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ARRA Readiness Assessments

November 20, 2009
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In an October 16, 2009 letter to ten major healthcare IT vendors, Senator Charles E. Grassley (ranking member of the United States Senate Committee on Finance) initiated a US Senate investigation of the corporate practices of HIT vendors. The inquiry launched after the senator’s office received a significant number of complaints from patients, physicians, technologists, etc. regarding the safety of HIT/CPOE systems. A new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care between those organizations with electronic medical records and without automation. Last year, the Joint Commission announced a sentinel event alert holding health systems responsible for errors caused by the introduction of HIT.

Over the past few months we have conducted/and are continuing to conduct numerous ARRA Readiness Assessments on behalf of clients – rural, suburban, large health system, single facility – representing vendors key vendors McKesson, Cerner, Siemens, Meditech, Eclipsys…. Our focus is not on the technology roadmap, but on the organization’s readiness to use the system’s meaningfully. We have found troubling signs that the industry as a whole has not reconciled the potential damage these systems will create if implemented poorly. Specific red flags include:
  • Disconnect Between IT and Enterprise Strategy. For years, the industry has discussed “alignment” of systems plans with health system strategic initiatives. ARRA has exposed the truth. Most IT plans are vendor roadmaps. When you ask health systems executives if they are willing to put a new facility on the back burner to accomplish meaningful use, it becomes clear they don’t few IT in the same realm as “real” healthcare strategic initiatives. Many haven’t made the connection between IT and physician alignment, quality and outcomes improvement and reimbursement
  • Few CEO champions. Approximately 1 in 3 CEOs we have assessed, personally embrace the role as the organization’s flag waver for clinical systems. Most have delegated it and some don’t meet with the CIO on a regular basis
  • Focus on Rapid Implementations by Vendors and Hospitals. With a focus on the HITECH $$$, many organizations are skipping necessary planning and change management steps to implement, implement, implement
  • Few Medical/Clinical Informatics Resources. Many Medical/ Clinical informatics resources learn their craft OJT. Physicians are often the local recruited IT geek who has a system in his practice rather than clinical change leaders. Clinical Informatics resources are often assigned to Nursing and they work more like a super user writing procedures or to IT where they focus on system build, versus the true work of an informatics professional
  • Immature Process Redesign Methodology or Expertise. 6 Sigma/Lean are hot topics but not fully disseminated. Rarely, if ever, are they integrated with IT system implementations in today’s healthcare systems
  • Manual Clinical Quality Reporting. Most quality metrics are “abstracted” from paper records and automated systems. Few health systems have begun the plan to “extract” the metrics at an aggregated, much less patient detail level. Many vendors say, I have an “app for that”, but these applications don’t always ensure consistent data interpretation or integrity
  • Limited Project Management Capabilities. Many health systems have not invested in project management training/certification, project management offices or tools to assist in project management within IT or across the enterprise
  • Continued Replacement Push by Vendors. Providers are still encouraged to replace “other vendor” systems in areas where an interoperability technology might work just as well

It takes years to fully realize the benefits, and only a few days to experience the pain of a poorly implemented system. It reminds me of the saying “good things are slow in coming, and bad things happen very fast”.

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