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Meaningful Use Anxiety

August 27, 2010
by Mark Hagland
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Interview: Daniel Garrett, Partner and HC IT Practice Leader, Pricewaterhousecoopers
Daniel Garrett
Daniel Garrett

Last month, 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 not currently 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).

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.

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've 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.

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?

Garrett: The challenge, and why this is taking so long, is that there's a lot of feedback that's been provided that the industry wants everyone to succeed, and that includes the category of folks that have the most work to be done. And we don't want to further widen the gap between the haves and the have-nots. So I think we'd all like to see a program that's realistic, where people have to earn the money, but where the bar is not set so high that large numbers of organizations fail. And if the bar is set too high, too many people who need to take advantage of this won't.

HCI: With regard to computerized physician order entry (CPOE) and quality outcomes data reporting, do you see those as the two biggest areas of hurdle?

Garrett: Clearly, there are issues in both of those areas; but if you look at meaningful use and the impact that we want to have on the industry, we really need to get as much focus on the reimbursement process, the integration around that with the health plan, and one of the most critical areas of the hospital, the emergency room. If you look at the spirit of what we're trying to do as an industry, moving to different reimbursement models and moving the industry in the most critical moments when patients need very difficult decisions made in a very short period of time, that's really going to test how well we're integrating information about a patient, and what more critical area in which to do that than an emergency room? Certainly for me, if I'm ever unfortunate enough to end up there, that's meaningful use.

And in terms of rallying their organizations forward, one of the things CIOs might do is to point to some of the specifics of the report, and use that with internal audiences. Because this situation is a call to action for CIOs; and it's an opportunity to think about what this means for one's institution. It's tough, but I think we'll look back and these next couple of years and will really be proud of what will be accomplished. We're all going to have this opportunity to put our best effort forward and really create something special here.

Healthcare Informatics 2010 September;27(9):52-54


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