Road to meaningful use bumpy for some

January 12, 2011 | Bernie Monegain, Editor

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Joanne Sunquist, CIO at 440-bed Hennepin County Medical Center

WASHINGTON – CIOs told a federal panel Tuesday about the roadblocks they have faced on their way to achieving meaningful use of electronic health records. Among those who testified before the Implementation Workgroup of the federal Health IT Standards Committee were five members of the College of Healthcare Information Management Executives (CHIME).

Meeting all requirements necessary to demonstrate meaningful use of electronic health records will be challenging for many hospitals, testified Joanne Sunquist, CIO at 440-bed Hennepin County Medical Center, a safety net teaching hospital in Minneapolis.

The hearing, "Real World Experiences Working with Meaningful Use," featured panels of eligible professionals and large and small IDNs, as well as regional extension centers and certifiers.

Four CHIME members, including Sunquist, participated on the hospital experience panel, which shared various perspectives from early adopters on installing electronic health records systems and achieving meaningful use objectives.

Another CHIME member took part in the implementation support panel to discuss the efforts involved in collaborative health information exchange. CHIME members who testified in addition to Sunquist were:

Russell P. Branzell, vice president and CIO, Poudre Valley Health System, Fort Collins, Colo.
Charles E. Christian, CIO, Good Samaritan Hospital, Vincennes, Ind.
Denni McColm, CIO, Citizens Memorial Hospital, Bolivar, Mo.
Linda Reed, vice president and CIO, Atlantic Health, Morristown, N.J.

The testimony before the HIT Standards Committee hearing is expected to help the Implementation Workgroup formulate recommendations to the Health IT Standards Committee and to David Blumenthal, MD, the national coordinator of health information technology, on early adoption of meaningful use.

"Creating the reports for eligible hospital MU objectives and quality measures has become an onerous, difficult and time-consuming process," Sunquist said. "This is in spite of the fact that we are working closely with our certified vendor who has provided certified reports. We are concerned that the difficulties organizations will face in producing the reports will result in significant delays in attestation, while not inherently adding value to the overall intent of MU."

Christian (pictured at right), CIO of a 232-bed community hospital in rural Southwest Indiana, told the panel his organization was fortunate to get a head start on implementing technology.

"GSH was early to realize the importance of the appropriate implementation of technology in the effective and safe provision of care," Christian said. The hospital and medical staff worked together to identify applications "that would improve the care process and create a safer environment in which to deliver high-quality care."

Christian points out that through hard work and a dedicated team, Good Samaritan Hospital has been very successful. However, its outcomes and experiences cannot be considered routine.

"In smaller facilities, the IT departments are much smaller and the spectrum of responsibility and effort ranges from management duties all the way to pulling and installing network cable," he said. "In many critical access hospitals, they have to depend upon the talents and services of outside expertise, as they cannot afford to employ certain positions on a full-time basis. In my conversations with smaller facilities, there is a concern that they will not be able to retain the level of expertise that the identified efforts will require."

Discussing health information exchange, Atlantic Health's Reed noted that achieving the meaningful use objective is more than a technology issue for most healthcare organizations.

"HIE ... includes appropriate use cases and the incorporation of acquired data into the physician EMR workflow," Reed said. "In various discussions with physicians in my organization, it is clear that they want autonomy in choosing technologies, but also expect to be able to send and receive data at will. The trouble is that many of them do not know what is required for this or whether they have capable systems."

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Dr Duncan says: It's even more difficult for doctors in private practice

January 12, 2011 | 3:54PM GMT

To Bernie Monegain, Editor

The CIO's of hospitals who are members of CHIME are saying that meeting all requirements necessary to demonstrate meaningful use of electronic health records will be challenging for many hospitals. What about doctors who are in private practice who are being required to totally revamp their workflows in a very short period of time in order not to be penalized by the government. Not to mention the already skyrocketing cost of running a practice when changes in reimbursements are at a virtual standstill compared to the costs.

This article states the hearing, "Real World Experiences Working with Meaningful Use," featured panels of eligible professionals and large and small IDNs, as well as regional extension centers and certifiers. It's nice that members of CHIME were able to participate in this. Who were the "eligible providers" that were included? Were they part of an organization for physicians similar to CHIME for CIO's? If so, I would like to know what that organization is. Were they representing specialty societies? Were they PCP's or were specialists included in the group? Were their careers dedicated to treating patients on a daily basis? Were they long time experienced users of an established EHR in their office or had they just recently implemented an EHR? Were they from academic institutions? Were they employed by a hospital or healthcare system or were they independent private practitioners? Were the salaried or were they reimbursed solely on production and medical/surgical services rendered?

To get a clear picture representing the "Real World Experiences Working with Meaningful Use" the Implementation Workgroup of the federal Health IT Standards Committee and the ONC needs to hear from physicians in all of the above environments and practice models.

I have been speaking up on this blog and other CMS and HSS blogs but I think my comments are probably not going to the right people and committees. As a specialist and the physician EHR facilitator in a private 115 physician multispecialy practice I feel like I am a lone voice in the wilderness in the feedback that the committees in charge are receiving. I think it is important for the ONC and its subcommittees to get feedback from private practice physicians in order to have a touchstone in the real world of the practicing physicians who their decisions are greatly affecting.

I would like to see an article on this site explaining how the ONC and its subcommittees are currently getting feedback such as I describe above. Are they even interested in such feedback? Should they or shouldn't they be interested?

Is there a way to have a blog such as this that would be seen by practicing physicians the comments of which could be seen by the ONC et al? Would the AMA or a coalition of American specialty societies be a better platform that would reach out to the real world of practicing physicians in order to assess the "Real World Experiences Working with Meaningful Use"?