Under final rules from the federal government, physicians can receive full Medicare incentive funding over five years if they meet Stage 1 meaningful use requirements in 2011 or 2012, and four years of slightly less funding if starting in 2013. Hospitals can get a full four years of incentives if they start no later than 2013, but a 2013 start likely means having to initially comply with Stage 2 requirements.
A fast track effort, however, is easier now than a few years ago because the culture of clinicians has changed, says Charles Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind. Because of the HITECH Act and the fact that EHRs now have become a competitive business edge in many markets, the tipping point for acceptance of electronic records has arrived, he contends. "Physicians are now getting the success stories from other physicians. A couple years ago, doctors said, 'Leave me alone.' Now they're coming to me and saying, 'I'm ready to go, are you ready to go?'"
But before deciding whether to fast-track EHRs and get incentive funds as quickly as possible, hospitals first need to honestly decide if the job is possible.
Bob Sarnecki, vice president and CIO at Phoenix Children's Hospital, believes fast tracking can be done. Beginning in 2007, the hospital in the space of 27 months completed two phases of nurse documentation and implemented computerized physician order entry. Sarnecki notes that comprehensive EHR initiatives can take three to seven years; it's not unusual for hospitals to sign five-year contracts to implement a suite of applications. But with availability of incentive funds, the bottom line is that hospitals can't afford to take three to seven years to implement, he argues. And there are ways to save time.
Others just don't see fast track as possible for their hospitals, even if they have a bunch of clinical processes already automated. Christian is proud of where his 250-bed community hospital stands on its EHR trek. The facility is at about Stage 3.5 on the HIMSS Analytics' measurement of EHR adoption, which tops out at Stage 7. With plenty of experience under its belt, Good Samaritan has learned ways to cut timetables to speed implementations.
Nonetheless, Christian is unsure of Good Samaritan's timetable for achieving government-defined meaningful use.
"I think we're in better shape with the relaxed criteria, but there are still some questions that I need to get answered," he says. "We still need to install CPOE, which is on the books to start early next year. We will also need to install the certified version of our EHR. That will require the vendors knowing who the certification bodies are and getting that work accomplished. I'm also working to get clarification on how the certification process applies to the other applications we have installed and if that could compromise our EHR project. I'm poring through the preamble of the regulations, making sure I understand the definition of the terms that are used in the core and menu measures. We've been fairly progressive over the years in the clinical technology arena, which will serve us well in this process. We'll by no means just step over the bar, but will have to take a little less of a running start."
Good Samaritan is eying the middle ground of possibly qualifying as a meaningful user later while still receiving full incentive funding.
But hospitals that don't have multiple clinical recordkeeping processes automated by this point should not even attempt fast-track implementation of EHRs, period, counsels Scott Joslyn, senior vice president and CIO at four-hospital Memorial Health Services in Fountain Valley, Calif.
EHRs mean massive cultural changes that take time-forgoing some stimulus funding would be cheaper than failing and starting over, Joslyn believes. "You get just one chance to succeed or fail, so you need to stack the deck and that takes time. Let this be driven by business needs and cultural needs. The stimulus is not enough to pay for the system so don't rush. Do it for good business reasons. If the stimulus wasn't there, we'd still be doing this."
Some providers aren't racing to get incentive payments. Clinicians at Peachtree Orthopaedic Clinic in Atlanta have-and like-their EHR that won't support meaningful use data collection and reporting criteria, and won't swap it out for a more comprehensive system (see story, this page). "We have no intention of moving ahead after studying the modified criteria," asserts Steve McCollam, M.D., president of the six-site practice with 27 physicians and 10 physician assistants. "We think the criteria are beneficial only for bureaucrats in Washington."
Tricks of the trade
Whether a hospital is racing to meet the 2011 timetable or a later one, there are some tricks to shaving EHR implementation times, says David Muntz, senior vice president and CIO at 14-hospital Baylor Health Care System in Dallas.
In July, the delivery system had EHRs from Atlanta-based Eclipsys Corp. in five hospitals and working its implementation way through the system.
Before installation started anywhere, Baylor conducted enterprisewide "design" sessions focused more on preparing workflows for automation than on the particular features and functions of EHRs. About 1,000 employees, nearly 5 percent of its 21,500 workforce, were involved in the effort. Baylor then started implementation at hospitals with lower levels of services, such as those without designated women's and children's health units.
The flagship 900-bed Baylor Medical Center is No. 7 in the lineup for implementation and work now is underway for its workflow changes, based on the enterprisewide model and lessons learned at the first five facilities.
The real timesaver at Baylor, however, is bringing into a hospital undergoing implementation a group of staff members from the next two hospitals that will automate, Muntz says. These members participate in various teams, such as workflow, and also participate in the implementation. In essence, they become super users for when their hospitals are next.
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