What can make or break an EHR implementation? Two words: physician buy-in, says Mike Davis, executive vice president of Healthcare Information Management and Systems Society (HIMSS) Analytics in Chicago.
Hospitals either have it, or they don't. And if they don't, they need to find a way to achieve it if they want to take advantage of the $17.2 billion in incentives associated with the American Recovery and Reinvestment Act (ARRA) of 2009, he adds.
Physicians surely play a role in all of this, particularly as one objective for 2011 is to use computerized physician order entry (CPOE) for all order types (including medications) as well as drug-drug, drug-allergy, and drug-formulary checks. The specific measure related to this goal is to capture the percentage of orders entered directly by physicians through CPOE.
Physician buy-in a must
The need for physician buy-in will be a rude awakening for hospitals nationwide, many of which are still in the early stages of EHR implementation. Nearly 16% of 5,073 U.S. hospitals surveyed during 2008 have not installed any type of electronic component for their laboratory, radiology, or pharmacy departments, according to the HIMSS Analytics EMR Adoption Model™.
The model, which HIMSS created in 2005, measures electronic record implementation nationwide based on eight distinct stages of adoption:
Stage 0: No electronic components are installed (15.6%)
Stage 1: Implementing electronic components for laboratory, radiology, and pharmacy (11.5%)
Stage 2: Building the EMR infrastructure, including implementation of a clinical data repository, controlled medical vocabulary, clinical decision support, and document imaging (31.4%)
Stage 3: Involving nurses and other clinicians, including implementation of electronic clinical documentation (flow sheets), clinical decision support for error checking, and picture archive and communication systems (PACS) available outside of the radiology department (35.7%)
Stage 4: Involving physicians, including implementation of CPOE and clinical decision support for clinical protocols (2.5%)
Stage 5: Affecting patient safety, including closing the loop on medication administration (2.5%)
Stage 6: Entering discrete data, including electronic physician documentation (structured templates), complete clinical decision support (variance and compliance), and complete PACS—progress notes, history and physicals, and discharge summaries are all online (0.5%)
Stage 7: Rolling out a fully electronic medical record for which the healthcare organization is able to contribute a continuity of care document as a byproduct of the EMR, and data warehousing is in use (0.3%)
The good news is that the number of stage 0 hospitals is down from nearly 20% in 2007. That means that hospitals are making slow but steady progress toward a more advanced level of EHR adoption. For example, stage 3 grew by more than 10% between 2007 and 2008. Davis says he expects the number of hospitals in stages 6 and 7 to continue to grow, especially as a result of ARRA. "I think there's good advancement in the market right now," he says.
Physician resistance remains a major hurdle. Stage 5 is often the most difficult phase to navigate because it directly affects physician, pharmacist, and nurse workflow, says Davis. And soliciting buying becomes more difficult when intuitiveness from a clinical perspective is lacking, he says. This commonly occurs in hospitals that select a vendor that is most affordable, but might not be most effective for helping physicians' complete their day-to-day tasks.
Physician buy-in is essential. This is especially true for hospitals at stage 4 and below, says Davis. For stage 0 hospitals, many of which are critical access hospitals, budgetary constraints are also a factor, he says.
CMS to provide additional resources
CMS recently announced its creation of a Web site dedicated to ARRA that will provide resources related to the following:
Health information technology incentives and support for adoption
Establishment of health information technology standards and infrastructure
Privacy and security pertaining to health information technology
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