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Measure Twice, Cut Once

June 26, 2009
by Daphne Lawrence
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As hospitals look to qualify for HITECH incentives, proving meaningful use means setting up tools for measurement, now

Dale Sanders

Dale Sanders

Are you getting the most out of your EMR? In order to qualify for the HITECH incentives from Washington, hospitals will soon be asked to demonstrate “meaningful use” of these expensive systems, so savvy CIOs are hard at work today trying to figure out just how their systems are currently being leveraged, if at all.

“I can't imagine any other way of measuring meaningful use if you don't actually measure its use,” says Dale Sanders, CIO of Chicago's Northwestern Medical Faculty Foundation. “In the past, people have tried to use CPOE as the benchmark, which I think is better than nothing. But it's far from everything.”

Celwyn Evans

Celwyn Evans

What's the sense of urgency about measurement? The HITECH timetable calls for meaningful use to be defined by the end of 2009 - in HIT time, basically right around the corner. Hospitals that can demonstrate such meaningful use will qualify for some of the billions of dollars in HIT money promised by Washington. “You can't wait for the definition to come out,” says Celwyn Evans, senior partner at Greencastle Associates Consulting, Malvern, Pa. “Classic clinical transformation technologies are not just ‘add water and go.’”

Linda Reed

Linda Reed

Linda Reed, vice president and CIO of Atlantic Health, a multi-hospital system in Morris Plains, N.J., has similar advice. “A lot of CIOs might be waiting until meaningful use is defined. Don't wait - just put a stake in the ground and measure against it.”

The question many are asking is where that stake should go. The four areas that most believe will be part of the meaningful use definition are CPOE, clinical documentation, quality reporting and interoperability; so finding ways to measure the adoption in these areas is a good first.

Some CIOs, however, are asking if it's worth it to try to qualify for the HITECH incentives at all.

The doubts are there for good reason, according to Dave Garets, CEO of Chicago-based HIMSS Analytics. Garets says only 388 hospitals out of 5,172 have the technology in place to document what many think will be meaningful use, though another 1,914 are within striking distance and will likely qualify within a year.

With numbers so low, Reed echoes a sentiment held by many, especially in these challenging financial times. “If I have to spend $12 to get back $8, maybe that's not worth it,” she says. “But I may need to spend $12 before I get $4 taken away.”

That's because by 2015, hospitals will begin to see Medicare penalties for not demonstrating meaningful use. So the real key, Reed says, will be timing. “Do you need to be ready before the money starts, or do you just need to be ready before the penalties kick in?” she asks. “I think it's all very individual.”

Evans says it pays to be ready either way, particularly since the C-suite is well aware of how much money is involved. “What CIOs are worried about is being held accountable to get all this money,” he says. “Many hospitals have built the road and no one's driving on it. That's not the CIO's fault.”

Garets agrees that CIOs should not be completely accountable for the money, and credits HITECH for some positive changes in this area. “What's nice about what HITECH has done is it put these issues on the plate of the executive management team of the hospital.” He says that everyone, from the CFO to the CNO to the COO, has to get involved in measuring outcomes and the impact of IT. “It's going to be an enterprise business initiative that has an IT component,” he says. “And if you don't get it done and wind up getting nailed by the penalties, it's not IT that gets nailed - it's the whole organization.”

Dave Garets

Dave Garets

CIOs can start measuring the use of their current systems right now. And many say that an assessment is the first place to start - with or without a consultant - using the four generic steps: determine your standard, gather data, compare to your standard and, finally, address the gap. According to Evans, midsize hospitals using outside consultants can expect to spend between $50,000 and $150,000 on a meaningful use assessment. “But hospitals can't wait until their budget cycle to do an assessment,” he says. “They need to assess right now.”

Evans says simple assessment steps will ensure that CIOs can easily put together a decent business case for IT - and it must be done now, no matter where a hospital is in the budget cycle. “A year from now,” he says, “the Board and CEOs are going to say, ‘We were able to get $8 million and we didn't. Why not?’” Evans says CIOs don't want to be in that position of having to answer that question.”


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