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HITECH Mega-monopoly

July 15, 2009
by vciotti
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Dr. Blumenthal's committee deciding what defines "meaningful use" to qualify for stimulus funds is unfortunately dominated by giant facilities like John Glaser's Partners and John Halamka's Beth Israel. These facilities have hundreds of FTEs in their IT departments and IT budgets in 7-8 figures. Yes, they are easily the most knowledgeable and articulate spokesmen for HIT, but they live in a rarefied atmosphere far from the reality of the typical community hospital, with but a handful of IT staff and an annual budget measured in thousands, rather than millions.

These mega-facilities may define "meaningful use" in a fashion that is only achievable in their super-sized world. Take CPOE: they alone can achieve a high percentage of use thanks to:
· Teaching environment, where interns and residents can be ordered to use it or not graduate, versus community hospitals where admitting physicians have little incentive to learn or use CPOE...
· CMIOs - know what the average doctor makes per year? How can a typical community hospital of 150 beds afford to hire a full-time MD to build screens and alerts, train other MDs, man a help desk, etc.
· RN Informaticists - the last few large hospitals I have been in had teams of nurse informaticists (3 or more) working full-time on assessments, care plans, BMV, eMARs, etc, to build their EMR. How many RNs can a Critical Access Hospital under 25 beds devote full-time to screen-building?

Per an AHA data base we purchased a few years ago for mailings, the median hospital bed size in America is 168 beds. That means there are about 2,500 under that number, none of whom are being represented on the DC committees. That's as fair as letting HUMVs set crash standards for Toyota Priuses. We need to get normal hospitals voices heard. If you have time to answer these "calls for comments" or know any of the mavens in Washington, please, tell them about the small hospitals who need the stimulus funds far more than AMCs and IDNs, but aren't having their voices heard!



Funds can be shifted. Incentives can be established. The end result of improved patient safety and improved outcomes clinically will be realized by the majority of institutions. And finally, the importance of early communication, collaboration, and team building will prove successful for organizations of all sizes.

Vince does raise pertinent points, but I have heard quite a number of voices speak up for the individual physician, small groups, small hospitals. There is undeniably a cost in adopting AND maintaining a HIT system just as there is a cost to maintaining a non-digital system.

I see that innovators are responding to the concerns raised by Vince and others and software as a service (SaaS) may soon become a viable solutions where small organizations can obtain products (actually services) built on best practices that are user friendly from the get go. Such a model would do away with the expense of backend computing and allow the user to work with networked workstation (PC, laptop, handheld, etc). The less talked about part of ARRA seeks to bring broadband to un- and underserved areas which would enable SaaS solutions access to a much wider group of potential users.

Hopefully these solutions are available while we have incentives still in place.

Check out Charlene Marieti's post re: North Dakota Hospitals.
It echo's Vince's points.
I think small hopitals even more so than small MD practices, are behind the eight ball on this one.

Good post...good points.
As for Green Leaves SaaS solution, we old digs (yes, you included) used to call that Shared Services and it's a good approach, but it's not new, and I don't think it will really address the issue. The hard part is the training and install not where the server is located and who has to back it up or reboot it.
The little guy is going to need feet on his street just like Mr. Big, that's where the bucks add up fast.