Newton-Wellesley Hospital (NWH) is at the mile 17 mark of the Boston Marathon. For several years, we have been the official medical provider of the marathon. As part of this sponsorship we are allowed to have a small number of charitable race entries to help raise money for the hospital. Each year, employee names are drawn from a hat to receive one of the numbers. My name was picked in 2010!
The interim final rule on meaningful use was unfolding about the same time I learned I had the opportunity to enter the Boston Marathon. Below are some analogies between my marathon experience and our hospital's tackling of meaningful use.
DECIDING TO DO IT
On January 22, I was told I had an entry number if I wanted it. The 2010 Boston Marathon was April 19, so I had less than three months to prepare. I was in pretty good running shape, but I needed to ramp up my mileage pretty quickly without injuring myself in the cold New England winter. Agreements and time commitments had to be made with my wife and three kids. At work, we were near the end of a two-year Soarian Financials/Scheduling implementation to integrate with our Meditech clinical system-the cutover date was late February.
GIVEN THE NUMBERS, WE CONCLUDED THAT WE WOULD SEEK TO MEET MEANINGFUL USE IN THE TIMEFRAME THAT WOULD ALLOW MAXIMUM INCENTIVE. REALIZING THAT I MIGHT NOT HAVE ANOTHER CHANCE TO MAKE AN OFFICIAL ENTRY IN THE BOSTON MARATHON, I BEGAN A TRAINING REGIMEN IN LATE JANUARY.
In fall 2009, with intense integration testing rounds happening for that Soarian project, I knew I needed to get my mind around the meaningful use requirements and the gap to close at NWH. Fortunately, I had a project manager and an informatics physician who had some cycles to complete the analysis. We presented our findings to executive management in December. For our site, we estimated $5 million in stimulus funds, $10 million in possible penalties and $1.5 million to meet Stages 1 and 2. While we had already completed several of the required milestones over the past five years, we still had much to do and some items remained undefined.
Given the numbers, we concluded that we would seek to meet meaningful use in the timeframe that would allow maximum incentive. Realizing that I might not have another chance to make an official entry in the Boston Marathon, I began a training regimen in late January.
TRAINING AND IMPLEMENTATIONS
Some locals prefer to run the Marine Corps (Washington, D.C.) or New York marathons in the fall because they can train over the summer. Taking long runs in the Boston area in February can be miserable. Much of the Northeast got heavy snow this past winter-Boston got a lot of rain. For one 10-mile run, the weather indicated 47 degrees and light rain. By about half way through, the temperature was near freezing and the water was coming down in buckets. I was soaked through my winter running suit and truly miserable. My only choice was to get home as quickly as possible. It would have been worse to stop.
We have major projects lined up to meet Stage 1 of meaningful use: a system upgrade, two forms of physician documentation and a medication reconciliation module. My marathon training regimen included long runs twice a week, with other shorter runs in between. Completing the training runs meant that time and energy were taken from home and work activities; I was doing less of other things. I knew that I had to build up to at least one 18-mile run three weeks before the race. The plan was in front of me, but I needed to take the time to train-there were no shortcuts and there was just enough time to get ready if I didn't experience any injury setbacks.
Similarly, we have a plan for our meaningful use projects, and there is just enough time to get them done if we don't get distracted. While the marathon is up to each individual, meaningful use will require effort by everyone in the hospital. We began this education by using our annual IS steering prioritization process. Despite being able to do few discretionary projects in the past few years because of the Soarian implementation, hospital leaders soon realized that much of the coming five-year agenda would be meaningful use related. We had to say no to several departmental projects that had been proposed two to five years ago.
Just like I needed to take my training runs every week, our hospital will need to focus on the meaningful use projects and complete each one, even if it's not that fun. Some of these, like the privacy and security requirements, will seem to have no benefit to the clinician, but are critical to obtaining meaningful use. The reward is a long term goal and the “training” steps may seem painful and unhelpfully time-consuming before the “big event.”
WE HAVE A PLAN FOR OUR MEANINGFUL USE PROJECTS, AND THERE IS JUST ENOUGH TIME TO GET THEM DONE IF WE DON'T GET DISTRACTED. WHILE THE MARATHON IS UP TO EACH INDIVIDUAL, MEANINGFUL USE WILL REQUIRE EFFORT BY EVERYONE IN THE HOSPITAL.
THE BIG DAY
Finally, April 19 arrived, but there was much to do to complete the event. One had to find their way to Boston Common by 6:30 a.m. and board one of the many busses used to take more than 20,000 people to the small town of Hopkinton, Mass. There, the “Athlete's Village” had hundreds of Porta-Pottys, bagels, water, coffee, and masses of humanity doing what they felt like they needed to do to get ready.
The purpose of the federal Health Information Technology for Economic and Clinical Health (HITECH) Act is to have providers adopt the technology, meaningfully use it, and drive better outcomes and reduce cost. When our meaningful use projects are completed, we will need to prepare to make an attestation to the Centers for Medicare & Medicaid Services that we are in compliance. This will include a security audit and description of how we meet each of the criteria for hospitals.
We expect to complete our implementations no later than July 1, 2012. This will leave at least 90 days for execution of meaningful use and meet the federal requirement by October 1 of that year. Sustaining meaningful use during that period and beyond will be quite difficult for some. During the marathon, I never doubted that I would be able to make the full distance. For the first 20 miles I just moved along like I did on my training runs. There were aches and pains-foot, hip, knee-but nothing too difficult. After I passed the hospital and headed toward the infamous Heartbreak Hill, it was harder to keep going. In the last four miles, I felt like I couldn't move any faster and that if I stopped I'd fall over and wouldn't be able to get up. I finally crossed the finish line, collected my participant's medal, and got wrapped in one of those silvery head sheets.
ONCE OUR HOSPITAL ACHIEVES MEANINGFUL USE, OUR CLINICIANS WILL NEED SOME TIME TO RECOVER AND MAINTAIN THESE NEW PRACTICES WITH TECHNOLOGY.
For our clinicians, some of the requirements are part of their practice today. They may not like it, but they do it. Other items are like the last four miles of the marathon-it will take all they have to meet the requirements. I am confident they will persevere to meet the meaningful use goal and that our institution will prosper-not only financially, but also with improved outcomes.
Following the marathon, I didn't feel like I could run with the energy I had before the race and sore muscles that prevented me from sleeping well. I am sustaining my running though. I don't need to do the long training runs, but I have to do enough to keep in shape for the next challenge.
Once our hospital achieves meaningful use, our clinicians will need some time to recover and maintain these new practices with technology. As they become more facile, use of the systems won't be as difficult as during that initial 90-day attestation period. This combination of technology adoption and use will improve our care processes. That will be the launching point for our next challenge.
I'm glad I decided to accept the marathon number. The training was long and sometimes boring, but was something that needed to be done. Marathon day was full of fanfare and some pain, but lots of fun. When it was over, it was worth it. Meaningful use will be too.
Scott MacLean is CIO of Newton-Wellesley Hospital in Newton, Mass., part of the Boston-based Partners HealthCare system. Healthcare Informatics 2010 December;27(12):42-44