Wouldn't it be nice to get paid to go paperless? Ambulatory surgery centers are included in a list of eligible recipients for $2 billion in stimulus funds that states will distribute as grants and loans to encourage adoption of health information technology (you can track the development of these proposed grant and loan programs at www.HealthIT.gov). The funding boost is designed to help you overcome the huge cost hurdle that has hindered EHR adoption thus far. Overcoming the other major hurdle — ensuring a smooth transition from paper to digital recordkeeping — requires careful planning and a thorough understanding of how the technology works in the real-world setting of your hospital, physician's office or ambulatory surgical center.

A process, not just a technology
In theory, electronic health records are supposed to simplify clinical documentation and other business processes in the healthcare arena in order to improve efficiency and outcomes. But that's not always how they work in practice. The biggest mistake you can make when implementing a new EHR solution is to fixate on the technology and overlook the business processes within which the technology will have to function. Be sure to choose an EHR system that provides solutions to the problems that exist in your current workflow.

Start by mapping out your current business processes in detail: everything from scheduling and billing to preference cards and inventory management. Identify any bottlenecks, barriers and areas prone to re-work or ambiguity. Don't make the mistake of automating corrupt data and poor business processes. Instead, view your digital conversion as an opportunity to tackle those problems and select a product that will help you do that. For example, it's quite common for healthcare facilities to suffer from data pollution — poor data management practices that diminish the value of the information you depend upon. The months before an EHR implementation are a perfect time to clean up your database, correcting inaccurate and incomplete information and removing duplicate information from the indexes vital to your daily operations. Addressing these problems first will ensure enhanced benefits from EHR implementation.

Seek direct input from your staff members who have ownership of the business processes at your facility. "If I had to do it over again, I would bring all the parties to the table to gather information and understand how the final product would interrelate with each group," says Michael Schroeder, RN, BSN, director of Novamed Surgery Center in Baton Rouge, La. "For us, that would mean billing, back-office functions, front-office functions, schedulers, the people at the registration and check-out desks, nursing staff, people doing clinical documentation and inventory and resource management. All of those people are going to have some part to play in the new information technology system and can help you understand how the system is going to work in your environment."

In the end, your staff's reward for assisting in the selection and implementation of your new EHR will be the increased job satisfaction and productivity that results when bottlenecks and barriers are removed from their daily tasks. And an EHR system that works in harmony with your facility's processes, from patient check-in to the close of a case, should also provide enough improvements in efficiency to yield a solid return on the investment in time and money you put into it.

Purchasing the right solution
When shopping for an EHR solution, consider the high-level goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Office of the National Coordinator for Health Information Technology:

• ensuring that each patient's health information is secure and protected;
• improving healthcare quality, reducing medical errors, reducing health disparities and advancing the delivery of patient-centered medical care;
• reducing healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care and incomplete information; and
• facilitating health and clinical research and healthcare quality.

The ONC will be updating its strategic plan with specific milestones for a variety of policy matters, and the Department of Health and Human Services will soon release additional EHR guidance based on the work of the Health Information Technology Standards Panel deliverables. Visit the HITSP Web site (hitsp.org) for regular updates that provide the nuts-and-bolts details that you will need to make the right EHR purchasing decisions. Make sure your vendors and their products keep pace with the government's milestones. You don't want to purchase and implement a new EHR only to find it doesn't qualify for funding incentives.

Qualifying for ARRA funds
The government and the health IT industry are springing into action to help doctors and healthcare facilities achieve the goal of establishing an electronic health record for every American by 2014. Over the next several months, decisionmakers in Washington will be hammering out the details of the 267-page HITECH Act, the health IT legislation included in American Recovery and Reinvestment Act of 2009. In order to benefit from the influx of available EHR implementation funding that may be coming your way, you should seize this opportunity to interpret and formulate your strategy before the stimulus package is moving at full speed. Familiarize yourself with the objectives, strategic framework and jargon of ARRA and the Office of the National Coordinator of Health Information Technology. If you fail to act during this critical ramp-up period, it'll be difficult to keep up with the rapid pace of change, and you may end up frustrated to find that you didn't qualify for the incentive funding because you misunderstood the intent.

The majority of the $19.2 billion in ARRA money allocated for health IT will be used to fund incentive payments through the Centers for Medicare and Medicaid Services. Hospitals and physicians, but not ambulatory surgery centers, will be eligible for bonus payments under either Medicare or Medicaid (depending on the patient population served) if they show they are making "meaningful use" of a "certified EHR" product. You'll need to understand what those two phrases mean in order to take advantage of those incentives.

• Meaningful use. In the months ahead, the HHS secretary will be defining the meaningful use requirement further, but for now the general consensus among HIT experts is that meaningful use can be demonstrated by establishing routine health information exchange connections with another provider, such as a lab, pharmacy, imaging center, hospital or other physician. These connections are already being made throughout the country via regional health information exchange organizations.
• Certified EHR. The government has yet to spell out the specific criteria EHRs will have to meet in order to be certified. Currently, the Certification Commission for Health Information Technology is the only government-recognized EHR product certification body, so it's safe to assume it will determine which products will be eligible for ARRA funds. Check out the organization's Web site (cchit.org) for a list of required EHR functionality to achieve certification and a current listing of CCHIT-certified products.