," he said. "It will require implementation or upgrades. Finally, register online, monitor compliance with a dashboard – often supplied by vendors – and "then do online attestation."
No question, there are challenges, both for providers and for vendors. For many radiologists, meaningful use is "changing current concept of clinically relevant technology." And while their EMR-making colleagues welcomed and were prepared for certification, many RIS/PACS vendors were caught off-guard by the new mandates.
But ultimately, the MU process is worthwhile, Dreyer reasoned. The radiologist extends the purview of his or her care, and a more complete RIS/PACS "becomes something of an imaging electronic health record."
After all, said Alberto Goldszal, CIO at New Jersey-based University Radiology Group, the "goal is to improve health outcomes." Meaningful use incentives are "not the goal – just a tool for you to get there."
