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Foundation Members:
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CHIME Presents:
The CIOs Guide to Implementing EHRs in the HITECH Era
CHIME Member Comments on
Chapter 12: Should IT Planning Change to Achieve Meaningful Use Objectives?
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Question posed to members:
Healthcare organizations are all at different places in their healthcare
IT journey. Meaningful use objectives will add yet another variable in executing
an IT strategy. How has MU caused you to rethink your IT rollout strategy? How
are you harmonizing your implementation game plan to match evolving MU requirements in the next few years?
Comments:
In our area, MU has accelerated the regional adoption of HIT in both the inpatient and ambulatory settings. Physicians and hospitals could not/would not get there without assistance and incentives. We have to get the IT part in, so we can reap the H or health rewards provided by HIT.
We have moved some projects earlier, and delayed others; i.e., we have rearranged our project timelines and priorities.
The MU requirements have certainly had an effect on our rollout plans. We developed our initial strategy based on our desire to successfully rollout an EMR in both our inpatient and ambulatory environments. The introduction of the MU requirements has caused us to re-evaluate. It has also set up some tension where we need to assess the desirability of hitting a particular deadline for MU against the initial goals and risk analysis we did in developing our plans. The MU requirements introduce the possibility of overstretching our ability and rushing the implementation, which would be a mistake in the longer term.
For the EMR timeline it hasn't, it has just reinforced our current plans. We did move an HIE implementation forward to now instead of starting a couple of years out.
We took the five key tables found in the IFR certification, MU, vocabulary/technology standards, reporting and privacy/security and treated them as outcome deliverables to understand what else we needed to do. We agreed as a leadership team on timing of incentives, then we chartered projects where we knew additional material efforts would be necessary i.e., LOINC and commercial lab transactions. Other elements of the tables were viewed as requirements, and where necessary, we handed them off to appropriate project or application managers to treat as additional scope or new operating build requests i.e., new clinical documentation captures.
We look forward to seeing the final rule as we understand it will potentially alter the work we have done. We will track these efforts through project sponsors and oversight as we do other such matters in our case, tying them specifically to our EHR-related efforts.
We have begun to re-forecast our schedules and spending rate to more tightly align with MU. While the majority of items were on our roadmap, their implementation was spread over the next three to five years.
Yes, and yes.
We are focused on giving our health system the best opportunity to maximize the ARRA funds, so we have adjusted our system implementations to ensure that we are completing our hospital work by 2012 and our physician clinic work in 2011.
MU will change some timetables and add some additional requirements, but we don't see these will affect our other IT implementations to a great degree.
We have reprioritized some of our work to better align with the MU criteria and are watching expectantly to further tweak that strategy if necessary. We have formed a Meaningful Use Executive Steering Committee which will provide vision and strategy approval for CPOE implementation and other MU-related IT deployment.
No, not at all.
Were rushing our clinical system selection and implementation slightly. We have also tabled the selection and implementation of a badly needed revenue cycle system and general financial system. We are a small, nimble organization. I plan on using that trait to allow us to tweak our implementation. These ARRA requirements may turn out to be like many healthcare regulations in effect retroactively.
Weve really not added or removed anything from the plan. We have re-ordered a few to match up with the timing as presented in the NPRM. We will re-check our timing once the final MU criteria is published.
We have been monitoring the legislation since its inception. Initially, we maintained a high level comparison between our strategic direction and MU. We are in the process of wrapping up a very detailed gap analysis that we will complete when the final requirements for Stage 1 are published. What we are finding is that our strategic initiatives are right on course with MU but maybe not in the same order of adoption. The detailed functional requirements are causing us to focus on some areas that we didn't necessarily plan on as part of implementation. We will be optimizing some processes much sooner than we would have without MU. This is largely due to the fact that we were not thinking of all the specific details that are included in MU.
Were completely upgrading our HIS, including MU in the project plan to achieve full stimulus funding.
Fortunately, we are in a good position for MU however, ongoing planning to assure we reach the final end game is in place. Much to do and plan for.
In an organization in the throes of EMR implementation, MU should make it focus on the aspects of most value to MU incentive recovery. This mat shift priorities and implementation schedules. In an organization that has recently installed its EMR, like us, MU requirements are being worked into our enhancement schedule to address areas we are short in.
The stimulus funds are only one of several issues that impact our rollout of EMRs to our specialty clinics. The bigger factors are other competing IT projects (for instance, a giant revenue cycle implementation that is consuming about 60% of our IT resources at present), and a frantic construction schedule, with five new facilities coming online in the fall of 2011 that all require IT support. That being said, we believe that in the free time between these other priorities, we can aggressively rollout the EMR in order to maximize our potential reimbursement from ARRA.
Not rollout so much, as we think we are okay with adoption. We are still waiting for definitions of who (providers) is really covered and what certification entails.
MU objectives were already part of our IT strategic plans for patient safety and quality prior to being defined by the government. The MU timelines may impact our dates - i.e. execute objectives - faster. However, there are some concerns with misalignment of objectives to true patient safety and quality. Example: having CPOE prior to electronic medication administration record (EMAR) and bedside medication verification (BMV). Our organization is capable of meeting the CPOE objectives in advance of EMAR, but is not a true patient safety value added without a complete EMAR in place for the providers to do medication management (which is really the gain with CPOE versus 10% orders of any type).
In our organization, weve taken the extra effort to create effective and MU timelines specific to each area of care that correlates with the MU requirements. We meet twice a month to go over/ rethink our plans and to ensure were keeping on track. We are a facility that enjoys being ahead of the game. We started our EMR implementation in May 2006 and I consider us more than ready to tackle anything the government hands down to us. We are excited to be able to keep pushing our team to be better! The response from our patients has been extremely positive and has helped with provider adoption.
Overall, MU has not changed rollout strategy that much. It has definitely accelerated it. We may have changed the order of some items and we have increased the emphasis on quality measures to get them in more quickly.
We have mapped existing automation roadmaps to MU criteria and made some adjustments in timing to be in sync with Stage 1 and 2, as well as a few gaps that were not specifically addressed on our roadmaps. There is as much harmony with MU as possible until final criteria are published.
Having been well along the journey prior to MU, we have not been hit as hard as many. However, we have taken the position that accelerating rather than slowing is still the bests approach. We are more aggressively taking on the peripheral areas such as interfaces where they may not have been seen as needed prior. Our goal is HIMSS Analytics Level 7. We are almost six. The journey continues.
Yes, it has. MU will speed up the completion of our EHR project, added in linking our EHR to other providers, and expedited our investment in data analytics / business intelligence reporting technologies.
We have had to assess the requirements with a gap analysis against our existing plan for MU requirements then decide if/how we would proceed. It has made us try to keep closer to our timelines and increased the complexity of our timelines.
Minimal change in EMR deployment fill in the gaps. Quality indicators may alter our analytics efforts. Our HIE plans have clearly speeded up. Expected Stage 2 requirements will lock in our meds barcoding timetable. It will accelerate our patient portal development.
I am new to my hospital (just over a year) and new to healthcare (first healthcare assignment). The MU objectives/healthcare reform have provided a recipe to follow for what we need to do in the next several years. I can't say, however, there is any harmony in our implementation game plan. It feels more like a tsunami.
MU tweaked our timing of deployments. We were on a track to MU anyway.
Strategy has not changed, implementation plans have been accelerated.
We have aligned our EMR optimization plans with the anticipated timing of the MU requirements. MU criteria will likely accelerate (and broaden the scope) of our use of a problem list; MU will also accelerate deployment of e-prescribing in our clinics, and may force us to rethink how its used by attending and residents.
MU has caused us to rethink our rollout strategy. Our plan to harmonize this starts with revisiting our road map of projects that are in the planning cycle. We are going to add new MU projects to this list, as well as other regulatory projects, then visit with our vendor to make sure we both agree that we have a complete list of things to do to achieve MU. We will then share this with our executive advisory group and eventually use it as the basis for capital in the following years. The road map will then move on to project planning and resourcing.
We were fortunate as the plans we had ended up being very consistent with the MU expectations. We had to do very little tweaking of our plan, but did put in place a MU czar to monitor progress and make sure we are getting our full basket share.
Fortunately for us, we were far along enough in the implementation of the EHR at the hospital and EMR at the ambulatory facilities that MU is a MOOT point (no pun intended). My personal belief is that implementing in IT strategy merely around the MU requirements is a rather shallow way to approach it. Getting to a level of automation called for in the MU criterion simply makes good business sense, and any CIO or healthcare provider/system should be pushing to this level because it simply makes sense. While I am skeptical that the federal government will ever get its collective act together to a point that we will ever realize a single dollar from MU, we should be well positioned to be in line with our hands out waiting, and waiting and waiting for that elusive funding.
Each site has to make a decision whether to initiate the MU early and receive the funding early or hold out for a short time, but all of this must be done by 2015 to avoid penalties. My organization decided to rollout early and combined it with a new bed tower. The strategy surrounded the design of the building actually was leaning to paper light so a decision to do 100% CPOE was not too far fetched. The harmonizing surrounds meeting the MU for 2010 but prepared for 2011s criteria. The package selected was chosen because of its ability to report as if we were meeting all of the requirements all at once (knowing the final-final MU has not been entirely defined yet).
No change. Since we had most all our products rolled out CPOE and documentation for physicians at the hospital was the last major rollout and we have planned to do this in calendar year 2010 anyway. Dont really see it having a huge impact on us other than we might have to move our upgrade up by six months.
Were already on a track to implement the application systems needed for MU. The new standards have caused us to:
Roll-out Strategy:
. Redouble our commitments to delivery dates
. Stress the importance of meeting these project dates to our IT customers (end users)
. Look at our current project work list and side track or slow down non-MU IT projects.
. Also, we have warned our customers that new non-MU IT projects are not likely for the next two or so years.
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Harmonizing:
. We are now focused on the use of these application systems as defined by MU. In the past the focus was on use as our customers wanted the systems to be used. This is a new and heavy hand prescription for healthcare users.
Our IT strategy has remained the same, although we are considering how MU will play a part in our implementation strategy of the EHR and reporting.
MU is enabling our organization to look at completing the EMR rollout in a more compressed timeframe. We are focused on the must-do for MU plus those solutions/components that make support workflow and processes to achieve MU. We are trying to match the Stages so that we achieve in the first year of each stage. MU is receiving priority for IT Capital and hospital capital overall.
Our questions while reviewing requests are:
Is this a MU requirement?
Is this required for compliance?
Is this required for a new program?
Everyone in the organization and on the Medical Staff is aware of our IT Strategic Plan.
We accelerated some of our plans related to MU in order to ensure we could have CPOE installed by 2013. Our intent is to qualify for as much of the incentive dollars as possible.
We were already planning to implement MU type solutions - meaning CPOE and EMR - and we were/are already doing data exchange with select physicians, typically as they are able to accept data feeds. MU has brought a heightened sense of urgency, and an element of worry, as there are many dynamics for us before we can achieve MU. Delays associated with vendor ability to deliver a yet-to-be defined certified product, along with the rollout sequencing needed to bring seven hospitals up, causes much concern IF the current timelines stay in place. Our harmonization is also impacted by the variety of system upgrade dependencies that exists in our environment. There is a lot of coordination discussion and planning activity underway.
MU has definitely sped up our timeline for implementing CPOE and physician documentation. For us (a critical access hospital), it is all about what can we spend that doesnt depreciate fast. So for us, we are working deals with vendors where we dont pay anything until we meet MU. That will allow us to recognize the full incentives instead of a slow rollout where software and hardware may begin being depreciated, thus reducing our incentive payouts.
Yes, we absolutely are prioritizing our project in order to demonstration MU as soon as possible. For example, we have two own provider groups using legacy practice management systems. The primary care group will be addressed before we even develop a plan for the behavioral health practices. I welcome this pressure because it helps our executive leadership prioritize our plethora of projects.
In the hospital environment we haven't changed our IT rollout strategy. Since MU, we have decided to provide an EMR donation/subsidy to our community physicians and accelerate our HIE implementation. We will be tracking the MU components as we implement the different EMR pieces.
MU hasnt really changed our strategy. We are not chasing incentive money. We are playing defense against the 2015 deadline and IF we can get there earlier, we will consider it gravy.
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