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Meaningful Use—It's a Gamble

October 25, 2009
by daphne
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They twisted my arm. Last week I went down to Atlantic City for the New Jersey-Delaware Valley HIMSS fall conference on meaningful use. First off, props to Rich Temple and the NJ chapter for such a well run and highly attended event—more than 400 attendees! Second, they really didn’t twist my arm — I wanted to see if there was a jackpot with my name on it.

Well, I didn’t hit the jackpot I expected. But I did, in a way, hit a different one. It was more like a can of worms, though. Let me explain.

The conference, “Stimulating HealthCare by Achieving Meaningful Use in Health IT” covered a lot of the usual ground, with real, practical advice for achieving meaningful use—thing like ROI, and barcoding with CPOE.

It wasn’t until Day 2 that Charlene Underwood, a HIMSS fellow and the Director of Government and Industry Affairs for Siemens pointed something out that could potentially be a real problem for hospitals if they don’t read carefully.

It’s in the final HIT Policy Recommendations for defining meaningful use matrix — the one from August.

Here it is, directly from the matrix: The 2011 OBJECTIVE for hospitals is for 10% of all orders (any type) to be directly entered by AUTHORIZING PROVIDER (e.g. MD, DO, RN PS, NP) through CPOE

So far so good. And I bet many hospitals thought they qualified — after all, that’s pretty broad and includes nursing documentation. In other words, it doesn’t have to be an order by a physician.

But here’s the kicker: The 2011 MEASURE is for % of orders (for medications, lab tests, radiology and referrals) BY PHYSICIANS through CPOE.

Are you following? The objective says that any caregiver entering orders qualifies for meaningful use. But the measurement to qualify only includes physicians.

I don’t know about you, but this looks like a mixed message to me. The thing is, most hospitals have already done the calculations to find out the dollars they expect to get from ARRA. Which calculation did you use? I wouldn’t be writing that money into any budget quite yet.

More and more, it seems like getting that HITECH money is a gamble. "Seeing Double"


Something is happening here but you don't know what it is, do you, Mr. Jones...
I can't help clarify Jim, because I'm not sure I get it either. I'm not surprised you're getting calls.
And so it begins...

I agree...It's not a big deal...
Unless the docs are NOT your employees, then it's a VERY big deal.
That's why the VA, Military and Phys owned hosp such as Kaiser, Geisenger, etc have been so successful over the last decade. Also Univ teaching hospitals where the house staff are basically hospital employees.
And the highest level of doc CPOE use in traditional community hosp is where there are Hospitalists on staff.
Attending docs make their money in the office, not in the hospital, so anything that keeps them from getting back to the office is a hinderance, not a help.

Good catch...but here we go again.
In my 35 years in this business the one true maximum I learned long ago is 'the devil really is in the details'. That's true for ALL federal regulation. And the little devils are begining to rear their ugly heads.
This is just the begining and if you are a vendor who is will to put wording in your contract that 'we will /can/ intend the meaningful use measures' out!

Everyone makes it sound like a scary proposition especially here at Halloween, but the VA has been doing almost 100% CPOE by physicians for years. There are many hospitals that have 90+% of orders done through CPOE both employed and non-employed community physicians. It isn't that big of a deal.

The messaging to hospitals and providers has to be the new workflow provides many efficiencies in care from time savings, to cost savings, and furthermore life savings.

If the VA can do it, so can everyone else.

I get your point; there's going to be many, many points of clarification between December 2009 and April 2010. At the TORCH conference last week, there were several talks that focused on points that require clarification.

I love Rich Temple's tie.

Glenn Mamary at Hunterdon is a highly accomplished CIO. He was awarded our highest honor this past summer in recognition of his achievements:

Glenn and Hunterdon's Integration Achievement:
Hunterdon Medical Center (Flemington, NJ)
Opportunity existed to both increase outpatient laboratory revenue and electronically link Affinity to the NextGen Electronic Medical Record and Practice Management System. Used InterSystems' Ensemble to integrate Affinity Order Management and external laboratory system to send results to NextGen without having to purchase a reference laboratory system. Realizing over $100,000 per month in new revenue for the laboratory and we now have the ability for our laboratory to compete against commercial laboratories. We anticipate even higher revenues as we have more practices to implement.

Joe, you never miss a thing, including Rich's tie.
It seemed to me that if there was such a disconnect between objective and measurement in the meaningful use matrix, how the heck are CIOS going to be able to plan. More clarification will be great, but my guys need to plan!
I was happy to meet Glenn there, thanks for the link. In general, the NJ folks were a very engaged bunch. And seeing the two of them side by side, I couldn't resist taking that picture.

Help! I am not sure that I get it (is that the point?). What percent of orders are expected to be placed by MDs in 2011?
Something is going on. I have been approached for two intensive consulting engagements in the past 72 hours.