 |
 |
|
Jenny McCaskey, RN
|
Erica Drazen, ScD
|
As 2011 and the milestone for the first financial incentive of "Meaningful Use" draws near, health care providers are trying to understand the impact of filling gaps in electronic medical records system features and associated workflows given their unique baseline situation. There is no "one size fits all" plan to "implement" Meaningful Use. Some providers have already implemented EHRs that are supported by best practice content and workflow. Others are only beginning the planning process and many others are somewhere in between.
Providers that have recently completed complex EHR projects may simply "check off the box" to indicate that they have achieved Meaningful Use. Other providers may be tempted primarily by financial incentives to develop an aggressive, unrealistic plan to meet the Stage 1, 2 and 3 deadlines. Despite the different starting points and incentives, there are some general rules to follow:
1. Don't assume you are at or near meaningful use: review the proposed requirements that were released on Dec. 30, 2009, now and check again when the final rules are published in the Spring. Most organizations will have gaps.
2. Don't present achieving meaningful use solely as a way to earn incentives. This is and should be a program to achieve safe, efficient, patient centered care. That goal will motivate providers.
3. Do review the approach and design of multi-disciplinary patient centered care. The traditional approach of designing separate processes for different clinical areas (ED, ICU, Peri-op) or roles (Physician, Nurse, Respiratory Therapist) build in inefficiencies in documentation, hand-offs and make reporting more challenging.
4. Conduct a scripted, multi-disciplinary Meaningful Use test using appropriate software features and applicable workflow processes.
5. Don't be lulled into thinking that because you can use the Stage 1 criteria to qualify as late as 2014 that you can wait. All providers also need to meet Stage 3 criteria by 2015 to avoid Medicare penalties.
Do start now. Assign ownership and develop a detailed workplan. Successful implementation requires redesign of processes, updates to database build and extensive testing and training initiatives. Cutting corners in any of these areas will greatly increase the risk of failure. Much has been written about the challenges of computerized physician order entry (CPOE) and implementing clinical decision support. The good news is that there are now many examples of success that provide useful best practices and lessons learned. Another, less discussed challenge is to implement the EHR so that quality reporting is derived as a by-product of care. This requires attention to how, why and where data is collected.
The Meaningful Use requirements are staged; the Stage 1 requirements are focused on capture of data; moving toward using HIT to transform processes and in Stage 3 to improved outcomes. Despite the staging, data must be collected correctly in stage one to enable the right process change in stage two and to document the desired outcomes in stage three.
Data quality must be high to provide credible information for improving performance and for reporting. This requires that the process for capturing data has the right balance between specificity and ease of recording and that it is reliably captured. It is essential to check that the data being captured will enable quality reporting. For example, in addition to using order sets, reminders and drop down menus to document that recommended procedures are being performed, it is also important to make it easy to record why recommended procedures were not appropriate for a particular patient. Data also needs to be collected early in the continuum of care so that it is available when needed, especially in high turnover areas such as day surgery and endoscopy. To the extent possible, existing data should be presented (such as the current medications as recorded in an ambulatory system) so that they only need to be validated and updated when the patient arrives. There are many new types of data that will need to be captured electronically either because it is specifically required or because it is needed for future process and reporting requirements. It is helpful to have common processes and standard reminders and prompts for each documentation. For example, have the same process for maintaining medication lists and problem lists from an emergency admission though discharge.
Certainly achieving Meaningful Use is far from the only priority facing health care organizations. It is essential to understand the timeline for investments, the costs and the value to the organization--both in terms of incentive payments and other priority goals. The potential incentive payments and penalties can be easily calculated. This can help put decisions about the timeline for achieving meaningful use in the context seeing the big picture of competing priorities such as adopting ICD-10, implementing other IT and process changes, system upgrades, construction of new buildings/services and other operational priorities.
Jenny McCaskey is principle, and Erica Drazen is managing partner, CSC.
|