Heck with “Meaningful Use” - It's “Certified EHR Technology” I'm worrying about

Posted on: 5.18.2009 4:13:27 PM Posted by Mark Harvey

I confess that I'm coming down with a serious case of Meaningful Use Fatigue. Since the ARRA included that phrase as a condition for receiving EMR incentive payments, the industry has been parsing those two words like a French literary deconstructionist. Google will give you about 9.1 million hits on “meaningful use.

“All the angst reminds me of those people back in school who were always obsessing over what was going to be on the test. Why not just learn the material? The test will work itself out. Likewise, it seems to me that the best advice for providers to follow today would be:

Get a system that works
Use like it's intended to be used

The end result will be real benefits for you and your patients, and you'll almost certainly qualify for a good chunk of incentive money.

However, the section of the act that addresses incentives under the Medicare program is titled, “Incentives for Adoption and Meaningful Use of Certified EHR Technology.” What is “Certified EHR Technology?”

For the last few years it's meant only one thing - the CCHIT blessing.

I appreciate the role that CCHIT has played. As a voluntary certification body, it has satisfied a very valuable need for organizations who are selecting a system; you had at least some independent confirmation that the system you were banking on was functional. CCHIT's approach to certification standards has been to influence system development by annually raising the bar. The exact same “certified” system that you contracted for last year, and are still going to be implementing into next year, may not be certified against this year's standard.

The process of certification that the vendors have to navigate is onerous enough that they have to make a business decision as to whether it's worth recertifying the superseded versions of their products against the new standards.

(To read this posting in its entirety, visit http://www.healthcare-informatics.com/mark_harvey)

Epic EMR Adoption, Utilization, and Cost

Posted on: 4.23.2009 4:16:28 PM Posted by Dale Sanders

The point of this blog is: purchasing and installing an EMR and hoping that you'll realize a positive return-on-investment is not enough. You need to dedicate the time and resources to constantly iterate, refine and improve the utilization of that EMR over time, far beyond its installation and go-live. It's a race without a finish line so you might as well train, budget and plan for that accordingly - up front.

At Northwestern, we take great pride in being one of the first fully-institutionalized adopters of an EHR in healthcare. We've had an ambulatory EMR (Epic) for 12 years and an acute care EMR (Cerner) for 10. For the past 18-24 months, we've been studying not just the adoption of the EMR, but also studying the utilization of the EMR. Drawing upon an analogy to illustrate the point, if a carpenter buys a pneumatic nail gun, I call that “adoption” of a new tool. But if that carpenter is still using the nail gun to manually pound nails as if it were a hammer, has he achieved “utilization” of the tool? If you believe there is added value to an EMR over a paper chart - or even a word processor - where does that added value reside and are we using it for those purposes? I've been slowly polling and collecting data in an attempt to understand EMR “utilization.” I doubt my data collection process would pass Gallup's scrutiny, but I still believe that it paints an informative picture.

(To read this posting in its entirety, visit http://www.healthcare-informatics.com/dale_sanders)

EMRs May Do Away With the Docs that Use Them

Posted on: 5.5.2009 8:37:39 AM Posted by Sam Bierstock, MD, BSEE

The President has announced his goal to digitalize our nation's medical record system. If achieved, this wonderful and lofty notion would certainly reduce medical errors, increase the quality of care delivered, bring consistency of care to our citizens, reduce costs associated with delivering health care, and quite possibly drive the physicians who are supposed to use them out of business.

The buzzards are already beginning to circle.

Physicians and nurses are the most pressured of all professionals, with expectations of their performance and its unimaginable responsibilities beyond the comprehension of people who have never made life and death decisions hundreds of times a day. With every decision and action comes the risk of being held liable and losing both their profession and their assets. The very mechanics of using electronic medical records in their current state of development has complicated the lives of many clinicians who use them and have been slow in being adopted for that reason. With luck, that will change.

What few people realize is that using a computer to document every decision, every action, and the assessment of every piece of information that streams to clinicians in real time represents a major change in the way clinicians have to think and work, and an audit trail that has begun the salivation process of every malpractice attorney who has finally realized what is about to be imposed on the medical profession.

(To read the posting in its entirety, visit http://www.healthcare-informatics.com/Bierstock)

The Calm Before the Storm

Posted on: 5.8.2009 10:06:35 AM Posted by Anthony Guerra

It's been an eerily quiet week on the healthcare IT front. While we usually publish four news items a day, a few days found us with nothing significant to write up. I honestly can't remember such a lack of noteworthy happenings since the week of Christmas/New Year's, more than four months ago.

I think we're waiting for the other shoe to drop.

That shoe, of course, is the first iteration of “meaningful use,” which should come out of David Blumenthal, M.D.'s (and John Glaser's, for a time) Office of the National Coordinator for Health Information Technology. An office, we all know, under HHS and its newly sworn-in chief Kathleen Sibelius. Blumenthal and Glaser have no shortage of input to consider when writing up the requirements, though it might have been gracious to issue those statements as comments after the definition had been put forth, as is the normal protocol.

Meaningful Use Definitions (with release date):

CHIME (May 1)
Markle Foundation (April 30)
AHIMA (April 29)
NCVHS Holds Hearing to Define Meaningful Use (April 28 and 29)
HIMSS (Acute, Ambulatory) April 27

But, of course, patience has no place when interests jockey for power and influence. Thus, HIMSS jumped the starting gun first, upstaging even Blumenthal's NCVHS hearing by injecting its input the night before that meeting convened. That organization's focus was, of course, on ensuring CCHIT-certified products took their rightful place. HIMSS is a vendor-supported organization, and the fact that it looks to further the interests of its largest members is nothing to howl about.

CCHIT, of course, continues to advocate for the fact that certification is absolutely necessary. Even if you aren't swayed when conspiracy theorists declaim a nefarious HIMSS/CCHIT connection, it is difficult to argue against the fact that CCHIT's input on the value of certification is of dubious value. I am not familiar with many organizations that espouse their own demise. Today, the organization is on the verge of either becoming uber-powerful or marginalized. It will either hold something akin to a medieval imprimatur or watered-down stamp of approval.

(To read the posting in its entirety, visit http://www.healthcare-informatics.com/anthony_guerra)

Healthcare Informatics 2009 July;26(7):16-18