I was recently asked the following by a colleague:

We know that every organization has some physicians who just will not fully use the EHR. They will have nurses, MAs, and other clinical staff do all of the data entry. They may just hand the staff a piece of paper and have them enter the problem list. A specific example would be the MU requirement for weight counseling – do you think it is acceptable for an MA to indicate in the record that the physician did the weight counseling? Clearly it makes sense to have nurses and other clinical staff enter medications and even other orders and even start notes, but where do you draw the line?

This question certainly walks the line between facilitating accurate data entry vs.what is appropriate.

If an organization is truly going to embrace this much-needed change in healthcare, they need to enforce that their clinicians do the right thing. In this case, it would be physicians taking 100% ownership of entering the documentation specific to weight counseling. They are the ones actually provided the counseling.

I understand that is a black-and-white response, but I strongly believe that if an organization’s culture accommodates physicians who choose not to do their complete EHR responsibilities (e.g. not documenting the counseling that YOU provided), then it defeats the entire purpose of what we’re doing.

The EHR revolution is strongly driven by the fact that paper is not efficient and creates too many points of failure. Not only is the medium (paper) antiquated, so are many of the policies and processes that support those paper workflows (e.g. documenting a note that you then pass on to someone else to then “document a note” on your behalf).

Unfortunately, I believe most physicians are put into a “get it done now vs. a get it done right” scenario due to the payers’ stringent reimbursement policies. I completely understand the time demands on these physicians. But the rule I try to instill with all of my groups is that, “if you did it, then you must enter it in the HER.” Otherwise, the effectiveness and efficiencies of an EHR are lost if the old way of doing things is still embraced.

The groups that I’ve worked with would require the physician enter that piece of documentation themselves instead of the MA. The only groups that I’ve worked with that would allow this scenario to happen would be if it was the physician’s nurse — not an MA –entering the documentation. To me, the issue is twofold. The first is workflow (reasons already stated), the second is the lack of credentials of an MA. I know I’d want a higher-credentialed healthcare provider entering that information if it’s not the physician themselves.

Mitch McClellan is manager of implementations at MBA HealthGroup of South Burlington, VT.

To avoid penalties of 1% of on Medicare Part B Fee-for-Service revenue in 2012, physicians must ePrescribe on at least 10 unique Medicare encounters by June 30, 2011. The G8553 ePrescribing procedure code must be submitted on all associated claims.

To qualify for a 1% bonus on Medicare revenue in 2011 under MIPAA (Medicare Improvement for Patients and Providers Act) and avoid a 1.5% penalty in 2013, physicians must ePrescribe on a total of at least 25 unique Medicare encounters by the end of 2011. I would recommend, setting the bar a little higher to be on the safe side and guard against claims filed under the wrong primary.

Please note that eligible physicians aiming to achieve Stage 1 Meaningful Use in 2011 and collect electronic health record (EHR) incentive money under ARRA (American Recovery and Reinvestment Act) cannot collect ePrescribing incentive dollars under MIPPA during the same reporting period. This may lead some to elect 2012 as their first EHR incentive payment year.