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Moving Forward on Meaningful Use: Heeding the Spirit of the Law

May 29, 2012
by Mark Hagland
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KMPG’s Joe Kuehn emphasizes the importance of advancing strategically—not tactically—to fulfill the MU requirements

In late April, the New York-based consulting firm KPMG released the results of a survey of more than 250 hospital and health system executives. Among the results of the webcast-based poll: 48 percent of those surveyed said they were confident in their organization’s level of readiness to meet Stage 1 meaningful use requirements, under the American Recovery and Reinvestment Act/Health Information Technology for Clinical and Economic Health (ARRA/HITECH) Act; 39 percent were somewhat confident; 3 percent were not at all confident; and 10 percent didn’t know what their level of readiness was.

At the same time, the survey also found that a strong majority (71 percent) of hospital executives surveyed said they were more than 50 percent of the way to completing EHR adoption.  Among the challenges hospital and health system leaders have faced in meeting Stage 1 meaningful use requirements have included the following: simply understanding the requirements involved in demonstrating meaningful use (25 percent); training and change management efforts (20 percent); capturing the relevant data electronically as part of clinical workflows (18 percent); lack of a dedicated meaningful use team (12 percent); and, not having the appropriate certified technology (6 percent).

Joe Kuehn, a partner in KPMG Healthcare, spoke with HCI Editor-in-Chief Mark Hagland recently regarding the results of the survey, and his perspectives on the challenges facing providers right now in meeting the requirements of meaningful use. Below are excerpts from that interview.

What are the most important challenges facing provider organizations right now, and how should we understand them?

We believe that the very first challenge is that many providers really don’t understand the underlying challenges of meaningful use. Most people believe that simply implementing or installing an electronic health record system will allow them to achieve meaningful use. And certainly, installing a certified version of an EHR is very important; but understanding the rules around collecting and capturing the requirements, that’s where the knowledge requirements lie. The majority of people we speak with don’t have a granular-level of understanding of this.

Joe Kuehn

Is it your experience that the size and type of hospital are major factors in sophistication and understanding?

Not necessarily, actually. While some larger hospitals are faring well, I’ve found that size in this case doesn’t matter. There are those at the large-sized organizations who have the same types of challenges and are approaching this as a technology play. Some early adopters whose organizations have significantly customized their innovations are having to rework their systems for meaningful use; and they would tell you they’re having to dumb things down or roll them back.

What are you finding people struggling with the most, in your practice?

It’s understanding the requirements throughout the organization. Once you get outside the IT shop and get to the clinical side of the house, it’s the physicians and nurses not understanding not only the objectives, but also what needs to be done to their workflows to meet the requirements. And having a dedicated meaningful use team to do all that work is a challenge.

Can you speak to the need for the involvement of clinical informaticists, with regard to the workflow modification?

I couldn’t agree more regarding how much they’re needed. And when we meet with clients, we find we do need a clinical analyst at the table, because they do know both sides of the house, and they can interpret and can provide that bridge. We need the physicians and nurses at the table, and we need finance at the table as well, to understand the significance of all of this. And in terms of meaningful use, many are after that finish line just to collect the dollars; and it’s a mistake if that’s the only goal.

The whole point is, this is not a checklist, right? Would you agree that it is very important to take a broad, strategic view of this process?

Yes, I would agree, those who are implementing meaningful use in the true spirit of the rules, are doing the best. This is a regulatory mandate with a purpose. If you’re moving forward in the spirit in which it was intended, you’ll do the best.

What are the biggest mistakes that CIOs are making right now, in your view?

Not implementing things in the spirit of the rule, and taking shortcuts in order to quickly get to the money. You need to reorganize workflow not only to get the data flows you need, but also to take the opportunity to redefine and redesign processes for improved patient care. The other mistake that’s being made is over-reliance on the vendors. And that gets back to, maybe, a lack of understanding of the requirements, and looking in a short-sighted way at the MU requirements. Providers need to not totally rely on vendors.

Were you surprised at all by the results of the survey?

Honestly, no; I think the results of the survey were pretty consistent with the kinds of conversations we’ve been having with our clients.

Do you have any explicit advice for the next year or two for CIOs and other IT healthcare IT leaders?

Overall, as they continue to install their EHR systems and move forward on meaningful use, it’s the need to implement those EHRs in a way that’s sustainable over the long haul, and that’s able to accommodate the requirements coming up in stages 2 and 3, and ultimately, to do it in a way that’s consistent with the spirit of the rule.

And it’s important to create synergies with other mandates, such as ICD-10; so if they’re building out smart order sets, for example, getting the data and information necessary not just to meet the meaningful use requirements, but also move forward on the transition to ICD-10. It’s also important to develop the needed data warehouses and clinical analytics—having that ability to look at this holistically, and also provide the training and the change management approaches to be successful over the long term. You also need to support the development of new care models under healthcare transformation—whether healthcare reform stands or falls, because the business community understands that our healthcare system is not sustainable.

We’re seeing the development of emerging new care models. And core to that will be the development of data analytics and technology to help drive the business, including real-time access to information to make real-time change to the quality and cost of care at the same time.


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