Lessons learned on the way to getting meaningful use payments

Good governance, project management and workflow analysis will help hospitals meet meaningful use today. Tomorrow, though, the focus will shift to health information exchange.

Though the Massachusetts Health Data Consortium's HealthMart 2011 conference was focused on how to receive meaningful use payments, some speakers cited quality improvements in patient care as the driving force in their organization's health IT adoption. Money from the Electronic Health Record (EHR) Incentive Programs is a nice byproduct, but many early adopters of EHR systems have other goals in mind.

Cost containment is one of those goals, especially in Massachusetts, where state health IT coordinator Richard Shoup is leading the way toward the vision of statewide deployment and adoption of health IT. "This is not a trivial exercise, as we all know, and there's going to be a lot of conversations about it," Shoup said during his presentation at last month's HealthMart conference in Worcester. "But at the end of the day, we need to figure out a way to manage costs and improve quality, safety and efficiency."

Massachusetts -- where legislation requires residents to have health care coverage -- is now looking to reduce costs while improving care quality. Ensuring that all the state's health care providers are using EHR systems and engaging in health information exchange is critical to those goals, officials say.

But most of the health IT adoption is happening in eastern Massachusetts, Shoup noted; the western part of the state is more rural and lacks the broadband needed to support HIE and EHR use. To help remedy this, the state created the Massachusetts Broadband Institute, which has been given $80 million in federal grants to establish a broadband infrastructure in western Massachusetts within the next three years. This infrastructure is expected to support roughly 330 hospital and provider entities.

The state has also aggressively recruited members for its regional extension center, the Massachusetts eHealth Institute (MeHI), which has enrolled 2,500 providers in its program. Shoup, who is also the director of MeHI, said the REC is launching a new website that will include a job board to help place graduates of the health IT training programs.

The REC also is looking to expand into consultative services, consumer education and even grant funding for select providers to help get them through that last mile of the meaningful use journey -- though Shoup was careful to note that these ideas still need to be vetted.

Patient engagement is key to the success of health IT adoption. MeHI is planning a communication outreach effort, Shoup said, to help patients understand the value of working with a provider who uses EHR technology. It needs to be communicated in a way that makes the patients understand what's in it for them, he added.

Secrets to success in getting meaningful use payments

"Meaningful use is not a destination, but a journey," said Bill Young, CIO of Berkshire Health Systems, at the start of his presentation. Berkshire is aiming to improve care quality, focusing on the value of EHR systems for the whole community, not just as a tool to earn federal grant money. Young and co-presenter John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center, shared some of their lessons learned from hospital EHR implementation.

Both CIOs emphasized the importance of change management and input from all stakeholders. Young said he was fortunate to have several physicians, nurses and clinical informaticists working part-time on his payroll, who were instrumental to the success of the EHR implementation. He does not have a full-time CMIO, but he has enough part-timers to fill the job requirements.

Halamka's organization began by going department to department and assessing the unique workflow requirements of each to figure out how they could meet the meaningful use criteria. It's important to get buy-in from department chairs, super users and others who take time away from clinical work to help with IT projects, Halamka said.

A good governance structure is also key to ensuring that meaningful use goals are aligned with institutional goals. "I cannot say enough about the importance of governance," Halamka said. "This is the group that sets your priorities. There's a lot of cool things you'll want to do, and meaningful use may not be aligned with everything you want to do."

The governance team at BIDMC would evaluate projects objectively based on quality, safety, return on investment, compliance and other factors, then come up with a single list of to-do items and execute on them.

I cannot say enough about the importance of governance. This is the group that sets your priorities.

Dr. John Halamka, CIO, Beth Israel Deaconess Medical Center

Meaningful use stages 2 and 3 will bring more health information exchange

All three presenters agreed that health information exchange will be a network of networks, and that it's a good idea to start building local HIEs now. Berkshire is building a regional HIE, and BIDMC is using Nationwide Health Information Network (NHIN) standards to give its providers the ability to share data with each other.

Berkshire started thinking about using a federated model, but "the more we think about it, the more we think we will wind up with a database structure that takes key elements from various systems and brings them together, so that we can push data to the clinicians, direct it, and report on it," Young said.

These regional HIEs will ultimately need some sort of backbone to connect them to one another. "How are you going to uniquely identify a provider if you don't have a statewide provider directory?” Shoup said during his presentation. “How are you going to uniquely identify an individual if you don't have a master patient index across the state? How are you going to communicate between states as patients transition from care settings across state lines?" 

Massachusetts will have a health information service provider (HISP), Shoup added, that will act as the backbone for statewide HIE.  

Another key to successfully getting meaningful use dollars is solid project planning and management. Berkshire has Six Sigma in place and is constantly analyzing data to measure its progress toward its goals.

It's much harder to track the progress of EHR adoption at the state level, though. "It's really hard to figure out where we really are," Shoup said. "We've got anecdotal information, we have some surveys, but you can't go to a single entity and say 'So where are we with respect to the adoption of electronic health records? What types of systems are people using? What kinds of issues are they facing?'"

MeHI is trying to pull this information together into a single source, giving providers a more complete view of the ecosystem.

Let us know what you think about the story; email Anne Steciw, Associate Editor.

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