How To Develop an Inpatient Action Plan

Oct. 28, 2009

Those who implement electronic health records early will reap the benefits, including receiving a greater amount of incentives for which they will be eligible.

With Medicare and Medicaid financial incentives for meaningful use of certifiable electronic health records (EHRs) becoming available to eligible hospitals and physicians Oct. 1, 2010, providers should act rapidly to establish eligibility and quality for the maximum incentive money. Providers should leverage their existing information-technology infrastructure, use a best-of-breed strategy and partner with vendors offering risk-sharing approaches.

The American Recovery and Reinvestment Tax
Act (ARRA) uses a “carrot-and-stick” approach to drive inpatient
and outpatient use of EHRs by 2015. The carrot is that the
earlier facilities begin using EHRs, the greater the amount of
incentives for which they will be eligible. Based on the number
of annual discharges and other factors, early adopters can
receive a minimum of $2 million to a maximum of $11 million
payable over four years.

Those who implement electronic health records early will reap the benefits, including receiving a greater amount of incentives for which they will be eligible.

With Medicare and Medicaid financial incentives for meaningful use of certifiable electronic health records (EHRs) becoming available to eligible hospitals and physicians Oct. 1, 2010, providers should act rapidly to establish eligibility and quality for the maximum incentive money. Providers should leverage their existing information-technology infrastructure, use a best-of-breed strategy and partner with vendors offering risk-sharing approaches.

The American Recovery and Reinvestment Tax
Act (ARRA) uses a “carrot-and-stick” approach to drive inpatient
and outpatient use of EHRs by 2015. The carrot is that the
earlier facilities begin using EHRs, the greater the amount of
incentives for which they will be eligible. Based on the number
of annual discharges and other factors, early adopters can
receive a minimum of $2 million to a maximum of $11 million
payable over four years.

The primary question for providers is how to create an ARRA-qualified EHR. The easiest and most expedient way for facilities is to piggyback on their existing infrastructures.

The stick is twofold. First, institutions
that start using EHRs in 2014 and 2015 will receive lower
incentive payments for three and two years, respectively.
Second, and more importantly, those that fail to adopt or use
EHRs after 2015 will have Medicare reimbursement reduced by 1
percent annually starting in 2015, reaching up to 5 percent in
later years.

Hospitals and health systems that already
have adopted or are on the path toward adoption are best
positioned to receive higher incentives. Organizations in the
preliminary stage of considering EHRs can catch up by acting
aggressively. Though the definition of meaningful use is being
defined, providers will be better off buying an EHR now instead
of later. Further, there is no reason to risk delay in
qualifying for incentives when vendors will upgrade systems to
meet meaningful-use criteria.

The primary question for providers is how to
create an ARRA-qualified EHR. The easiest and most expedient way
for facilities is to piggyback on their existing
infrastructures, using them as a foundation. This strategy will
not be too jarring for many organizations, as it will simply
reinforce a development that already is under way at many
facilities.

A prominent trend among providers over the
past decade has been to look for a single-vendor solution. The
current economic environment, however, makes a single-vendor
strategy economically unfeasible. ARRA’s staggered
meaningful-use deadlines leave hospitals little margin for error
if the vendor encounters technical difficulties or fails to come
through. Consequently, organizations should use their existing
infrastructure as a baseline platform, while adding proven,
best-of-breed clinical solutions to address areas of need.

Another reason for this approach is that
vendors of large hospital-information systems (HIS) historically
have struggled to automate high-acuity areas, such as the
emergency department, intensive-care units, labor and delivery
units, neonatal intensive-care units, operating rooms, and
post-anesthesia care units. Meaningful use can only be achieved
by collecting and distributing meaningful data that resides
primarily in those high-acuity areas.

When selecting EHR vendors, hospitals would
be wise to partner with either HIS companies that have acquired
best-of-breed high-acuity solutions through mergers or
partnerships, or with companies that specialize in automating
clinical-documentation solutions they need. Whatever HIS vendor
EHR a facility selects should interoperate with best-of-breed,
high-acuity solutions and vice versa.

To further minimize risk and ensure optimal
IT investment, facilities should:

Seek vendors willing to enter into
risk-sharing or performance-based pricing models. This model
ties payment to performance on metrics, such as decreased
average length-of-stay, improved staff efficiency and retention,
and reduced costs.

Use the revised recommendations the federal
Health Information Technology Policy Committee approved as a
guideline for evaluating EHRs. Under the proposed requirements
for 2011, organizations must use computerized physician order
entry for 10 percent of all orders of any type and provide
patients with an electronic copy of their health information
upon request.

The U.S. Department of Health and Human
Services (HHS) will use the recommendations to develop a
proposed administrative rule to implement the incentives. The
rule, which will be released by Jan. 1, 2010, is expected to
provide greater detail and clarity about meaningful-use
requirements.

Prioritize areas for automation. The growing
need for high-acuity applications should be balanced with the
hospital administrator’s challenge of deciding where to begin
implementing those solutions. One approach is to group clinical
modules around “functional clusters,” or strategic functions or
initiatives.

Hospitals will be best served by creating an
HIT infrastructure emphasizing outcomes-relevant, connected and
simple use of enterprise EHR systems for mobile and busy
clinicians. This means putting the power of patient information,
a streamlined ordering process, easy access to drug/clinical
decision-support database information, and medical-device
interface interoperability at the clinician’s fingertips.

Progress has been made in improving quality
and eliminating inefficiencies that cost the health system
billions of dollars, but only 1.5 percent of hospitals have
adopted a comprehensive EHR, according to a New England Journal
of Medicine survey. By providing $17.2 billion in incentives to
encourage hospitals and physicians to use EHRs, the government
is addressing the financial barrier that has kept providers from
automating care delivery.

As HHS moves to finalize meaningful-use
requirements, facilities, vendors and other stakeholders should
collaborate to meet meaningful-use requirements and improve the
quality, safety and cost effectiveness
of care.

For more information on
CliniComp International solutions:
www.rsleads.com/911ht-207

Alan Portela is chief operating officer of CliniComp International, San Diego.

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