There is no getting around it: One financial challenge hospitals and health systems will face going forward is planning to demonstrate the meaningful use of IT and making sure the investment can be leveraged for the system’s goals of improved care and efficiency. Meeting federal meaningful use standards, however, is only the start of a long journey—and those health care industry players who aren't aware of this fact must not only get on board quickly, but implement a deliberate, multifaceted strategy for doing so. “It is not something you can throw on as an extra task in your project plan,” said Elizabeth Johnson, vice president of applied clinical informatics at Dallas-based Tenet Healthcare Corp.
Johnson, who serves on the federal Health IT Standards Committee and, as such, is participating in helping to draft the technology standards for electronic health record (EHR) products, discussed Tenet Healthcare’s efforts in this regard at HIMSS 2011, during a session on enterprise business intelligence. Tenet Healthcare has a network of 49 acute care hospitals extending across 11 states and 63 outpatient centers in 12 states; its facilities have a collective 57,000 employees and serve some 500 million inpatients annually. The hospital system expects to receive about $320 million in incentive payments for meeting the three stages of meaningful use requirements before the 2015 deadline. If it did not participate in the meaningful use program, it could expect $90 million a year in penalties for not complying, according to Johnson.
Streamlining ITIn attempting to establish the best direction for satisfying the requirements, Tenet Healthcare decision-makers closely investigated the entire concept of meaningful use. “We spent a great deal of time understanding the intent of each [meaningful use] measure,” Johnson stated.
Decision-makers realized early on that the hospital system did not have the clinical data necessary to predict and change patient outcomes. “Our hospitals had had the leeway to choose their own systems, so there was a lot of best-of-breed technology out there without any real data standards,” Johnson explained. Without such standards, meeting meaningful use goals is impossible, she noted.
To address the issue, a decision was made to replace the hospitals’ disparate EHR systems with a single EHR system. A number of systems were evaluated, with the objective of finding an evidence-based computing platform that would facilitate meaningful use not only by affording secure access to individual EHRs at the point of care, but by organizing information to satisfy the specific and individual needs of care providers as well as front-and-back office providers. The new EHR system is being interfaced with the disparate EHR systems currently in use in the facilities’ emergency departments. Rollout is occurring at a rate of approximately six sites at a time to allow ample leeway for training, testing, and modification. The project was halfway complete as of late February 2011.
A separate initiative related to demonstrating meaningful use has involved a complete revamp of Tenet Healthcare’s computerized physician order entry system. An investigation of the system revealed the presence of 7,500 order sets across all 49 Tenet hospitals; these order sets were reviewed, consolidated, and eventually streamlined to a “more reasonable 488,” Johnson said.
Engaging StakeholdersEven before the rollout of the new, unified EHR began, Johnson said, steps were taken to ensure that what she deemed the crucial elements for success in deploying and deriving value from any EHR system—namely, to communicate, to ensure that physicians and staff are on board, and to understand down to specific data elements what the system is doing—were in place. Notably, a training plan was designed for physicians so that they could better understand how the system would impact their workflow and what adjustments they might need to make to accommodate the new technology.
To be certain they were on the right track and to borrow ideas from peer institutions, Johnson’s team continuously scoured the national media. “We looked at what other hospital systems were doing and how they were incorporating everything that [was] needed,” Johnson recalled.
As a result, Tenet Healthcare formed an advisory group made up of representatives from every medical discipline and hospital department. In biweekly telephone meetings held over a period of several months, group members worked on the documentation of clinical standards for the EHR system (in large part based on individual meaningful use measures), as well as on rendering such documentation in agreement with overall workflow. In addition, Tenet Healthcare appointed a clinical informaticist and a “physician champion” for each hospital.
“This was our way to keep our clinicians engaged, and to help to move the process along. It is impossible to fully leverage any system, let alone satisfy the regulations for meaningful use, without communication and buy-in from every discipline and department,” Johnson concluded.
Julie Ritzer Ross is a contributing writer for HealthCXO.com.