Make Haste, Slowly

The urgency of the HITECH Act is upon us. Often described as a “feeding frenzy” of new market entrants, hospitals issuing RFPs, consultants and vendors at all time highs of activity, HIT may exceed Y2K and the dot-com era in terms of impact on the industry. With 2011 looming, many providers are aggressively planning deployment of CPOE, CDSS and HIE.

Titus, the emperor of Rome, had a symbol of a dolphin wound around an anchor inscribed on coins minted in his reign.The dolphin was regarded as the swiftest and most mercurial of fish.The anchor represented delay and unchanging conviction. Together, they symbolized the failure that comes from rushing into something and the failure that is the result of hesitation or undue caution.Through the years the dolphin and anchor have been used as a family crest with the explanatory motto Festina lente, "Hasten slowly." It expresses moderation between two opposing ideas.

Hospital and physician leaders must balance the urge to act too quickly and the urge to wait too long.Action is required due to the runway needed to gain buy-in, redesign processes and successfully launch required applications.Caution is required on a number of fronts.This week, I’m attending the HIT Symposium at MIT.One of the most interesting speakers was Kerry Weems, Former Administrator of the Centers for Medicare and Medicaid Services.He reminded us that Medicare is a payment system.The rules for payment of the incentives will be out soon and the process for payment must be developed.He shared CMS’s initial experience with the Physician Quality Reporting Initiative (PQRI). 700,000 physician practices receive payment in the Medicare system. All were eligible for benefit under PQRI. Roughly 100,000 chose to participate in program. Of the 1 in 7 that participated, only ½ participated successfully. Errors prevented 50,000 physicians from not receiving the payment.

The Medicare Doctor’s Office Quality-IT Initiative is also worth examining. Between 2005-2008, CMS hired the national network of private Quality Improvement Organizations (QIOs) to support 3,600 small-to-medium sized adult primary care practices in 3 tasks: 1) Spur successful adoption of EHR systems, 2) Redesign clinical workflow to use EHR to improve patient care and 3) Use EHR to report clinical quality data to a CMS data warehouse. David Schulke, Executive Vice President of the American Health Quality Association, the QIOs recruited over 3900 practices. The program exceeded expectations in terms of use of the technology for care management and overall physician satisfaction. The reporting of quality measures failed nationwide.

There will be a process for reporting to CMS to demonstrate that you are a meaningful user. Certainly there is concern that demonstrating meaningful use is going to be burdensome. Additionally, we must remember that CMS has an over-riding focus regarding the prevention and monitoring of fraud and abuse—what rules will be put in place to make sure the system isn’t gamed? It appears from discussions this week there is great emphasis on not creating an extra reporting burden, but only time will tell.

Hospitals can begin the work today in partnership with their medical staffs to define good processes for quality measurement and reporting.Data definition and normalization, data analysis and monitoring, feedback loops for correction of collection problems – all essential elements.A disciplined process that can be married to CMS rules will be essential.We have found with clients a higher likelihood of success if part of a broader evidence based medicine and clinical integration initiative.For those organizations, who haven’t started down this path it is clear that HITECH and health reform are inextricably linked to quality metrics.Hospitals must step up and work with their community physicians to begin the discussion.Make haste, but take time to collaborate and design quality reporting systems that work.