CMIOs give meaningful use mixed reviews (Part Two in Two-Part Series)
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It will take a while for clinicians to absorb the information in the 800-plus pages of the final rules for Stage 1 meaningful use of electronic healthcare information. It will take longer for the results of this rule to emerge. However, CMIOs weighing in on this far-reaching initiative already say they have mixed opinions of it.
“Overall, I think the rule is fair. If I had to give it a grade I’d give it a B minus. I’d give the CMS folks in collaboration with ONC an A for effort,” stated Ferdinand Velasco, MD, CMIO at Texas Health Resources, a system of 13 hospitals serving North Texas, based in Arlington.
Although Texas Health Resources already considers itself a meaningful user of health IT, there will be notable challenges ahead, said Velasco, who is in a four-year deployment of Epic’s EpicCare EHR and has two installations to go before system-wide completion. With the implementation of an EHR with computerized physician order entry (CPOE), the organization has seen a reduction of as much as 50 percent in medication errors, he said.
“We know in our hearts if we are a meaningful user or not,” stated Velasco. “We don’t need the regulation to tell us that. It’s just a matter of us demonstrating that to CMS so we can get the incentives.”
Velasco said the final rule’s inclusion of emergency department patients in all of the hospital measures was a major surprise. Although the inclusion of ED patients in the CPOE metric was reasonable, the addition of the ED to the scope of problem list documentation, medication lists and medication allergies was unexpected. “It was an eye-opener because a lot of people weren’t requesting or expecting that,” he said. “That’s going to be a twist.”
Given the timing of the publication of the final rule, according to Velasco, the implementation timeline is extremely compressed for both vendors and providers, and achieving meaningful use by Oct. 1 (the beginning of the first payment period) is ultimately unrealistic for most hospitals. “We don’t have any certifying bodies so we don’t have any certified EHRs,” he said. “We only have, effectively, two months before the reporting period begins.”
According to Velasco, the biggest challenges for Texas Health Resources will be the quality measures because they have never been tested in a real-life setting.
The final rule is “still quite formidable,” Velasco said. “Even though they lowered the threshold, it’s still going to be a challenge.” If only a minority of hospitals achieve meaningful use based on Stage 1 criteria in 2011, the federal government will end up basing its Stage 2 definition next year on limited data. “This could lead to a vicious cycle,” Velasco said.
Looking ahead to Stage 2, Velasco and colleagues are looking into barcode medication verification and advanced clinical decision support as well as medical device integration to connect the EHR with physiologic bedside monitors. Velasco is hoping to use the incentive money to “fund ongoing investing in IT so we keep staying ahead and improving information systems.”
A reasonable rule
On the other hand, Brian D. Patty, MD, vice president and CMIO at HealthEast Care System, a system including three short-term, acute-care hospitals, one long-term, acute-care hospital and 14 primary care clinics based in St. Paul, Minn., said his initial reaction to the final rule was that the goals the federal government set forward are very reasonable.
The criteria are "attainable across organizations nationwide. Certainty if you’re shooting for FY11 or FY12, you have to have been well on your way to an EMR implementation,” Patty said. “Even an organization that started [its] implementation when the initial rule came out a year and a half ago I think can easily hit it in the 2013 timeframe and still qualify for the majority of the of the funding.”
“A three- to five-year journey for an organization is reasonable to get up on an EHR,” added Patty.
Although Patty said most of the criteria made sense, HealthEast will have to adjust its timeline on certain initiatives, including interoperability capabilities with surrounding organizations and the ability to capture data and report it to CMS.
“We do have to go through a major system upgrade to McKesson 10.3 from the 10.1 platform, [so we have to] adjust to get the 10.3 upgrade into our timeline and get our systems to the point where we can submit to CMS after the upgrade,” said Patty. “That was a significant re-jiggering of our timeline.”
Informatics will become more highlighted in organizations because they will realize they can’t just roll out an EMR but have to implement it in a way to get some outcomes, he said.
“You’re going to see a shake out after a year or two if some of the major vendors don’t have a lot of client base hitting stimulus dollars,” Patty said. “You’ll see a shift in the market if a vendor can say it has 30 organizations that hit meaningful use in 2011 and will have 40 in 2012, and another vendor can only say they have two. That’s going to be a selling point.”
“You’ll see the potential of improving clinical outcomes through the use of an EHR being reached by more hospitals sooner than if this legislation had not been passed,” concluded Patty.