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Is There a Realistic Approach to Meaningful Use?

 |  By gshaw@healthleadersmedia.com  
   March 01, 2010

Compromise and balance will be the key to meaningful use success.

At the College of Healthcare Information Management Executives (CHIME) 2010 CIO forum held in Atlanta, GA, this week, participants in a town hall meeting made that clear as they discussed a variety of topics, from getting physicians to embrace technology, such as computerized physician order entry (CPOE), to the wisdom of telling your executive team that it must invest in technology to be eligible for stimulus funds under the HITECH provision of the American Recovery and Reinvestment Act (ARRA), which some fear will end up an unfunded mandate.

In a CHIME member survey released at the event, nearly 30% of respondents listed EHR upgrades or implementation as their biggest hurdle. And 41% listed it among their top three concerns. But culture, not systems, will hamper adoption, said panelist Paul Tang, MD, vice president and CIO of Palo Alto (CA) Medical Foundation, who is the vice chair of the HIT Policy Committee and chair of the Meaningful Use Work Group.

Clearly not all healthcare organizations are prepared to meet the requirements. "Everybody is trying to do the right thing," Tang said. "But it's a call to action. … It's up to us to figure out how to get it done."

One audience member asked what CIOs can do to ensure the government takes a more realistic approach to meaningful use. It can't be an all-or-nothing proposition, he said, but must be a "palette approach."

It's impossible to predict what parts of HITECH will be difficult for individual hospitals or health systems to employ—they should be able to choose some aspects of the requirements to postpone. Another way to achieve more flexibility is to "significantly lower" the threshold in the early years while still committing to improvement over time.

CHIMES' comment to the Centers for Medicare and Medicaid Services' (CMS) on its EHR Incentive Program stressed that point, saying that it doesn't take into account providers' need for flexibility and does not reward incremental progress. CHIME wants CMS to give providers until 2017 to achieve EHR implementation. Their proposed incremental approach would deem a provider a meaningful user if it can achieve 25% of objectives by 2011, 50% by 2013, 75% by 2015, and "substantially all" by 2017.

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."

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