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From HIMSS: Gaining a Deeper Perspective on the Complexities of Meaningful Use

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As always, this year’s HIMSS Conference was a whirlwind of activity, interactions, and energy. This being my 19th HIMSS Conference, I do have some perspective on the vortex that is HIMSS every year. And what I will say is this: never before have I seen so much focus on a single theme (not that there weren’t others, but they tended to be overshadowed by the dominant one), that being the meaningful use requirements under ARRA-HITECH, of course.

What is clear is that ARRA-HITECH is transforming the healthcare IT industry, and healthcare IT. And that, of course, relates to the core intention of the stimulus legislation passed in February 2009. Not only did the Obama Administration and members of Congress who voted for the federal stimulus want to help the healthcare industry, they also wanted to use the opportunity to push healthcare forward towards the automation that will be critical in order to improve the patient safety, care quality, efficiency, and cost-effectiveness of patient care delivery.

Sometimes that bigger picture gets lost amid the frenzy over the details, and people fall “into the weeds,” as it were, in a panic over the details. I had a fascinating discussion Tuesday evening with Pam Arlotto, an Atlanta-based consultant who is one of our magazine’s respected bloggers. Pam had just presented that day on the topic “The EMR Value Assessment: A Score Card for Stimulus Preparation.” She and I agreed passionately that so many in healthcare and healthcare IT have become hung up on the details, including the many understandable frustrations, around ARRA-HITECH, that they’re not understanding some of the fundamentals. Indeed, as I told her (and she agreed), those patient care organizations that are the pioneers in the industry, including organizations like Children’s Hospital of Pittsburgh and its umbrella organization, the University of Pittsburgh Medical Center (UPMC) Health System (which received our Innovators Award this year), have been moving forward steadily under the banner of patient safety and care quality for years, and as a result, are very well-positioned for meaningful use already. As I told Pam, it would be tragic if some hospital organizations missed out on the HITECH funding and then came to view the process as a futile exercise in checking items off lists.

On the other hand, I also had fascinating encounters with CIOs who have exactly the right spirit regarding HITECH, but who are feeling frustrated by some of the details. One of these is Gregg Veltri, CIO of Denver Health, a public healthcare system based in Denver. Veltri gave me a few great examples of how some of the devilish details in the meaningful use proposed rule are going to make things difficult for him and his colleagues. For example, he says, “We do a strategic plan, and are currently running about 150 projects, under 14 different managers; and we pride ourselves on high-quality projects. But ARRA has actually derailed us in part, because we’ve had to pick up two aspects”—building a patient portal, and ripping out their custom-built ambulatory system (he and his colleagues had extended Siemens Soarian for inpatient, into their outpatient area, for which it won’t be certified).

As Veltri noted, with a 47-percent Medicaid census, doing a patient portal just wasn’t an effective means of providing access to patients, as most Denver Health patients don’t have regular Internet access. On the other hand, Veltri and his colleagues had created access in an alternative way, by creating a capability for cell phones of interacting on chronic health management issues, including providing patients with the ability to enter their daily vital signs and other measures on their cell phones (cell phones are devices that most of their patients do have access to).

So inevitably, HITECH is forcing CIOs to backtrack and rearrange priorities in order to meet what can feel like a cookie-cutter approach to moving forward on clinical IT. And what Veltri told me echoed what Pam McNutt, senior vice president and CIO at Methodist Health System in Dallas, had said on Sunday morning at the CHIME Media Breakfast—that she and her team had already prioritized certain quality data reporting capabilities, but that HITECH was forcing them to reprioritize to respond to a one-size-fits-all mandate.

So these are among the diverse facets of what the industry is going through right now, and were reflected in the encounters I had at HIMSS this year. I believe that the federal government is absolutely right in its overall priorities on meaningful use; the challenge will be for the industry to respond to what is being proposed in a smart, responsible way, for that industry response to be listened to carefully by the federal authorities; and then for everyone to push forward as needed to get to the meaning part of meaningful use.

And HIMSS 2010 reflected beautifully the excitement, the stresses and strains, and the diversity of perspectives and experiences around all this, and thus fulfilled its purpose better than ever. Those who say that having a dominant, annual industry conference in healthcare IT is anachronistic, don’t know what they’re talking about. I, for one, found this year at HIMSS, along with all the inevitable hype and distractions, very meaningful.

As always, this year’s HIMSS Conference was a whirlwind of activity, interactions, and energy. This being my 19th HIMSS Conference, I do have some

Comments

Mark, I'd like to pick up the Project Management theme you raised.  Speaking as the vendor-representative blogger at HealthCare-Informatics, we certainly can resonate with the reprioritization burden that ARRA-HITECH brought.  So can our clients who were counting on our published product roadmaps.

As Daphne Lawrence raised in one of her HIMSS blog posts, project management, always important in HCIT, becomes one of the two major competencies necessary to be successful with ARRA.  The second is financial engineering, but I digress.

Coordinating multiple projects is referred to as program management.

Interested readers who are not familiar with something called Scrum should start here.  The essence relative to your post is this: it's critical to reprioritize the project backlog, probably monthly.  This needs to involve all stakeholders, which include your customers, your senior management, and with clear input from those on the project team. 

I spent a half hour at HIMSS 2010 at the Project Management Institute's booth, just outside the "C" exhibit hall. The attracted a steady stream of visitor, all of whom had experience with badly failed projects.  Apparently, that's what's required before people learn to value project management, and the importance of regular backlog reprioritization and an focus on scrum iterations.


Still interested in Scrum?  Here's the fancy version from Harvard Business Review; it's considered the first significant discussion of Scrum theory and practice.  It was published in 1986; HCIT vendors have been using it since the early 1990s, as have software vendors in other industries.  If you're more of a video person, the author of the definitive book on Scrum describes it here.