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Could Ten Percent Be About Right...?

July 17, 2009
by Mark Hagland
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I’m going to step out on a limb here and comment on the CPOE element of the revisions announced yesterday to the recommendations of the Meaningful Use Work Group of the ONC’s HIT Policy Committee, per the ARRA-HITECH funding (my colleague David Raths wrote an excellent blog report on the announcement of the overall revisions yesterday).

So here’s the thing: I think that whatever requirement gets set in stone regarding the 2011 requirements for CPOE as an element in meaningful use, would be criticized by one faction or another in the industry. Some will say that the 10-percent-of-orders requirement is far too weak a requirement; others, that any firm requirement for 2011 will be impossible for most hospitals to achieve.

I’m going to take a middle-of-the-road view here (or at least, what I consider to be a middle-of-the-road view!) and say that, in a situation that is going to require that we all accept imperfection to begin with (after all, this whole process is going to be like asking a thousand archers to try to hit a bull’s-eye on a moving target, I think!), 10 percent sounds more or less about right to me. Why is that?

Well, to begin with, just requiring some level of implementation of CPOE by 2011 will indeed be a rigorous demand for the majority of U.S. hospitals. For one thing, it means that, if this revised set of recommendations is solidified, the vast majority of hospitals will have to rush—and I do mean, rush—just to get their CPOE implementation to that level in time. In fact, if hospital CIOs around the country aren’t moving right now to budget for CPOE implementation and beginning at least the first stages of its planning (vendor evaluation, internal multidisciplinary working group planning and preparations, etc.), they won’t make it. And I’m talking about now, meaning this week or this month.

And yes, some might say the 10-percent requirement is too lax; but basically, what it does is to compel hospitals to get the core CPOE functionality live on at least one significant unit within a hospital. In my reporting on CPOE, I’ve found that the most common unit for hospitals to go live in is one of the ICUs, for a variety of reasons, including the smaller number of clinicians regularly working on that unit; the smaller number of patients; the close physician-nurse communications required in an ICU; and other clinical and operational reasons. In any case, if a hospital goes live on one significant unit or one floor, it means that at least an important portion of the groundwork has been laid for the ongoing rollout of a CPOE system.

What’s more, the feds will almost certainly raise that level for 2012, and thus, will be compelling hospitals forward in an important area.

My September cover story on CPOE will give HCI readers a look at what some of the CPOE pioneers have done to leverage the power of CPOE. What I can say now is that those organizations that are at least two or three years out on CPOE go-live (and thus by definition ahead of 90 percent of their peer organizations nationwide) have terrific stories to tell. All of those I interviewed for the September cover story approached CPOE not as an IT project, but as one strongly facilitative component in an overall drive towards improved patient safety, clinical care quality, and clinician workflow. And aren’t those the areas that all the purchasers, payers and policymakers want healthcare to move forward on, anyway? I’m glad that the feds are going to compel CPOE forward; and I hope they figure out a way to move the pace car forward at a reasonable pace, one that neither causes hospitals to fail through rushing nor lets hospital leaders think they have forever to get going. The right pace would also mean acknowledging the pressure that will be put on vendors and consultants to help hospitals implement so much, so quickly, en masse. There’s no perfect solution here, but with the right combination of carrots and sticks, the feds could maybe get the pacing of this whole thing just right after all.

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