Recently, the Office of the National Coordinator for Health Information Technology issued its interim final rule for meaningful use, health information technology standards, and certification criteria and implementation specifications for electronic health record incentive payments. Widely expected to produce some clarity around what’s required and how to move forward with health IT implementation, the proposed rule raises as many questions as it answers.


For instance, independent physician practices are asking how to proceed if they have staff privileges with multiple hospitals that choose different EHR packages.

Hospitals are concerned that multi-campus facilities will have to purchase systems and adhere to EHR requirements separately, but will only be eligible for one incentive payment.
Quality advocates worry that EHR technology does not provide the necessary functionality for public quality reporting.

And all providers are deeply concerned about the aggressive timeline and the implementation costs, particularly if emerging networks have to be refined to facilitate an open exchange of data.
Hence the blessing and the curse associated with a government EHR mandate.
The blessing is that we have a mission, timeline and guidelines as to what needs to be in place and how it must work, providing more clarity than we would have if we implemented these technologies independently. The curse is that Washington has glossed over details and oversimplified an incredibly challenging effort to simultaneously “wire” the entire healthcare system. 
Providers should seek more clarity from the national coordinator and make the appropriate requests for modifications that address the larger details. However, as is typical in these cases, providers are going to have to develop rapid implementation plans that fit within the government’s overarching vision, working out for themselves the business relationships, processes and technology platforms that work best for their patients and unique local networks.
Historically providers have not come together to share information on how to best implement HIT. But with a mandate to create an interconnected healthcare delivery system that supports free-flowing information (under appropriate privacy and security requirements), the best way to fast track execution, maximize investments and ensure public health benefits is an organized, collaborative effort.

One example illustrates the power of a collaborative approach. Last year, shortly after the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, non-profit hospital members of the Premier healthcare alliance created the HIT Collaborative. Since then, these hospitals have been working together to share the latest knowledge around requirements, compliance strategies and lessons learned.
To that end, this group recently developed an HIT best practices library that outlines steps and approaches that must be executed prior to and during implementation. Backed by literature and real-world experiences of the collaborative members, the best practices library features specific guidance on achieving the objectives outlined in the meaningful use criteria in the areas of computerized physician order entry, medication management, clinical documentation, quality measures reporting, privacy and security, health information exchange, population health management and personal health. 

Taken together, these prioritized resources can be used to help focus implementation efforts around specific tasks required to achieve meaningful use – leveraging the experience of others to achieve smoother, faster adoption of EHR functions.

Regardless of where an organization is in the EHR implementation process – from just starting out to fully mature – the library can be used to improve the likelihood that hospitals receive HITECH incentive payments in 2011 and 2012.

The result of a successful EHR implementation should result from the balance between common approaches based on learned best practices and appropriate individualized approaches based on the needs of each organization. After all, we don’t want a “one size fits all” approach that quells all flexibility and innovation. But the key to success will be careful coordination, open communication and collaboration to avoid mistakes and ensure a system that works for all.

William  Spooner is senior vice president and chief information officer of Sharp HealthCare and chair of the Premier HIT Collaborative


Keith Figlioli is senior vice president of healthcare informatics for the Premier healthcare alliance