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Meaningful Use Anxiety

July 8, 2010
by Mark Hagland
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Web-Exclusive Interview: Daniel Garrett, Partner and HC IT Practice Leader, PricewaterhouseCoopers

Last week, the PricewaterhouseCoopers Health Research Institute, an arm of the New York-based PricewaterhouseCoopers, released a report entitled " Ready Or Not: On the road to the meaningful use of EHRs and Health IT.” Fifty percent of the respondents to the survey that formed the basis of the report said they were currently not ready to apply for the 2011 funding under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act. Among the biggest barriers respondents said they faced were: reporting requirements (94 percent); clarity of meaningful use criteria (92 percent); balancing meaningful use work against other management priorities (83 percent) and the ability to meet the requirements within a specified timeframe (80 percent).

The report surveyed 120 CIOs and healthcare IT executives who are members of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME). The report’s researchers also interviewed 14 CIOs and other leaders from healthcare organizations.

Lead report author Daniel Garrett, partner and leader in PricewaterhouseCoopers’ national healthcare IT practice, spoke this week with HCI Editor-in-Chief Mark Hagland regarding the results of the survey and findings of the report.

Healthcare Informatics: Overall, about eight out of ten CIOs expressed some level of unreadiness for meaningful use to your team, correct?

Daniel Garrett: Yes, and that’s a big issue. Eight out of ten said they were worried about being able to document meaningful use.

HCI: What struck you most about the survey results and your team’s interview findings?

Garrett: The general theme we’re hearing is, we know that meaningful use is here, it’s serious, and we’re implementing electronic health records as an industry. But connecting these electronic health record [EHR] systems that we’re implementing and have implemented, and connecting all these systems and creating information and then knowledge around that information, is what the end goal is.

HCI: And they feel they’re very early in the journey?

Garrett: Yes. Even the people who have implemented electronic health records haven’t done it to the level that the federal authorities are asking for under meaningful use.

HCI: The delay seems to have been difficult for CIOs, because of their need for the granular details in the final rule.

Garrett: The reason why people are going to be challenged to adhere to any definition of meaningful use is the sheer fact that there’s a lot of work to be done. And you just can’t avoid that. So people want to get started. And I would add that, while we all know that there’s plenty to do, people are looking for clear directions.

HCI: What do you see as the biggest challenges in all this right now for CIOs?

Garrett: The biggest challenge for the CIO is how to combine this important exercise around being compliant with meaningful use, with driving the institution that they’re part of, to a new level of performance in terms of patient safety, quality, and efficiency.

HCI: Overall, what’s being asked for under meaningful use is where the U.S. healthcare system has to go anyway, correct?

Garrett: Yes. Given where we were as an industry prior to the HITECH Act—put in perspective, this is a great thing. Like any other large transition of an industry, combined with a massive deployment of technology across that industry, this is a challenge. It’s further highlighted by the fragmented nature of the industry, and the multiple participants, all with different agendas.

HCI: Your team examined the progress being made by the pioneer patient care organizations in the industry. Those leader organizations have run under the banner of patient safety, care quality, efficiency, correct?

Garrett: The leaders that have created strong relationships with their physicians, patients, and health plans, have a major advantage, because if you have those kinds of working relationships, and you’re already got business relationships and existing transactions and processes that are integrated, you’ve got half the battle already solved.

HCI: What is your advice for CIOs of organizations that are behind?

Garrett: First, I would recommend that they take advantage of the things the pioneers have already done and the lessons already learned. Second, I’d take advantage of existing assets—experienced personnel, business relationships and models that work, technology that works, and stick with processes and vendors and partners that have been proven to be effective.

HCI: What percentage of hospital organizations will be able to demonstrate meaningful use compliance in 2011, 2013, 2015?

Garrett: Let me put it this way: if it’s not a high percentage, then we as an industry have failed; and the federal initiative has failed. The intention here is not to penalize anybody, it’s to stimulate the economy and create a better technology infrastructure to deliver better healthcare.

HCI: Do you think a large percentage will qualify for 2011?


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Good interview and informative study. Can't say I am really surprised that many do not think they will be ready to meet MU criteria.

Two thoughts:

1)On June 23, 2010 John Glaser, Ph.d who is the CIO of Partners Helathcare in Boston and was a senior adviser to National Coordinator David Blumenthal, M.D., shaping HITECH's Meaningful Use rules, was interviewed by the Motely Fool Investment newsletter. When asked about meaningful use he said:

" It kind of depends on how many hospitals and doctors' offices you thought should be able to qualify for the incentives in 2011 and 2012. I think there was a lot of belief that a majority of them should, but that was never congressional intent. The intent was that a minority, maybe a significant minority, would qualify. Part of it is that expectations are out of line."

So the bar has been set high and will go higher.

2) On 7/08/2010 CMS announced:
The Centers for Medicare & Medicaid Services has issued a proposed rule imposing a 0.25 percentage point reduction to the fee schedule increase factor for outpatient hospital services.

So, where's the downside? If you do not meet meaningful use criteria, which most providers won't per the Glaser interview, you get a reduction in the Medicare payment adjustment.

Let's see that'll be:
-.33 times -.0025 +.000825 increase! OR is it, .66 times -.0025 -.000166 (decrease)

Seems to me either way you come out better, without taking on a risky multi-million dollar investment.

Frank Poggio
The Kelzon Group
For a more detailed discussion see "A Meaningful Ruse" at: