Meaningful use for the pediatrician.

it seems that every other week something is new in our medical offices; we are bombarded from all directions. Insurance claims, electronic health records (EHRs), medical boards, hospital privileges—change has become the norm and medicine has become a moving target. Meaningful Use, through its application to EHRs, hopefully has the potential to drastically change how we practice medicine in the next five years in a good way. There are compelling reasons to move your office to the electronic age. Let me explain. In February 2009, President Obama signed the American Recovery & Reinvestment Act into law, a landmark bill that contained within it the impetus to restructure healthcare into the electronic age. Seventeen months later the Federal Register released the Final Rule for Meaningful Use. This document broadly outlines the functional requirements of EHRs in order for eligible providers and eligible hospitals to earn the significant federal stipend that was earmarked in this landmark legislation to offset the cost of computer system implementation and training. Two criteria must be met to earn the federal EHR reimbursement. First, providers must obtain a qualified EHR product that has been certified through designated agencies. Secondly, the provider must prove functionality of this electronic record by producing health data reports for a government review. Once both steps have been successfully completed, the provider must meet either Medicaid or Medicare patient volume qualifying standards to finally earn the stipend. For pediatricians, the standard is Medicaid volume, based on the percentage of patient visits. An Eligible Provider (EP) is defined as a physician, nurse practitioner, certified nurse-midwife, dentist, or physician assistant (who works in a federally qualified health center). In order to qualify for federal funds in the first year, the provider must first attest that >20% of his/ her patients seen in a 90-day period are Medicaid-insured. After the first year, the 90-day period is expanded to a full 12 months. There are two categories of stipends—a higher stipend of $63,750 is reserved for EPs who work in a federally registered health center, or whose practices serve a Medicaid patient volume that is >30%. The second category, with a lower stipend of $42,500, is for those pediatricians whose practice volume consists of 20%-29% Medicaid insured patients. This latter category encompasses the typical pediatric practice. Practices who successfully meet the EHR stipend criteria are eligible to receive federal stipend dollars commencing in 2011 with a five-year payout. The final date to apply for these funds is set for 2016 in order to complete the incentive payments by 2021. Given that funding streams are affected by future politics and budgets, it is recommended that EPs apply for these funds in a timely fashion in order to guarantee access to the full payment. The first year’s payment is based on the attestation that the EP has adopted, implemented and upgraded their EHR for Meaningful Use. The objectives of Meaningful Use are to improve quality, safety, efficiency and limit disparities in health care. Furthermore, the hope is to engage patients and families in their own healthcare, to improve care coordination, to improve population and public health as well as ensure privacy and security. The ultimate goal is to drive down the cost of health care and to improve health outcomes. The second year’s payment is based on achieving the three standards set forth in Stage 1. First, a provider must enroll at least 80% of his/her patients in a certified EHR. Second, the EHR must pass extensive security thresholds. Third, EPs must provide reports on 20 of the 25 Meaningful Use objectives that showcase the capabilities of the EHR. Some items