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Early Adopter Perspectives

January 21, 2011
by Jennifer Prestigiacomo
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One director recommends clear clinical data standards and quicker turnarounds of MU rules

Last week’s HIT Standards Committee Implementation Workgroup hearing “Real World Experiences Working with Meaningful Use” culled together voices from around the country to share what’s really going on with the meaningful use of electronic health records (EHRs). Robert Murry, Ph.D., M.D., Medical Director of Informatics, Hunterdon Medical Center of New Jersey shared his thoughts with HCI Associate Editor Jennifer Prestigiacomo on his panel “Early Adopters of Meaningful Use Seeking Attestation– Eligible Providers’ Experience,” as well as some recommendations he shared with the Office of the National Coordinator for Health Information Technology (ONC).

Healthcare Informatics: What did you find most interesting about the Implementation Workgroup hearing?

Robert L. Murry, M.D.: It was very interesting to see where other people around the nation are and to hear the opinions of other early adopters on my panel. It was a wonderful exercise of democracy for the people involved in the legislation to be really listening while preparing the next round of regulations. I thought that the panel was very attentive and thoughtful of what the policy committee had recommended and intent on using that information to make the next rounds even better. ONC and CMS were there, and I thought their representatives were really sharp and listening to what we had to say.

HCI: What was the central message you wanted to convey during your testimony?

Murry: I certainly wanted them to know that I support the concept of meaningful use. It’s well-designed in general. I did want to make sure they knew that the delayed announcement of the measures and then the summaries of the measures is putting massive time pressures on vendors, physicians, and healthcare organizations. In general, meeting the measures means upgrades of very complicated existing systems. I think from that point [that we get summaries] to the start of attestation, meaning the vendors are starting to make their changes and the organizations are making their upgrades, needs to be one and a half to two years, as opposed to four months.

I wanted to stress the need for clinical data standards in Stages 2 and 3. The focus of Stages 2 and 3 is communications between EHRs, and I was trying to get a point across that they need to be strict for certification systems to make sure that the EHRs that are certified are able to produce and absorb very clinically robust data.

I made a point that even though I love our vendor [the Horsham, Pa.-based NextGen], it needs to be easier to switch EHRs to be able to take all your data with you. For that to happen, all that data has to be standardized.

HCI: Can you go into a little more depth about what you said about meaningful use slowing down your organization’s implementation?

Murry: For early adopters who already have systems up and running it just becomes a resource issue. We don’t have staff and resources to do the required upgrades for meaningful use and continue our aggressive go-live. The committee gets that. I tried to make the point that every measure comes with a price in terms of work. So the measures need to be few in number and very carefully thought out to achieve their goals.

HCI: Can you go into more detail about this statement you made: “EHR implementations fail when they became IT projects, as opposed to clinical projects involving technology.”

Murry: Clinical leadership in these HIT projects is absolutely essential. Here at Hunterdon, we have a history of early adoption; we’ve been a Most Wired Hospital. Part of that is due to the commitment in terms of hiring people with clinical experience and backgrounds into IT. You have RNs as project managers. It’s not banking software; it involves highly specialized and skilled workers. And speaking from a physician’s standpoint, the physicians need someone who speaks their language and understand the time pressures of understaffed offices and booked schedules. When projects don’t have both languages, clinicians reject them because they think them to be foreign and being imposed on them.

HCI: What can CMS and ONC do to improve their communication regarding MU requirements?

Murry: I was very impressed with their attempts to really listen to what the panel was saying and hear time and time again that they needed to give us more time with clear measures and quicker turnaround from 800-page documents down to useful summaries. They were very responsive to that. They need to announce simultaneously, or very quickly thereafter, the measures in all of their gory detail, as well as summaries so we can wrap our heads around it and plan implementations.

I was also impressed with the improvement with the CMS meaningful use Web site. Over time it’s gotten more and more useful with more succinct documents ready to download. They’re putting a lot of thought into that, and I applaud that.

HCI: What is the next step from this meeting?

Murry: I believe that the Stage 2 [requirements] are due out of the policy committee by February. And obviously they will be soliciting public comment at that stage. My understanding is that the Implementation Workgroup we testified before was to synthesize our testimony and make recommendations back to the policy committee in time for them to review the Stage 2 requirements. I know the co-chairs of the committee were furiously working in their own minds to synthesize a day and a half [worth] of testimony into something the policy committee can really use. I hope they came away with the message that we need clinical data standards that will facilitate exchange between EHRs—because we’re just missing too much of the possible benefits of everyone being electronic if people are having difficulty talking to each other.

HCI: What challenges does your organization face and how do they compare to those that you heard from other organizations?

Murry: I think that our biggest challenge will be core measure 13, which requires the patient be provided with a clinical summary of the office visit 50 percent of the time. Our physicians are not used to writing a document that the patient can understand. We get phone calls back in my office all the time, ‘I don’t understand what the doctors said,’ ‘which medicine was I supposed to start and stop.’ So, the whole thing is a fantastic idea, but getting doctors to really change their workflow is going to be a big challenge for us and others.

I do think we’re ahead of the curve in general, I know a lot of different NextGen clients that are having to implement electronic prescribing and lab interfaces to do those basic data [exchanges] that meaningful use Stage 1 was driving at. If you’re an early adopter, and you’ve got the basic data exchange in place, then you’re left with challenges similar to ours, you need to do your upgrades and plan them accordingly.

HCI: What is planned for your organization’s February 2011 upgrade?

Murry: We’re installing NextGen KBM 7.9.1 at the end of February. That involves lots of communication and training. We’re holding weekly conference calls with practice [Hunterdon Healthcare Partners, a partnership between 180 local physicians and the Hunterdon Medical Center] representatives, and they’re responsible for doing their own workflows and gap analyses. We need to know from them how this upgrade is going to affect them.

The next step is to begin regularly reporting back to the practices and get reports they can generate themselves to see where they are with meeting the measures. I think that some of our practices are literally going to attest 90 days after their go-live. Other practices will be trickling with their attestations in 2011, but I believe they will all be able to attest in 2011 and meet meaningful use. I think we have eight go-lives in 2011, and we’re also rolling out a patient portal. We’re also trying to take our very local HIE and add new functionality to it and expand its scope.


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