Below are two links to substantive accounts of the latest MU evolution. The first, released yesterday, is an explication by HHS National HIT Coordinator Dr. D. Blumenthal & CMS deputy administrator M. Tavenner. Given tables summarize new Core and Menu Set objectives.

The second link takes you to HISTalk’s Inga, who had by early morning today, compiled a straight-forward contrast, sort of a “then-and-now,” as regards MU after yesterday’s announcement by HHS.

You’ve probably spent the last 24 hours squinting at as many websites & sources as we have. Trying to keep you up-to-date while avoiding information overload & repetition, the blogmasters extend what we’d like to call a representative sample of our latest research done for you by our agents in the field.

Meaningful Use Regulation for EHR

Inga's Comparison

The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

Another popular discussion point at HIMSS2010 is the intrinsic need for workflow change when practices move to an EMR. Simply installing a new solution will not necessarily fix process issues and inefficiency. As our brand new EVP of Sales stated “EMR is, and should be, more than just a pretty screen.”

You are introducing a new element that must change the way you work. For instance the process of a nurse putting a folder on an exam room door, to notify the doctor that a patient is ready (sometimes accompanied by a little green flag on the door frame), will be unnecessary and redundant. The number of these processes and workflows that need to be reviewed, and adjusted accordingly, will greatly depend on each practice’s current state of documentation, but everything should be evaluated.

This massive evaluation isn’t in vain, every change should be an improvement and every improvement, great or small, will have a ripple effect that at the end of the day will improve patient care and patient safety. Ultimately, that is the overriding goal. (Oh, and cost savings…but that’s understood, right?)

More Reading:

www.emrandhipaa.com (don’t miss the comments here)

"Workflow of the Workflow"

Dr. Greiver: Workflow is King

HIMSS wrapped up today and as a recap I thought I’d post some interesting conversation topics. First up is a conversation with some good folks at Henry Mayo Newhall Memorial Hospital (HMNMH).

How important is it to have a Physician Champion for your EMR projects? According to the two doctors and the Physician Project Manager from HMNMH, there was no doubt that it’s essential. I gleaned from that conversation that one of the overriding concerns of doctors, who have yet to adopt a certified EMR, is that many don’t want to change a system they are already comfortable with. Those doctors need a colleague who have seen the benefits of an EMR; an expert who can optimize the project, provide education, champion the project, mentor staff, and generally be a guide who garners support.  A role that was once defined simply as a “subject matter expert” has evolved into a position of critical importance integral to the success of ERM adoption.

This is no longer a one-way street with the IT department handing down process changes and the Champion promoting them, a good Physician Champion is involved in the entire redesign of processes and workflows, ensuring that changes align with how a clinician thinks and works. (Digitized Medicine).  The goal is to use the Physician Champion’s expertise to structure the project and optimize the way the EMR is used. From structured document templates to order sets and support tools, the Champion is a key player in strategic decision making. Selecting and installing an EMR is just one half of the battle. Participating doctors need to be on board and ready to use their newly adopted systems. A Physician Champion can rally the support needed to bring the whole thing full circle on the Information Superhighway (you know that speedway we were warned about?).

Projects that do not commence with a Physician Champion can experience problems on a variety of levels resulting from a lack of insight and general usage. A Champion is the person who can make a new EMR implementation a win-win for doctors, patients, and IT administrators (maybe a win-win-win?).

Stay tuned for more conversations from HIMSS.

More Reading:

The Healthcare Blog

EMR Selection: The Physician Champion

Are Physician IT Champions Necessary?

By: Mary Ann Ciccone

As part of ARRA, Medicare and Medicaid will provide reimbursement incentives to physicians and hospitals who become “meaningful users” of EMR. This effort will begin in 2011 and end by 2015 at which time all providers will be expected to utilize EMR. Changes will be implemented in stages and include data sharing, compliance with HIPPA and state laws, evidence based order sets, the engagement of patients and families, and care coordination. The final draft recommendations that will define meaningful use were published by the ONC for Health IT in December 2009. Eligible facilities and providers can incorporate these guidelines into projects currently in progress to meet the requirements.  

The result of following the meaningful use guidelines for all stages will be improved and more efficient patient care through the use of disease prevention and reduction of medication errors, greater communication between providers, efficiency in meeting reporting mandates and claims submissions, and lower healthcare costs.

 The recommendations for Stage 1 are listed below.

Source: HHS website for meaningful use.

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.

By: Bruce Cerullo, CEO

As the dutiful son of a proud, reasonably healthy, but aging 83 year old, I have had the pleasure of accompanying my Dad on many doctors’ visits. Yesterday, we visited an orthopedic surgeon's office. In the exam room with him I witnessed “CPOE” in action – Yikes!

First the set up: the doctor is a young, highly regarded surgeon at a top ranked practice affiliated with a leading Boston hospital. His practice has very recently deployed eClinincalWorks, which seamlessly interfaces Mckesson’s RIS System. Before the doctor came into the room, his Medical Assistant brought my father’s EMR up on the screen and loaded his CT Scan disc onto the desktop … everything was teed up for the doctor.

When the doctor entered the room, he consulted the main screen for an overview of my father’s record and began an examination of my Dad’s foot – so far so good – but then, the physician’s “meaningful use” began to deteriorate quickly.  As he returned to the computer to review past records, he had severe difficulty navigating the file and could not advance the images on the CT scan. Frustrated, he left the room and asked his assistant to “fix it.”  She sheepishly took stock of the situation, hit the escape key a couple of times,  and pronounced it "fixed." She then served as his computer navigator; a role that included entering his notes and orders for him! 

After the doctor left the room (under my gentle questioning) she admitted that a number of the doctors in the practice had been “too busy” to attend formal training and were doing their best to learn the application on-the-fly. The moral of this story: effective technology tools and their role in minimizing the inefficiencies of our healthcare system will only have a real impact if the clinicians truly embrace the change.  I know you all already know this … I just feel better having stated the obvious!

Have you had a similar experience?

By: Susan Sitarchuk, Healthcare Executive

While the majority of Health Facilities CIOs and Executives are scrambling to get information on accredited EMR systems and to get a handle on what is truly defined as “Meaningful Use” there exists another population of Healthcare Executives who are actually seeing the money. Who are these lucky people? These folks are the people who struggled endlessly prior to February 2009 and ARRA to get government sponsored funds: the Grant Department of Health Facilities and Teaching Hospitals.

In the old days, prior to February 2009, the grant writers would have to jump through large hoops to secure funding for the clinical studies and research that is so vital to healthcare. They were in charge of putting together volumes of documentation that were sent to the governing bodies that dole out federal grant monies. This process could take months to acquire all of the correct documentation to secure the most funding and while compiling all of the information needed, the health facilities may not have received any of the intended monies at the end of this road because the funding had run dry.

Well times have changed. These folks are now able to more easily write a grant request and go after the money made available by ARRA. Here is the nice part; they are actually getting the funding very quickly. There is a sum of grant money that was made available by the US government under the ARRA and each month the government website is updated with new grants. Through ARRA states have allotted grant money for particular research and studies.

The University of Pennsylvania (UPenn) has received more than $30 million in research funding from ARRA, awards that fund more than 100 studies in gene therapy, robotics, public education, neurological disorders, tobacco’s effect on health, and more. One such award is a $500,000 NSF grant to continue research into haptography, the science of capturing and recreating the feel of real surfaces. Not only does the field appeal to young scientists and encourages engineering careers, but the applications are widespread and include robotics assisted surgery, medical training and simulation, interactive museum exhibits, online shopping, and stroke rehabilitation. Other grants that UPenn has been awarded enable the purchase of high end instrumentation equipment to be used for biomedical research. Also, grants were awarded to supplemental research into the genome and for upgrades to core facilities to support biomedical and/or behavioral research.

This is just the tip of the iceberg; more funds are being released on a daily basis. Due to ARRA, 2010 should continue to deliver positive growth in the research arena. Healthcare facilities need to get organized and go after these funds. HIT departments must, regularly, pursue federally funded grant money as well as the monies that they will be eligible for when they have an accredited EMR system and can prove “meaningful use” of that product. With more money available for research grants and improvements in IT, the economy and our health have a better future.

By: John Smaling, Executive Vice President

As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.

Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:

1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.

2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.

3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.

4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.

5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.

While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.

By: Eric Egnet, CIO

Camp Concerned or the “CCs”

Camp Concerned is an overnight, all summer long camp…these campers need to completely adjust their living situations because what they have in place just isn’t working.

Hospital CIOs in the third camp have reason for concern. They know they will have to replace their inpatient system or upgrade to the latest vendor version. Their current system capabilities are insufficient, and/or the amount of time and money it would take to make it HITECH compliant is just not practical. They also don’t have a common ambulatory system for their physicians, so there is a knowledge that they will need to make a decision about that. Add to this, the significant amount of work and investment dollars required to enhance their IT infrastructure to support these new systems: the costs and timeframes are really starting to add up.

Most of the CCs have also had to downsize their staff this past year due to the current economy and there aren’t the internal resources to take on and execute these important initiatives. Outside help is needed to both manage and staff augment these projects and they are concerned about finding the right resources when they need them.

Funding for this Hospital CIO is a real problem. The capital that will be required to get the hospital from where it is today to where it needs to be is significant. The Hospital Board is concerned about the mounting costs and their ability to raise enough capital in this tight market. In fact, some are concluding that the costs just may be too great, and that they may need to sacrifice the HITECH incentives and deal with the penalties, to keep the hospital’s financial health in order. Sometimes strategy is what you don’t do.

Meanwhile, CCs are trying hard to find the most efficient and cost effective way they can accomplish the task at hand. There are deep discussions with their inpatient system vendor to identify creative ways to upgrade, while containing costs and spread them over time. On the ambulatory side, they are considering inexpensive ambulatory solutions that offer just enough to meet compliance requirements. Alternatively, some of these Hospital CIO’s are looking at license free open source EMR offerings that might fill the bill such as OpenEMR and ClearHealth.

Finally, from a resource perspective, these Hospital CIOs only have a small management team and staff that manage the day to day operations of the hospital. Without question they will need vendor and outside consulting firm assistance to help them on these many projects and initiatives. This will become yet another challenge for them as they diligently try to navigate through these difficult circumstances.

Which of those three camps do YOU belong in? Take the poll in the side bar and let us know what your concerns are in the comments!