As we gather together stakeholders for strategic planning of next year's priorities, what are we hearing and what we have learned?
1. Clinicians are overwhelmed by the current demands of Meaningful Use, hundreds of quality measures, population health, care management, and patient/family engagement. All of these are good ideas individually but the sum of their requirements overwhelms providers. In an era when we're trying to control costs, adding more clinical FTEs to spread the work over a large team is not possible. The end result is that providers spend hours each night catching up on the day's documentation and are demanding better tools/automation to reduce their strain. However, current EHRs are in an early stage of development and are data capture tools rather than customer relationship management systems. As we gather requirements for FY16, we're thinking about the projects that could be innovative breakthroughs, replacing human work with a next generation of technology and workflow.
2. The consumerization of software (BYOD devices and apps) has created infinite demand and high expectations. The difference between the $2 app and the $2 billion dollar EHR is that the $2 app is easier to use, more convenient and possibly even more useful. There is no question that EHR transactional systems will need to exist to support compliance and regulatory imperatives, but increasingly we'll look to third party apps to provide modular functionality on top of the transactional systems.
3. The cloud is clearly the way that people want to work. Social networking ideas of collaboration, file sharing, availability anywhere/anytime, multiple device support, and convenience are driving forces. The good news is that Amazon Web Services offers low cost, HIPAA compliant hosting/storage/groupware/mobile support. We've learning as much as we can about AWS.
4. It's increasingly difficult to balance supply and demand for IT. Stakeholders prefer to discuss the vision for the future rather than the details of allocating existing resources in the present. Incremental progress no longer feels satisfactory and users want a big leap forward. The solution to this quandary seems to be spreading work among as many parties as possible: IT, third party solution providers, business owners, power users, and energetic innovators. Unless there is a sense of federated collaboration, build and buy, central and local support, IT will be seen as the rate limiting step.
5. ICD10, the Affordable Care Act, Meaningful Use, and the HIPAA Omnibus rule may be the focus of regulators and legislators, but they are not the focus of most users. Stakeholders want to know when their projects will be accelerated and when the distraction of federal regulations will end. Big change management projects in IT are hard on users, forcing them to accept decreased short term service for long term gains. The problem is that the agenda of most IT departments has been co-opted by federal programs and the users are no longer willing to wait. This is one of the reasons I have suggested that Meaningful Use Stage 3 be deferred. Providers and the industry need more time to catch up on all the deferred projects and adjust to the thousands of pages of new regulations that have already been finalized.
With these observations, what are we planning to do in FY16? Over the next month, we will present a five-page list of "bottom up" stakeholder enumerated high priority projects, categorized as core, advanced, and innovative.
Stakeholders will refine these categorizations and I hope they will collaboratively agree on focus areas for the FY16 and beyond. I look forward to optimizing our governance, our projects, and our vision to accommodate the needs of stakeholders in the post Meaningful Use era.