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Cake For Breakfast

August 10, 2010
by Bobbie Byrne
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Long before “meaningful use” was a glimmer in the eye of some Congressional staffer, and probably about the time I was still logging 200,000 miles a year in the air, my hospital had planned a rough path to get paperless. It was a multi-year project with CPOE towards the end. There were fits and starts along the way. There was the inevitable discussion about staying with the longstanding spouse (a.k.a., legacy vendor), versus throwing her over for a hot young new model. Once the decision was made, there was then continued angst over whether or not it was the right path.

Right about the time I showed up, seven months ago, the organization had about completed its soul-searching and was well into a project to upgrade to a modern version of the system that has been supporting out organization for 20 years.

So I think we are pretty typical. We are long past vendor selection, but we are by no means one of the early adopters. So, when we read “meaningful use,” we are reading it with the eyes of a Main Street U.S.A. hospital USA (and we are in the Midwest, to boot!). I absolutely agree that ONC listened—but I cannot help but believe that perhaps they listened too much. It is almost like when my kids complain about the healthy breakfast I have prepared and argue that a blueberry muffin would be better. To me, a muffin is just cake for breakfast. To my kids, it is practically a fruit. What do you want? They are 12 and think that Facebook is profound literature.

So, circling back to Meaningful Use. I realize that our long-term plan to get paperless does not really sync with meaningful use. We will have to push up CPOE and some of the patient engagement functions. The bar-code med administration that is already live and successful does not help us meet stage 1. I was expecting to experience a lot more pain for my $6 million taxpayer-funded dollars.

The whole thing is not exactly convenient for me—and it requires a smidge of intestinal fortitude. But to those who complain: what did they expect? Cake for breakfast?




Thanks for a fun read. I also thoroughly enjoyed co-presenting with you at TORCH a few months back in Texas. When I saw your first blog, I was thrilled to be getting more pragmatic insight!

I visit with and have phone or Skype video chats with CMIOs from across the country every week. Yesterday, we completed our annual user group meeting. I conducted a private advisory board for physicians whose organizations are strongly invested in respectfully and agilely working through the physician changes (workflow, behavior, etc) associated with CPOE, Problem Lists, and other practical challenges of MU. (We already have CPOE broadly deployed in our install base whether that translates into attestable and qualifying numerators and denominators is making smart and competent CIOs very nervous. For some, the denominator just exploded with the final rules.)

Engaging physicians is unlike (and better than) it has ever been in the last several decades. Increased peer-to-peer communication is essential, in part because there is no relevant precedent for the time-crunched, effectively federally-mandated changes of MU.  Unlike IHE integration profiles, there's ambiguity in the regs and no reference implementation!

To your point, I invited several clients to send their CMIO to sit on our advisory board who declined the invitation. One of the arguments was that they were not going to allow ARRA-HITECH incentives to derail their intelligent and carefully constructed strategic plans. They choose to not pursue their equivalent of your six million dollars.

When we polled the physician attendees at our advisory board, they were all pursuing 2011, Medicare Hospital ARRA MU strategies. Those organizations who didn't attend are apparently planning to skip breakfast.  These are tough decisions made by smart people who know their local dynamics better than anyone else, so, no judgment of them is intended in that last statement.

Keep those great blog posts coming, Bobbie!

Hey Joe!

Interesting thoughts. I wonder how many of those CMIO's CEOs, CFOs and board members will this that "staying the course" with their plan is better than making a few changes and cashing the check.
I could understand if the requirements were not part of an organization's vision and mission but who can say that patient engagement and patient safety are not core to who they are as a healthcare organization?
For me, I would rather work to go get the money instead of trying to explain why we are not doing it.
But then again, I am fortunate to have an organization that movesand moves quickly. I know that is not common in many healthcare organizations today!