Is There a Realistic Approach to Meaningful Use?

Looking for an end run around CPOE

Another question from an audience member left panelists shaking their heads: Physicians at one CIO's hospital want to use scribes to enter orders. But doesn't that defeat the purpose of CPOE?

The beauty of CPOE is, of course, that physicians are entering information at the time of decision-making and use the information at the time of treatment. The use of scribes doesn't allow that to happen, the panelists agreed. And it's important to do CPOE right because it offers a "big bang for the buck" in terms of cost and quality, Tang said.

On the other hand, verbal and phone orders do happen—and shooting for 80% compliance could disturb workflows. "This is a call for vendors to make better products" that address both usability and workflow, Tang said.

Why are physicians trying to make end runs around meaningful use requirements? There's no incentive for them to participate because the money goes to the hospitals, said one audience member. There are incentives for implementation—but none for usage. If hospitals are not going to pay for scribes or give incentives to physicians, why should they participate?

"Sometimes the payment system gets in the way," Tang said. Reimbursement must shift from episodic payment to pay based on outcomes, he added. He said he thinks that change will happen before 2017.

Making promises you might not be able to keep

Another audience member who works in a rural area wanted advice on how to avoid having to live out of a refrigerator box. He's asking his senior leaders to make a big investment in technology to meet meaningful use requirements that he's not confident will actually happen, he said. Will hospitals and health systems really see stimulus dollars?

Panelist Elizabeth Johnson, RN, vice president of applied clinical informatics at Tenet Healthcare Corporation, said even large systems have the same question. "My expectation is that the money will be spent," said Johnson, who is also a member of the HIT Standards Committee. "The money is actually appropriated" and Congress won't have to "re-up it every year."