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

By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

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.

They’ve got their list and they’re checking it twice…meaningful use is still on everyone’s mind. CHIME just completed a survey of 176 of their member CIOs on their “ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines.” Most of the CIOs admitted that they are concerned. In the words of David Muntz, Senior VP and CIO at Baylor Health Care System in Dallas: “Early attempts at standardization were not rousing successes. It’s hard to believe that we will be able to adapt to new standards in time to qualify for the rewards from the stimulus. I’m hopeful we’ll be there before the penalties are levied.” (from CHIME summary).

Over at HealthcareITnews.com the CIOs from Sharp HealthCare, Brigham & Women’s, and Shriners Hospitals for Children discuss what meaningful use means to them and their hospitals: CIOs Discuss Meaningful Use.

 Those three sound like they are ready and waiting for their incentives.

How prepared are you?

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: Robin Shine, Senior Vice President

In September our minds turn away from summer vacations and long warm days to thoughts of back to school, rededication to long work days, and FOOTBALL. Whether you are a fan of high school, college, or the pros weekends will soon be filled with games featuring your favorite teams.

As I listen, read, and absorb all of the information and speculation on the ARRA HITECH legislation, and the debates surrounding the definition of those crazy words “meaningful use,” some questions come to mind in juxtaposition with football!

• What costs more: the new Cowboys stadium or the HITECH portion of ARRA?
• Which are worth more: NFL TV contracts or ARRA incentives?
• Does pre-season football camp remind you in any way of HIMSS?
• Which are more complicated: the rules in the NFL rule book or the CCHIT rules?
• Who is their team’s projected MVP: Tom Brady or David Blumenthal?
• Which produce more revenue for their institutions: BCS football teams or university medical centers?

So, as we all continue to learn more about “meaningful use” send us your comments and questions regarding the definition debate AND the meaning of football or post your own questions on the VCS Blog.