Lessons Learned and the Road Ahead in Meaningful Use

June 5, 2014
How can the meaningful use program become more meaningful? Judy McCarthy, chief technology officer at National Jewish Health, shares her thoughts in preparation of the Health IT Summit in Denver later this month.

In the meaningful use (MU) program, much of the attention has been on the development of electronic health records (EHRs), which can become information silos.  As the data in EHRs becomes more robust and comprehensive, organizations can begin to analyze this information in an effort to provide higher quality care and affect outcomes.

On July 23, 2014, at the Hyatt Regency Denver Tech Center, Judy McCarthy, chief technology officer at National Jewish Health, a Denver, Col.-based respiratory hospital, will discuss how Stage 2 of meaningful use is pushing providers to deliver better care through the use of EHRs, during a panel session at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2). (Since December 2013, iHT2 has been in partnership with Healthcare Informatics, through its parent company, the Vendome Group, LLC.) Separately, McCarthy recently sat down with HCI Associate Editor Rajiv Leventhal to talk about lessons learned from the MU program so far, providers’ feelings on the program, where the challenges lie, and what the future holds. Below are excerpts of that interview.

What lessons has the industry learned from the meaningful use program so far?

Many organizations have been able to attest to Stage 1, and I think that has a lot to do with the stimulus dollars to at least get folks started. But vendors are still struggling to improve their applications and be able to implement in time for all the organizations that are trying to attest. It’s a little different from a hospital perspective than it is for eligible providers because so many of those providers are small offices that have to take on a fairly large expense in order to position themselves to attest for MU.

Judy McCarthy

Overall, the program takes away time that needs to be spent on other high priorities, and that is something that I hear a lot as organizations are struggling with dollars and resources in order to push forward. One key lesson is that you can’t just throw it in the system, and think that the data will just be captured. You need a coordinator—someone to manage the program since it’s ongoing. I do think organizations have looked at it to be a lot less of a drain on resources than it really is. In several cases, I have seen organizations not capturing as much data as they would like to, and as a result, end up having to do twice the amount of work to reach their goal. So are we accomplishing the overall goal? Certainly that should be asked. Looked at from the beginning, from the dollar perspective, interoperability and decreasing costs, we’re not there yet, and we have a long way to go to see those benefits.

How are you progressing in your hospital?

Originally, we didn’t even think we qualified. We are an ambulatory hospital with very few inpatient beds, so from an inpatient perspective, we wouldn’t have qualified. We are now looking at it from an eligible provider perspective, working with vendors to get on right version so we can attest this year, Stage 1, Year 1.

What will be the impact of CMS’ recent proposed rule that would provide providers more flexibility for MU reporting in 2014?

It could be significant when you’re looking at the provider level. There are a lot of provider groups that have yet to do it, didn’t think they could do it, weren’t prepared, or hadn’t sought out a vendor. A lot of provider groups have joined forces in order to obtain a system—my physician did that, rather than attempt to do it alone. A lot of the bigger hospitals are already there, so they’re making the move to implement their systems to allow them to go to Stage 2, as they have probably been in Stage 1 for at least a year, if not two.

 It gives the vendors a reprieve a bit, too, and that’s where the bigger struggle is. It’s not necessarily that the vendors haven’t prepared the systems, but having the staff and resources to get their customers implemented has been a trial. They have also hurried to get to the Stage 2 2014 version, and it may not perform as well as needed. So this could really help a lot of providers, and give them a bit of an option where they don’t feel like they have to cram something in. But hospitals might already be past that point.

How concerning is it that just four hospitals have attested to Stage 2 so far?

Honestly, I would have anticipated it to be higher, as just in our area in Denver, I know that hospitals have all attested to Stage 1 within the last couple of years. I do think they’re still struggling in having the resources and the vendor application preparedness to move forward to Stage 2, though. Of course, there are a lot of competing projects, such as quality reporting and value-based purchasing, and with many other regulations and changes coming down the pike it has really become an issue keeping up with everything. The delay of stage 2 helped, as no one would have been ready had there not been one. So while it is somewhat concerning, hospitals will step in and move forward. The systems being used on hospital side are bigger and broader than those used on the provider side. You have the big players such as Epic and Cerner, so the vendors will be ready.  It’s more about the hospitals making sure they have the resources and making it a priority.

So is the provider community growing increasingly frustrated with the program?

I actually hear that a lot, as I’m pretty active in the Colorado Health Information Management Systems Society (HIMSS) chapter. They are saying, “Let us do our jobs, let us care for patients.” Having to put systems in or change systems (perhaps they’ve already been collecting data in a way that supports their practice), in order to meet MU can be such a drain on resources, and they feel like it’s just another burden. The government is telling us to do this and this, and we feel like we have been doing it all along, but apparently not the right way, they say. A big part of the frustration is due to the fact that we haven’t seen the intended benefits yet, which are data sharing, knowledge of your patient and what that patient’s history is, interoperability, providing better quality care, and decreasing cost. If you’re not seeing the benefit, it’s a difficult sell. Why devote the time and resources to it then?

What needs to happen for those intended benefits to be seen?

That’s a great question. Well, it needs to be less about the money, and it will be, because this is the last year you can get any stimulus dollars for Stage 1. It needs to be more about the patient itself. The best requirement that is out there is all about patient engagement and making the data patient-centric so the patient owns the data. As far as interoperability, I hate to say it, but a lot falls on the vendors. There has been an interoperability showcase at the HIMSS conference for more than 10 years I think, and it’s typically the same vendors talking about one area. Obviously, HL7 messages can be moved and accepted between applications, but that’s not seamless, and it can be costly, too.

Are organizations actually starting to put the patient at the center of everything, or is it still all talk?

I think they’re trying to. A few years ago it would have been a really hard sell to any organization to say the patient owns the record. People thought that the patient won’t understand it and the physician will have to take calls and explain it, meaning work will never get done. That was a big concern about the patient portal and its data. But data has showed that is not necessarily true—patients want the information and while they might call to talk about it, they also might save that conversation for the next visit. They do want it though, and patients are becoming more involved in their care by their own choice. That has opened the door to make healthcare more patient-centric.

But providers are struggling with the view/download/transmit piece of MU. Doesn’t that make what you’re saying a catch-22?

It is a catch-22. And the view/download/transmit is not just for Stage 2, remember—we have to deal with that for Stage 1 in 2014. We also have issues with that from a Direct messaging perspective, having to find a health information systems provider (HISP) as well as someone who manages direct messaging and is certified in that. Our regional health organizations may not be there yet, and many applications are not prepared for that, either. How do you make that work within your system? The technology behind it needs to improve, and that’s where we have fallen down a bit.

Where do you see the MU program a few years from now?

Oh boy, that’s a tough one. I can see where some view it as a success, and others as a disappointment. Overall, it has promoted the use of EHRs, and it is promoting interoperability and the electronic exchange of data. It is also forcing the collection of appropriate data where you might not have been collecting that data in the past. The frustration to put it all together is big for all organizations, though. In due time, I believe it will be seen as a success by those who have been active in it, started early, and have put the resources and dollars into it. But smaller provider organizations who struggled to implement systems, have not spent the dollars, and did not have the resources available may not see it that way.

To learn more about making the meaningful use program meaningful, please check out the Health IT Summit in Denver, July 22-24, sponsored by the Institute for Health Technology Transformation.

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