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EHR implementations must go slow to ensure patient care: Federal panel

Testifying before a federal workgroup, providers explain why slow and steady EHR implementation is better for both meaningful use and patient care.

Electronic health record (EHR) implementation is a complex process that requires thoughtful, structured steps and plenty of time to manage any problems that might arise and to ensure patient care, according to industry stakeholders testifying before a federal workgroup.

Providers and vendors discussed their experiences during a daylong meeting of the federal Health IT Standards Committee’s EHR implementation workgroup in Washington this week. State officials, hospital executives, vendors and doctors presented a “starter kit” to help the health care industry address implementation and the EHR meaningful use criteria.

Health IT must be embraced as a function of change, but it is not the end goal by itself, said David Muntz, senior vice president and CIO at Baylor Health Care System in Dallas.

“The primary job of a nurse, therapist, physician or other clinician is to provide care to the patient, not to use a computer or other device,” Muntz said in his testimony to the workgroup. “And yet, as we are moving technology and software across our hospitals, we expect these individuals to blend these new tools into their interactions with patients such that that relationship is not interrupted, but is enhanced.”

Baylor Health Care’s electronic health record implementation work has been ongoing since 2004, and is part of a broader clinical transformation project for the system, according to Muntz. Baylor is planning to comply with meaningful use requirements through a timeline that aligns with its broader project, and it does not expect to be fully compliant until 2013, instead of 2011.

It’s an incremental approach, Muntz said. “We are not modifying our timeline to meet the earliest adoption period. We will have some hospitals and clinics that will be ready prior to 2013, but the enterprise will not be ready until then,” he said in his testimony. “The patient is at the center of everything we do -- and we must not allow speed to divert our focus.”

Speed is a concern in general for those who will have to comply with the meaningful use mandates expected to become law by this summer. Just implementing computer physician order entry (CPOE) software is costly and difficult for physician offices, according to Charles Christian, CIO at Good Samaritan Hospital in Vincennes, Ind.

“If you do not have the supporting pharmacy, nursing and laboratory solutions live and integrated, you will not get the safety benefits CPOE can deliver,” Christian said in his testimony to the workgroup. “CPOE requires more than simply moving the prescribing and transcribing processes from paper to electronic,” he said.

The hospital has been analyzing its current IT rollout to make sure it aligns with meaningful use criteria, and expects to focus heavily on CPOE software and quality measurement to be in compliance, Christian said. Good Samaritan now conducts quality reporting through a manual, statistical-sampling process because there is no specific electronic application that allows someone to push a button and produce a report.

The patient is at the center of everything we do -- and we must not allow speed to divert our focus.

David Muntz, CIO, Baylor Health Care System

Overall, the EHR implementation timeline has led the hospital to embrace change at even higher levels, Christian added. Good Samaritan is benchmarking itself against the requirements for the Malcolm Baldrige National Quality Award, which is given to hospitals that demonstrate excellence in specific categories. “I used to think we were doing a really good job until I looked at the Baldrige criteria,” he said during the workgroup meeting.

Rolling out products to providers also takes time, according to Michelle Freed, vice president of San Francisco-based McKesson Corp. The healthcare services company is Good Samaritan’s vendor, and presented with the hospital during the meeting of the workgroup.

McKesson’s products are currently on target to comply with most of the criteria in the federal requirements, but constant updating and refining will be needed to ensure ongoing compliance, Freed said.

In addition, without the clarity that the final meaningful use rule will provide, it’s hard for vendors to move forward with products. Providers need a long timeline to make the right decisions about products, Freed said. “There’s a huge potential risk of going too fast.”

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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