How Ready Are Hospitals for Meaningful Use?

Every hospital leader that I have spoken with in the past six months or so has been confident that his or her organization is in a position to qualify for meaningful use and capture all of the incentive payments from the HITECH Act. Yet, both hospital and physician organizations have recently expressed concern about providers' abilities to meet the requirements of meaningful use defined by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator. For example:

• Hospitals have "serious concerns that the new health information technology rules severely limit hospitals' ability to access federal financing for health information technology that is used to improve patient care," said the American Hospital Association. "Only hospitals that are considered 'meaningful users' of EHRs can receive much needed financial assistance."
• The Medical Group Management Association said that the proposed rules are "overly complex and that medical groups will confront significant challenges trying to meet the program requirements."
• The College of Healthcare Information Management Executives said "several provisions within the regulations merit closer scrutiny and will pose significant challenges for providers hoping to implement electronic health records." For example, CHIME is concerned the reporting requirements will overly tax providers, because "many of the measures will require organizations to gather information that span both electronic and paper-based systems, such as the percentage of orders entered through CPOE systems."

So how close are hospitals to meeting the meaningful use requirements? About halfway, according to a report by Falls Church, VA-based Computer Sciences Corporation, a provider of technology services in the healthcare sector. CSC surveyed executives at 58 hospitals this past fall about their readiness to capture the HITECH incentives based on 50 indicators in five general categories—the use of a certified product, criteria for meaningful use, standards adoption, quality reporting, and privacy and security. Being halfway there can be viewed as good or scary depending on your point of view, says Erica Drazen, managing partner of the healthcare group at CSC.

"People, in general, and the industry are overly optimistic," she says. "If they haven't already started, it is going to be a challenge to meet the deadlines—even the extended deadlines." The starting points may be more liberal, but the end point hasn't changed. "Either the crunch is at the beginning or end," says Drazen, adding that it can be done. The question is how many facilities can organize themselves to do this successfully the first time, because there won't be enough time for a second chance. Drazen was most surprised that one-third of hospitals hadn't even assessed where they are yet.

The results from the CSC survey on providers' progress towards readiness are:

• Use of a certified product – 67%
• Current use of capabilities required for meaningful use – 32%
• Standards adoption –54%
• Quality management and reporting –54%
• Privacy and security protection –73%

Other key findings include:

• Only one-quarter of hospitals met at least 70% of the readiness indicators.
• About two-thirds have assessed where their current systems have gaps that must be filled to achieve meaningful use.
• Although 70% have systems with capability for computerized physician order entry, only 8% have CPOE in routine use throughout the hospital.
• Less than half the hospitals have a plan in place to migrate applications to ICD-10. Only 44% use the LOINC coding system that is recommended by the ONC standards committee.
• While almost all hospitals—89%—report on core quality measures, only about half of the hospitals pulled more than 50% of the reported data directly from an EHR system. In addition, less than one-third of the hospitals tracked quality of care measures during the patient's stay.
• Most hospitals—98%—have a policy in place to limit the disclosure of protected health information, only 52% use encryption technologies to render data unreadable or unusable in the case of unauthorized access.

Not surprisingly, some of the biggest challenges for hospitals will be meeting the CPOE requirement, reporting quality data, and managing the problem and medication lists. "It is challenging because it is operational changes to the process," says Drazen.

Because those cultural and workflow changes are often time-consuming to implement, providers should stop waiting and get started now if they plan to capture the incentive payments and be deemed meaningful users of electronic health records. This advice is something that I have been hearing since the announcement of the HITECH Act. But most providers and vendors have been in a holding pattern waiting for the definition of meaningful use. Now it is here, but "the temptation might be to wait until the final, final rule is released," Drazen says.

There are steps that hospitals can take now regardless of the final, final rule, she says. For instance, organizations can start defining order sets, they can assign clinical leaders to work with the IT department, and they can push their vendor to get interim certification. "It has been available since October and very few vendors have done it, but if your vendor isn't going to be certified you won't qualify for meaningful use," she says.

Overall, there have been very few changes to the meaningful use criteria from the HIT Policy Committee's original recommendations, says Drazen. "It is highly unlikely there will be any significant changes, so stop waiting and start moving. At least assess where you are."