Time Can Heal This Hangover

John Halamka, MD, is outspoken, but in an article last week on Health Data Management’s website, he is saying something that resonates with the nation’s healthcare IT executives.

Halamka, chief information officer at Boston’s Beth Israel Deaconess Medical Center, would like reconsideration of Stage 3 of the electronic health records Meaningful Use program.

In a candid interview with HDM Managing Editor Greg Slabodkin, Halamka expresses the frustration that many are feeling with the inexorable cadence of the program, which has been at the forefront of the healthcare IT industry since 2011.

Halamka calls it “the Meaningful Use hangover,” and it’s a sentiment I heard a lot during my tenure as senior director of communications at the College of Healthcare Information Management Executives (CHIME). There, many CIOs shared how it was getting difficult to maintain momentum on IT projects, which seemed to come in an endless stream.

For IT staff, there’s implementation fatigue of never being able to catch one’s breath between projects, and always seeming to be in “go-live” mode. The same is true for clinical staff, which often learn “just enough” to cope with a new system so they can continue doing their full-time jobs of caring for patients. As a result, users easily “fossilize” at a survival level of using a system, and there’s no time really to build much beyond that basic knowledge…before another change in IT systems comes along.

Further, super-users and champions always face the challenge of never leaving that pressure-packed role. And last we heard, they have full-time day jobs as well.

As much good as the meaningful use program has done in getting healthcare organizations on the EHR bus, the pace is so frantic that no has time to figure out why they’re on the bus.

And that’s the point, isn’t it? Meaningful use was intended to transition from forcing providers to move from conforming with a checklist of requirements to meaningfully use the software to provide better care with more efficiency and less cost. Just because the checklist has become shorter for Stage 3 doesn’t mean it’s not a checklist. It’s the rate of change, evidenced by the lack of attestation to Stage 2, that suggests a change in pacing or approach needs to occur.

The apparent success in transitioning to ICD-10 probably bears study. Healthcare organizations knew ICD-10 was a biggie, and many spent the better part of a year, or more, getting ready for the change. Multidisciplinary groups met; linkages between information systems were uncovered; senior executives were engaged and informed; systems were tested, and tested again; user education got a lot of attention; and every aspect of preparation was detailed and specific. Everyone in the industry knew ICD-10 merited a lot of attention, and it got it.

Given that level of preparation, perhaps it’s no surprise that the transition to ICD-10 appears to be going well. It’s surprising how the industry is in disbelief that this major change could go so well. It shouldn’t be – there was a major investment in time, money and effort, and everyone is reaping the benefits.

The correlation of the ICD-10 transition with EHR implementation is not exact, but the success factors of time, attention, training and perceived importance are likely to apply to both. The lessons learned in the ICD-10 transition can bring value to ongoing EHR implementation.

The battle to implement these systems has changed. Reporting and attestation are necessary evils related to getting incentive reimbursement, and that exciting period may have been transitional – it’s not enough to elicit the continued change that needs to occur.

It’s time to give providers some breathing space, to allow them to optimize the use of clinical systems so that providers get better at using them, thus achieving more value for their organizations and the healthcare system as a whole.