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The Path Ahead: Taking the Next Steps Toward Meaningful Use

December 20, 2011
by David Raths
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Even the best-positioned hospital and health system organizations have been struggling with some aspects of meaningful use. What are the implications of their struggles for the path forward into Stages 2 and 3? A look at the current challenges on the ground, and the path ahead.

At about the same time this issue of Healthcare Informatics hits your inbox, so will the Notice of Proposed Rulemaking for Stage 2 of meaningful use under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act of 2009. And if the pattern from Stage 1 holds true, there will be several months of tension as provider and vendor organizations push back against regulators, advising the Centers for Medicare & Medicaid Services (CMS) that the new measures are too heavy to lift.

Because of the tight timelines they were facing, the advisory committees of the Office of the National Coordinator (ONC) didn’t have the benefit of much provider feedback on Stage 1 before they had to make proposals for Stage 2. But with more time at their disposal, CMS officials will no doubt weigh both what providers are saying about Stage 1 and the number of hospitals and physicians participating. (Only 10 percent of the 778 hospitals in a September 2011 HIMSS Analytics survey reported having the capability to address all 14 core measures and at least five of the 10 menu items. Another 31 percent of the hospitals should be prepared to meet Stage 1 of meaningful use shortly, reported HIMSS Analytics, a division of the Chicago-based Healthcare Information and Management Systems Society.)

The turn of the New Year provides a good vantage point from which CIOs and other healthcare IT leaders can take a look back at Stage 1, and as they begin to ramp up for Stage 2 apply some of the lessons they’ve learned. We asked a few CIOs where the pain points are and if there are things CMS could change to provide more clarity and flexibility and reduce the reporting burden.

Devil in the Details
Perhaps the biggest surprise to come out of 2011 is the relative difficulty even some of the most sophisticated users of health information technology reported having in working to attest to MU in Stage 1.

At the recent American Medical Informatics Association symposium, Len Bowes, M.D., a senior medical informaticist for the 22-hospital Intermountain Healthcare in Salt Lake City, Utah, described the difficulty his organization is having with software and workflow changes around its homegrown electronic health record (EHR) systems. Intermountain, which has received numerous industry awards for e-health innovation, has to both certify its own EHR systems and get hospitals and physician groups to achieve meaningful use. Its meaningful use project team identified 105 items in a gap analysis. “From a high level, the list doesn’t look too challenging,” Bowes says, “but the devil is in the details.”

Intermountain has bolstered its meaningful use project team to 22 full-time-equivalent employees working on issues ranging from medication reconciliation to problem lists. But reworking computerized physician order entry (CPOE) is the largest challenge, Bowes says. Officials decided that Intermountain had to make widespread changes to get every physician using CPOE in the hospitals, and that is taking time to implement. “We want to get them something that works and doesn’t have redundant workflow,” he says. Intermountain postponed its Stage 1 attestation for hospitals until mid-2013. “If we get half of our hospitals to achieve meaningful use then, it will be good,” Bowes says.

Clinical Quality Measures:‘Premature, Non-standard'
“Simplify and clarify.” That’s Denni McColm’s mantra for meaningful use going forward. The CIO of Citizens Memorial Healthcare (CMH) in rural Bolivar, Mo., is optimistic about the potential value of meaningful use, as well as an outspoken critic of how some of the measures were rolled out. CMH’s 76-bed community hospital attested to meeting Stage 1 at the end of May 2011 once federal officials signaled that Stage 2 would be postponed for those hospitals achieving meaningful use in 2011.

Denni McColm

In October, McColm testified before ONC’s Meaningful Use Workgroup about CMH’s experience. In that presentation and in a recent interview with Healthcare Informatics, she noted that although her organization has achieved Stage 7 on the HIMSS EMR adoption model, it had some serious challenges qualifying for meaningful use in Stage 1, and that other rural hospitals just beginning that journey to EHR adoption have a lot of work ahead of them.

For McColm, several of the Stage 1 items were problematic because they were poorly defined or confusing. For example, although it is standard practice at CMH to provide a summary care/transfer record upon any transfer of a patient to another facility, officials there were unsure about which transitions of care to include in the summary care record measure; or what format or content the summary care record should include; or how to report that the summary care record was provided.