CHIME Members Testify about implementing EMRs

March 9, 2010

ANN ARBOR, MI, March 8, 2010 – Four members of the College of Healthcare Information Management Executives (CHIME) provided testimony before a federal panel today on challenges they foresee in implementing electronic health records. The members shared their observations before the Implementation Workgroup, which was chartered by the HIT Standards Committee, a federal advisory panel that reports to David Blumenthal, MD, national coordinator for health information technology.

The Implementation Workgroup heard reports on the topic, “Implementation Starter Kit: Lessons and Resources to Accelerate Adoption.” The workgroup is charged with developing real-world implementation experiences that can be included into recommendations of the HIT Standards Committee. Its suggestions will be aimed at accelerating the adoption of proposed standards or mitigating barriers to adoption.

The four CHIME members participated in an “implementation experiences panel,” which sought to share different perspectives on their experiences in installing electronic health records systems. Those CHIME members who took part in the panel included: Mitzi G. Cardenas, vice president and CIO, Truman Medical Centers, Kansas City; Charles Christian, CIO, Good Samaritan Hospital, Vincennes, Ind.; David Muntz, senior vice president and CIO, Baylor Health Care System, Dallas; and Michael J. Sauk, vice president and CIO, University of Wisconsin Hospitals and Clinics,


The CIOs provided testimony with their vendor partners on the challenges they are facing, and how that could manifest itself nationwide as healthcare organizations make plans to implement records systems to get stimulus fund payments under the Electronic Health Record Incentive Programs.

According to Muntz, implementing EHRs requires organizations to undergo significant changes in how they operate and provide care to patients.

“The successful implementation of an electronic health record is the result of many complex, coordinated activities,” he said. “These include new technology, new processes and new behaviors on the part of clinical staff.” The primary job of a clinician is to provide care, not to use a computer or any other device; but “as we are moving technology and software across our hospitals, we expect these individuals to blend these new tools into their interactions with patients.”

To transform clinical care through the use of enabling technology “does not happen without process redesign and change management support, training, rehearsals, strong leadership and coaching to support the paradigm shift that each caregiver must experience,” Muntz added.

The rapid timeframe for implementing electronic records is a challenge being faced at Truman Medical Centers, Cardenas said. Currently, proposed regulations for defining the meaningful use of electronic health records set out 23 objectives that providers must meet to qualify for stimulus fund payments through either Medicare or Medicaid programs.

“Stage 1 requirements are well beyond our current use of the electronic record and will require our physicians and nurses to do more of their work assisted by an EHR,” Cardenas said. “The timeline for achieving meaningful use is much more compressed than a traditional implementation schedule. We have worked closely with our vendor partner to apply best practice to the implementation sequencing so we ensure the safety of our patients as well as sustainable provider adoption.”

The proposed regulations also require providers to supply the Centers for Medicare & Medicaid Services with a variety of data on the extent of usage of EHRs and quality results from care delivery.

“Current reporting of core measures and other required reporting is already cumbersome and resource-intensive,” Cardenas testified. “We are concerned about CMS’ new increased reporting requirements for both the quality and functional measures for meaningful use and the resulting burden it could place on the organization.”

The meaningful use objectives in the proposed regulations target important EHR capabilities, but it’s important for other applications and processes to be in place to support clinical transformation, Christian said. He highlighted the use of computerized provider order entry as one example.

“Some time ago, we identified CPOE as that ‘capstone solution’ for a complete, closed-loop medication management process,” he said. “But if you do not have the supporting pharmacy, nursing and laboratory solutions live and integrated, you will not get the safety benefits that CPOE can deliver.

“For CPOE to make an impact on coordinating and improving care, you must have the foundational applications and standardized evidence-based content that is critical to enhancing the physician’s medical judgment and decision-making process,” Christian said. “It’s important that the transmission of the order and interaction with department-specific decision support be key to the success of the process; otherwise, the process of requiring an electronic record with no transmission and interaction is simply a replacement of the paper order, which provides no feedback to the provider.”

Sauk said his organization is working on quality and external reporting requirements outlined in the proposed regulations, but noted that progress is difficult because CMS is not able to accept electronic submissions of data, so University of Wisconsin Hospitals and Clinics can’t comply with the requirement until that changes.

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