CMIO Summit: Meaningful use could mean take the money and run
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A better title might be “A CMIO Looks at Meaningful Use: The View From Under the Bus,” Coleman quipped. Before meaningful use requirements, “you were responsible for all clinical errors. Now you’re responsible for the financial survival of your hospital as well.”
Nevertheless, Lifespan is ready to submit data for attestation for Stage 1 Medicare EMR incentive payments, he said, and “we think we’re OK for Stage 2, based on what we think the requirements will be.”
For the myriad facilities that are not as far along with meaningful use, Coleman discussed what Lifespan has done and why duck and cover, one and done and take the money and run are not the best options .
“I could make a case that the investment we need to make to achieve meaningful use is too high and the returns are too low, and that the penalties are tolerable.” However, the penalties increase over time, and will cost non-participating hospitals down the line.
The one and done approach—in which an organization addresses one requirement and gets the money—applies to Stage 1, but "short-term solutions don’t get you where you want to go if what you’re interested in is improving quality and improving safety.” In addition, “if you attest in year one, and at the end of year two someone comes and looks it over and you’re not really doing it, can they take the money back?”
Given the political uncertainty of 2012 and beyond, it’s certainly tempting to take the money and run: “[In 2012], people are saying we may get a big swing and HITECH may get unfunded and healthcare reform may get undone,” Coleman explained. Although that’s far from definite now, “I am advocating that we get certified as fast as we can and get the money. But I don’t think this should be the goal, either. It’s got to be for quality and safety.”
Lifespan divided its meaningful use efforts into several projects, he said.
Standardization was one of these projects. Lifespan “LOINC’d [Logical Observation Identifiers Names and Codes] our lab and radiology,” and has converted about 75 percent of its formulary to RxNorm. Semantic interoperability is important because the information produced in the hospital must be usable by physicians outside the walls. “Only by putting data together with other data can we extract information,” he advised.
To electronically collect clinical documentation, “we built our documentation systems around data. Our physician notes, nursing notes, home medication lists, everything is built around defined data fields. So when doctors and nurses are charting, they’re putting info into fields and we’re reporting it in the data warehouse [so] we can extract it later. That is a ton of work; it’s a separate project. It was worth it in the long run because we now have a very rich and full data repository that we can actually query and get information from."
Transitions of care translates to “living and dying by CCD [continuity of care documents]. CCD was easy for us to build once we got it—very easy discharge instructions and point-and-shoot interfaces for the doctors,” he added.
For quality indicators, “we put all of our orders into the warehouse, all of our medication administration, nursing observations, most of our lab results. For the last eight months, we’ve been collecting all medications on discharge; diagnoses are something the hospital has been collecting for years. For meaningful use, every one of our quality measures we can extract from data warehouse without doing any data abstraction,” said Coleman.
In addition, “we have built a registry and repository, using a commercial product that we’re customizing. It follows XDS-b [Cross-Enterprise Document Sharing]. The ability to communicate this information is actually the second holy grail of MU. We are producing the data as CCD, and pumping CCD into a repository. Every time a doctor downloads this and gets the patient’s medication list, allergy list and problem list, … it’s a major gain for healthcare.”
Hopefully, protecting patient information is nothing new to any facility, he said. Whenever Lifespan installed a system, “we made sure it was compatible with the rules and regulations around security. We didn’t have to do much … it was part of our system at the time we started working on meaningful use.”
Finally, Coleman advised those now embarking on meaningful use: “Break it up and do the things that you would want to do to make your IT systems work better regardless: Standards, documentation, a data warehouse, quality reporting—these are all things you should do whether or not meaningful use is out there.”