As the industry lurches toward automation spurred on by the HITECH Act, reading the tea leaves on meaningful use is becoming all important. And while the HIT Policy Committee has issued a fairly extensive matrix on the subject, many of the apparently clear details dissolve into fuzziness upon closer examination. To tackle these issues, and provide a snapshot of where the industry stands, HIMSS Analytics has released a report on the subject. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with the author, EVP Mike Davis, about healthcare’s all-consuming quest to collect the stimulus funds.
GUERRA: HIMSS Analytics recently issues a report called, “State of US Hospitals Relative to Achieving Meaningful Use Measurements.” What was the motivation behind that report? Are you trying to help the hospitals, send a message to the politicians, or both?
DAVIS: Well, it was mostly to let the market know, especially the hospitals, what the industry looks like, so that they could understand where they stood and how much work they were going to have to do. The thing that we probably did in the report is validate the approach ONC is taking because, from what we can see right now, they’re going to be pretty loose in their interpretations of some of the measurements in 2011. And I think that’s appropriate because what they want to do is give people a taste of the money.
2013 is going to be a pretty difficult achievement for many hospitals, because in 2013 you must have not only CPOE up and running with most of your physicians but you must have closed loop medication. And so, as you look at our model, and as we’ve been studying that model and applying it to the industry over the last four years, what I can tell you is that when we did the evaluation of Stage 6 or Stage 7 hospitals, 90 percent will tell you that the closed loop is probably one of the toughest steps.
GUERRA: What is it about the closed loop that’s so difficult?
DAVIS: There’s two parts that make it difficult, other than the capital expense. The first one is that it disrupts the workflow of the physicians and the pharmacists and the nurses. So you’re having to reengineer, or do the change management, for all of those clinicians as part of that process.
Number two, they need to integrate the barcode or RFID technologies and, right now, I’ve only seen one hospital using similar RFID, and I don’t know if they’re even doing it anymore, but integrating the barcode technologies into that internal process is key. Pharmacy has to create the barcode for the medications and dispensing, the patients have to be bar-coded, you’ve got to do the whole thing where you’re scanning the medication, the patient, and then tying that all into clinical-decision support so that you’re managing the five rights of administration. It’s a big step.
GUERRA: So 2013 is going to be very tough.
DAVIS: Yes, I think 2013 is where they really must have their act together and, right now, we see challenges in the following areas. One is getting physicians onto CPOE, especially if you’re a hospital working with a lot of affiliated physicians and not necessarily residents or physicians that are on contract. Turning the tide may be the fact that many hospitals are hiring hospitalists, and that’s having an impact because part of the contract will be they have to use CPOE. I think that really helps adoption.
One of the things that we track right now is the percent of all medical orders being entered by physicians when we’re looking at the Stage 6s and 7s. The Stage 6s right now, they can vary anywhere from about 10 percent up to 70 percent. For Stage 7s, most of those hospitals have 90 percent+ of all their medical orders being entered by physicians. And that has a huge impact. When they first turn on that closed loop, they start to discover errors they never ever knew existed. So I think – from the standpoint of what ONC is doing with meaningful use – they’re doing a very good job. I like the approach they’re taking. I think, for 2011, they’re being very pragmatic. For 2013 and 2015, they’re going to ratchet up the requirements.
GUERRA: Under the 2011 measures, you write about the importance of nursing documentation and you used the word clinical documentation, you specify physical therapy, respiratory therapy, but you don’t talk about physicians. From the meaningful use matrix, it’s clear they want 10 percent CPOE, but it’s unclear if that’s 10 percent of clinicians or 10 percent of physicians.
DAVIS: Well, I think it’s a little bit nebulous by design. The way we interpret that is they want 10 percent, which can include MDs, RNs, physician assistants, or nurse practitioners, so again, very pragmatic.
GUERRA: So you don’t need 10 percent of your physicians? You need 10 percent of your eligible clinicians, which means you may not need any physicians to qualify.
DAVIS: Well, I think that’s the part where they’re being pretty open. That’s why they included all those different clinicians. Our interpretation is that, for 2011, they’re just trying to get some advancement of CPOE use.
GUERRA: Right and, theoretically, you can get the clinicians that are employees of the hospitals onto CPOE much easier than the independent docs.