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MU Attestation: Is the Glass Half-Empty or Half-Full?

November 6, 2011
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At this stage of meaningful use, hospital attestation can be seen any number of ways

A recently released survey from HIMSS Analytics has found interesting results: among respondents representing 778 hospitals, 10 percent of respondents’ organizations are ready to meet all of the stage 1 meaningful use requirements, while another 31 percent are now ready to meet 10 or more core of the 14 core measures, and at least five menu measures (five of the 10 menu items are required), meaning that, as of September, 41 percent of hospitals were “well-prepared” to meet stage 1 meaningful use, compared with 25 percent in February. (All of this was revealed in a Nov. 1 press release from parent organization HIMSS.)

Not surprisingly, the HIMSS Analytics folks found that larger hospitals by bed size, and hospitals that ranked higher on the HIMSS Analytics EMR adoption model, were better-positioned to meet stage 1 of meaningful use. What’s more, academic medical centers were advancing more rapidly than other types of hospitals.

At this point, it would be safe to say that how one would interpret these statistics and findings really depends entirely on one’s perspective. On the one hand, if one’s hospital organization has not yet begun its attestation period, it is now impossible to attest to stage 1 during calendar year 2011, given the 90-day testing period required. And while a larger number of hospitals and eligible professionals got out of the starting gates this summer on early attestation, if only 41 percent of hospitals ended up attesting for stage 1 sometime in 2012, that would obviously fall short of a majority of hospitals at that point.

And, given how intense a ramp-up will almost certainly occur in terms of the rigor of the stages 2 and 3 requirements, if only 41 percent of hospitals attest under stage 1, what percentage will be able to do so in 2013?

Still, even these numbers are considerably more positive than one might have expected seven months ago; back then, all the talk at the HIMSS Conference was laced with anxiety and, in some quarters, downright pessimism. In contrast, the kinds of conversations heard at the CHIME Fall CIO Forum last month were significantly more positive, with CIOs generally expressing a kind of “nose-to-the-grindstone” attitude towards everything. Or, as one CIO put it to me, “We all know what we have to do, and now it’s just a matter of getting it all done.”

So, in sum, one could either view the situation as hope-inducing or anxiety-provoking, depending on one’s place along the glass-half-empty-glass-half-full temperamental continuum. For myself, I’ll choose to take something of a middle-of-the-road view of this; on the one hand, hospital IT leaders are going to need to ramp up their efforts in order not only to meet the stage 1 requirements, but also to not fall hopelessly behind when it comes to the inevitably greater rigor of stages 2 and 3. On the other hand, things seem to be moving generally in the right direction, and with some hospitals moving ahead faster than others, there will inevitably be opportunities for the leaders of those organizations that are not as advanced to learn from those that have made the necessary strides.

Glass half-empty or glass half-full? It really does all depend on one’s perspective at this point.



Great comments, thank you very much, Joe! There is indeed a problem with inertia among many patient care organizations nationwide right now. The problem is that the MU process won't allow for inertia, and in situations like this, the whole industry, organization by organization, is being dragged forward, with those organizations that are way behind experiencing multiple problems, including the inability to engage the best consultants, etc. I also very much liked your "sludge at the bottom of the glass" extension of my glass metaphor! Thank you!

Thanks for the link and your analysis. There's a nice piece by Chris Dimick in JAHIMA October 2011 that I linked here ( on MU attestation. My read is that it's more than a bi-modal distribution as suggested by the glass fullness metaphor. As Dimick points out, those with substantial EHR programs underway when ARRA was announced are the early attesters. Not surprising.

There's a different or additional phenomena at play in the late majority. Inertia. Enrico Coiera points out that this empirically is a fundamental property of our health system and exists at multiple levels - clinical inertia, system inertia, and organizational inertia. The fastest way to MU attestation involves a "Middle Out" approach where exclusive control is given, essentially giving people a "patch", their patch, that they control as an organizational strategy.

In an accompanying tutorial on this topic of MU Complexity, Dr Kolodner gave explicit examples of how this was used to successfully overcome the inertia in the VA. He offered four examples illustrating and elaborating each of these concepts:

One - Think evolution and encourage and incubate innovation (rather than command and control approaches)

two - Choose a few simple rules (dont try to educate and train the opposite)

three - Start with your early adopters (dont try to raise all ships at once)

four - Look for your Positive Deviants (business intelligence with service audits are essential).

Poorly or mishandled inertia amounts to sludge at the bottom of the glass. Perhaps the better perspective is a drainage model.  Look at the half-full / half-empty glass as being half full with costly, poor quality delivery processes that are remedied by the MU core and menu objectives. The simple continuum model suggests that we can ignore (and separate out) the inertia issue. That suggests that CIOs can manage this inertial complexity on their own by focusing heads-down on implementing HCIT. That, of course, has never worked.