Putting It All Together

What is your advice for those organizations coming up from behind on progress in all these areas?

I think in some areas, you can do the minimum, but do it in a focused way; or do something between the minimum and the maximum, but in a safe way. Several times in the paper, we said you’re headed to the right end point if you plan appropriately. And you may be only halfway through that plan, and you can meet meaningful use, but you can still prepare correctly for the future.

So the key problem is shortchanging strategic planning?

Yes, or inadvertently creating problems or going down a detour. Creating problems relates to the whole safety thing—creating workflows that don’t make a whole lot of sense to clinicians and that could lead to errors or something worse. And a perfect example of a detour would be not acknowledging that physicians have to maintain the problem list, and setting up some whole elaborate system by which others would be maintaining the problem list; because you won’t be able to rely on the problem list for care or use it for billing, unless physicians maintain it. And it’s the type of detour that could happen, and someday, you’ll have to knuckle down and do it right, anyway.

Admittedly, it’s already a lot to do meaningful use, but at least if you do meaningful use, and you’re sure that every step is a real step forward and a safe step, you’re way ahead of the alternative. I think that’s what this paper is talking about. It does set a different bar. However, where we’ve said focus your patient engagement on the patients who need it the most—you’re going to be working on patient engagement. And we’ve said, get experience with the patients who need it the most, not necessarily the ones who are easiest. So don’t take the easy way out on patient engagement; put some more effort into it and focus on it; it’s an investment in the future.

One thing that is becoming clear to more and more people over time is that readmissions work is not detached from everything else; it’s related to everything else.

Absolutely; and that’s one of the focus areas we thought made a whole lot of sense as you’re working through meaningful use. Readmissions are really tough, because it isn’t just a readmission to your hospital. And the hospital isn’t going to know as much as CMS knows about where the patient is popping up. So this is really going to emphasize the need for post-discharge follow-up, and really good discharge planning that includes follow-up appointments, and lots of information that the patient understands. So from the hospital perspective, I do think that’s the big test on continuity of care.

Do you think CIOs and CMIOs realize the breadth and urgency involved?

I think it’s pretty hard to keep up with all these programs, and that’s frankly why we’ve done some of the analyses that we’ve done. And one of the problems is that the people in the quality department are likely to have figured this out first—whoever it is who has to read the latest stuff from CMS. So the trick is really to first make sure that all the quality improvement and care management efforts are addressing the issue or heightening the priority of this issue, but then to coordinate this sometimes-separate big project that’s called HITECH. Admittedly, an awful lot is happening, so we thought trying to pull the two together in a rational way could help with the process, because you’ve got some people in an organization watching HITECH, and there are ongoing clarifications, and we’ve still waiting for stage 2; and you’ve got another group paying attention to healthcare reform.