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Early Adopter Perspectives

January 21, 2011
by Jennifer Prestigiacomo
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One director recommends clear clinical data standards and quicker turnarounds of MU rules

Last week’s HIT Standards Committee Implementation Workgroup hearing “Real World Experiences Working with Meaningful Use” culled together voices from around the country to share what’s really going on with the meaningful use of electronic health records (EHRs). Robert Murry, Ph.D., M.D., Medical Director of Informatics, Hunterdon Medical Center of New Jersey shared his thoughts with HCI Associate Editor Jennifer Prestigiacomo on his panel “Early Adopters of Meaningful Use Seeking Attestation– Eligible Providers’ Experience,” as well as some recommendations he shared with the Office of the National Coordinator for Health Information Technology (ONC).

Healthcare Informatics: What did you find most interesting about the Implementation Workgroup hearing?

Robert L. Murry, M.D.: It was very interesting to see where other people around the nation are and to hear the opinions of other early adopters on my panel. It was a wonderful exercise of democracy for the people involved in the legislation to be really listening while preparing the next round of regulations. I thought that the panel was very attentive and thoughtful of what the policy committee had recommended and intent on using that information to make the next rounds even better. ONC and CMS were there, and I thought their representatives were really sharp and listening to what we had to say.

HCI: What was the central message you wanted to convey during your testimony?

Murry: I certainly wanted them to know that I support the concept of meaningful use. It’s well-designed in general. I did want to make sure they knew that the delayed announcement of the measures and then the summaries of the measures is putting massive time pressures on vendors, physicians, and healthcare organizations. In general, meeting the measures means upgrades of very complicated existing systems. I think from that point [that we get summaries] to the start of attestation, meaning the vendors are starting to make their changes and the organizations are making their upgrades, needs to be one and a half to two years, as opposed to four months.

I wanted to stress the need for clinical data standards in Stages 2 and 3. The focus of Stages 2 and 3 is communications between EHRs, and I was trying to get a point across that they need to be strict for certification systems to make sure that the EHRs that are certified are able to produce and absorb very clinically robust data.

I made a point that even though I love our vendor [the Horsham, Pa.-based NextGen], it needs to be easier to switch EHRs to be able to take all your data with you. For that to happen, all that data has to be standardized.

HCI: Can you go into a little more depth about what you said about meaningful use slowing down your organization’s implementation?

Murry: For early adopters who already have systems up and running it just becomes a resource issue. We don’t have staff and resources to do the required upgrades for meaningful use and continue our aggressive go-live. The committee gets that. I tried to make the point that every measure comes with a price in terms of work. So the measures need to be few in number and very carefully thought out to achieve their goals.

HCI: Can you go into more detail about this statement you made: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Murry: Clinical leadership in these HIT projects is absolutely essential. Here at Hunterdon, we have a history of early adoption; we’ve been a Most Wired Hospital. Part of that is due to the commitment in terms of hiring people with clinical experience and backgrounds into IT. You have RNs as project managers. It’s not banking software; it involves highly specialized and skilled workers. And speaking from a physician’s standpoint, the physicians need someone who speaks their language and understand the time pressures of understaffed offices and booked schedules. When projects don’t have both languages, clinicians reject them because they think them to be foreign and being imposed on them.