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Live from HIMSS: The Quest for Meaningful Use

April 4, 2009
by aguerra
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As one might suspect, all the talk at HIMSS has been around the meaning of “meaningful use.” Of course, that term refers to the mysterious criteria by which hospitals and physicians will (or will not) qualify for a piece of the HITECH Act. I have never in my career as a journalist seen such a hunger for information related to a particular piece of legislation.

The reason? CIOs I’ve spoken with know this is not merely an opportunity to score some cash for their organizations, rather they are absolutely and completely on the hook to their CEO and CFO to get this money, and they’re a little nervous about being on the hot seat.

There are so many questions around qualification at this point, so many pitfalls that seem ready to derail an organization’s best efforts to qualify. Those questions include:

What is meaningful use?

What if I’m not on a CCHIT certified product?

What if I can’t come up with the money up front?

What if I can’t get physician buy in?

What if I can’t get the local practices to exchange data in time?

What if my vendor can’t give me the attention I need because they are inundated with work?

What if I can’t staff up because all the qualified HIT experts have been booked?

What if everyone I need jacks up their prices because they know I have a deadline?

What the room of CIOs was told today at the CHIME symposium by those in the know (as much in the know as anyone can be), was that meaningful use will have to be a standard that isn’t too onerous (so no one qualifies), isn’t too simple (so qualifying doesn’t really mean anything), but is just right.

What will probably come to the relief of many is that the industry won’t just get the definition dumped on it in December, the process will be much more methodical and by the CMS book. First, a proposal will be issued sometime this year, then the industry will have time to comment on it, just as any other CMS regulation. The comments should provide a fascinating look at how the different segments of the industry view HITECH, their agendas, their fears and aspirations.

Takeaways from my many conversations with CIOs over the last 24 hours include the following:

Like it or not, you are on the hook to qualify for the money. Remember, penalties start in 2015, so why miss out on all the goodies just to suffer the punishment?

You must start securing vendors, consultants, lawyers and staff. If you wait, there may be few left to help (and those left will be of questionable ability – think of the last kid picked for the kickball team).

You do have an advantage: being on the hook for this means you will probably have serious support from your CEO/CFO, and it will be incumbent on you to clearly explain to them what obstacles lay in your path. Do not try and be a hero. Be specific about the funding you need, the support the work will demand, and clearly identify INDIVIDUALS who are blocking progress. Communicate your progress, at the very least, monthly. Your biggest weapon is keeping everyone informed about what’s working and what’s not.

Be sure to comment when the proposal comes out. This is your big chance to have some influence on the final rules.

Here are some specifics offered by outgoing ONCHIT Coordinator Rob Kolodner, M.D., and John Glaser, CIO at Partners (Glaser will be working with incoming ONCHIT head David Blumenthal, M.D.):

Within the next 90 days, there will be a posting of regulations for privacy (by May 18).

An operations plan must be presented to Congress regarding how to spend the billions that have been allocated. That must be done by the end of the fiscal year (September).

There is a Standards Committee and a Policy Committee dealing with this. The Policy Committee has just been announced.

The Standards Committee must publish how it will respond to the recommendations of the Policy Committee in 90 days.

The definition of meaningful use is still down the road. By Dec. 31, CMS must have gone through the rulemaking and issued a first set of standards for certification of meaningful use starting in 2010.

Glaser adds, “More than whether you have it is how you are using it.” He suggests doing scenario analysis to see what can be accomplished based on hypothetical definitions of meaningful use. Bottom line: if you are not on a certified product, get on one. “This will not go away. This is here to stay. I would start moving on this thing.”

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Comments

John Glaser of Partners was spot-on in saying, "More than whether you have it [stimulus dollars] is how you are using it," which goes to the heart of what should constitute "meaningful use." The goal should be not simply to improve operational efficiency at medical practices and hospitals. Rather, it should be to improve the connectivity of providers with other constituents or stakeholders in U.S. healthcare. Our system, with few exceptions, is disaggregated. It requires IT that improves information sharing and incentive alignment.

Your article, Anthony, also shares the counsel that providers must move now to identify and vendors, consultants and others to do the work. Here, again, medical practices and hospitals would be well advised to choose vendors that bring the people, processes and technology to improve their connectivity with patients, payers and other constituents in order to not only meet "meaningful use" requirements but truly improve the quality and cost of care for consumers.

aguerra

Anthony Guerra is Editor-in-Chief of Healthcare Informatics. His blog contains story lineups for...