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Early adopters share EHR meaningful use best practices

Achieving meaningful use for electronic health records requires a solid plan, one that two early adopters of EHR technology helped outline at the recent Healthcare Stimulus Exchange in Boston.

Even before the federal government finishes its rules on electronic health record (EHR) meaningful use, two Boston health systems are well on their way to being compliant. Doctors from the two systems shared some of their experience at this week’s Healthcare Stimulus Exchange road show.

Dr. David Bates, medical director of clinical and quality analysis at Brigham and Women’s Hospital, and Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, said their teams have been working on as many of the proposed meaningful use specifics as they can.

At the Exchange, Bates and Halamka highlighted several best practices that helped their facilities get on the fast track to EHR meaningful use.

  • Perform a gap analysis. Assess where you are now, versus where you need to be when the meaningful use provisions go into effect. Brigham and Women’s took stock of its current EHR features, compared them with what the rules will eventually require to measure quality improvement and earn incentives, then set medium- and long-term goals to closing the gaps, Bates said. Key items his hospital had to work on included getting data points, such as vital signs and advance directives, into the EHR system.
  • Plan realistically. It was important to Brigham and Women’s to devise an EHR implementation plan that is sustainable, not just designed to earn financial incentives, Bates said. Key to a successful EHR implementation: Concurrently analyzing both HITECH Act deadlines and the feasibility of creating a lasting system.
  • Determine security up front. Should your facility manage secure data exchange on a per-site basis, or enterprise-wide? When addressed early in the process, this question can help steer EHR implementation.
  • Understand certification. As soon as certified EHR is defined and certification bodies are named, sift through all the requirements and craft a workflow in which your nurses, doctors and support staff understand which data points they will need to get into the EHR system, such as immunization records, body mass index and other quality indicators the eventual certifying bodies will mandate.
  • Influence the rulemaking and guidance. When regulators offer comment periods and other opportunities for input during the next several years as they build out rules surrounding EHR meaningful use, offer your input based on the pain points you’re experiencing firsthand -- and ask for clarifications to vague language or all-inclusive rules, such as being required to put the smoking status of infants into the EHR system.
  • Investigate state resources. Find out about the health care IT grants and support available for your EHR implementation through state governments, health care information exchanges, regional extension centers and regional health care information organizations. Tap into them.
  • Find out who is still using paper and plan the transition. While Beth Israel is 95% electronic, clinicians use paper for certain esoteric processes, for example, in the neonatal intensive care unit, said Halamka, who is also chair of the US Healthcare Information Technology Standards Panel (HITSP). “Every time you write for a drip for a baby that weighs under a pound, it’s a lot of very complicated computation,” he said. But they’re working on computerizing that, he added.

Overcoming obstacles to achieve EHR meaningful use

Bates said that while he feels that Brigham and Women’s and the 11-hospital Partners Healthcare System to which it belongs will be in “good shape” regarding EHR meaningful use compliance, he worries that the rules might be tough for many of his organization’s peers.

“I think this is going to be a challenge for most networks. I’m hearing from organizations like Intermountain [Healthcare], Catholic Healthcare West and [the Mayo Clinic], that they’re really not sure whether they’re going to be able to do this or not,” Bates said. “When I put on my policy hat, that’s quite concerning. I’m hopeful that rules will be relaxed a bit, because I think it’s important for more people to be able to achieve [compliance],” he said.

The 110 quality reporting requirements the Office of the National Coordinator for Health Information Technology (ONC) wrote into the proposed EHR meaningful use rule might seem intimidating at first glance, but they probably won’t all end up in the final rule, Halamka said. His reasoning? It’s easier to take items out of a regulation than to put them in after the fact, he said

Getting the governance right, getting a clinician champion who, in your institution, will say, ‘Yeah, we got to do this!’ and getting people who can do it in the trenches -- that’s the [hard part].

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

“The folks at ONC tried to put in a very large universe of quality-reporting metrics with the idea that they may be either taken out, or extended to future years,” Halamka said. “They’ve all been retooled to be EHR-friendly, based on data elements we’re all recording already, so I think this will be doable.”

By law, the proposed meaningful use rule’s companion interim technology-standards rule takes effect Feb. 13, setting the stage for implementing EHR meaningful use provisions next year. Despite all the technical items to cross off checklists -- such as making sure the EHR system covers growth charts for children until they are 20 years old, and monitoring the smoking status of all patients -- EHR meaningful use will ultimately be accomplished by workers, not software and interoperability, the experts said.

“It’s all about the people,” Halamka told after the presentation. “It turns out that getting the governance right, getting a clinician champion who, in your institution, will say, ‘Yeah, we got to do this!’ and getting people who can do it in the trenches -- that’s the [hard part].”

That can be tough because it’s tempting for hospitals to look at EHR adoption as a technology issue and try to solve it by concentrating on vendor selection, Halamka said. The real issue health care providers need to focus on is EHR use, its implementation by employees and building trust in the EHR system. Not an easy task for workers often juggling many different priorities on any given day in a fast-paced work environment.

“The technology is really mature; the technology really isn’t a barrier,” Halamka said. “But getting those three elements of the people together is the hard part -- especially the senior management engagement and clinician championship.”

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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