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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!

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