The great thing about the HIMSS10 roundtable that I attended this past Wednesday was that there were great discussions, which means multiple blog entries for me.
In Thursday's blog, I discussed the roundtable participants' concern that ref="/directory/electronic-health-record-ehr" target="_blank" class="directory-item-link"><a h</a>ref="/directory/electronic-health-record-ehr" target="_blank" class="directory-item-link">EHRs and EMRs were given too much emphasis with regard to stimulus funding and meeting meaningful use requirements when other healthcare IT products offer perhaps greater value for certain hospitals.
Another equally important topic that came out of the roundtable was whether the proposed meaningful use criteria are too stringent for providers to meet. The champions of healthcare IT were concerned about a number of issues. Everyone agreed that CPOE ought to be delayed until a later stage. Those who have helped hospitals implement CPOE are in agreement that it is very difficult to implement and get it right. It took years for some hospitals to get to a comfort level with their CPOE component. Is it realistic, they wanted to know, to ask hospitals to implement and achieve 80 percent of physician order entry to be electronic? It's a set-up for failure. At the very least, said one RN/IT director for a hospital system, allow the emergency department to be counted as part of the 80 percent computerized physician order entry.
The healthcare IT journey is long, everyone agreed. You need to solidify mission-critical systems and infrastructure, which takes years. How can -ospitals that have not begun any healthcare IT initiative even conceive of implementing an EMR/EHR and achieving meaningful use? "Why bother?" asked one attendee. If it's all or nothing, if a hospital meets 14 out of 16 meaningful use criteria, that first step may not even be taken, some fear.p>
One participant conjured up the scenario of the physician who has been practicing for 20 years and taking good care of his or her patients through a paper-based system. Now he or she is being told to implement, maintain and sustain (heavy emphasis on the burden and cost of sustainability) an IT system, as well as meet meaningful use criteria. Is the resistance understandable? Absolutely. I didn't bring this up at the roundtable and I only quickly bring this up because I don't want to veer off of the topic at hand. In his keynote address Wednesday morning at HIMSS10, David Blumenthal, MD, National Coordinator for Health IT, said what's going on is social change versus technology installation. Social change is what I believe will take us over the hump. It may not be pretty and it will certainly be painful, but social change and generational change will get us to the other side of the tipping point of healthcare IT ubiquity.
Back to meaningful use. Some participants advocated for lowering the point of entry and add those requirements at a later stage. Others advocated instead for lengthening the time to meet meaningful use. On both points, I agree. There are some who would say this would slow things down or dilute the push for healthcare IT adoption. I disagree. There are too many hospitals that are at ground zero. Even with regional extension centers and a trained workforce to assist, even with additional private market resources and tools, it may not be enough to get them on board or to meet meaningful use.
If the point of the regulations is to improve the quality of healthcare, improve patient and population health, create an efficient healthcare system and save money, major barriers should be removed. Onerous criteria (for ground-zero hospitals) and a very tight deadline are major barriers.
The other big issue - and a "real fear" - to the participants goes beyond meaningful use criteria. Providers are being told to derive meaningful use out of these healthcare IT systems. The thing that is not addressed upfront is ensuring sustainability of these systems. It's going to take smart executives at these hospitals to figure it out. One hopes that the regional extension centers will be able to help in this very critical matter.
Patty Enrado blogs daily at EHRWatch.com.
