McKesson - Performance Strategies

10 Steps for Getting There from Here —
One Organization's Roadmap for the Journey to
Meaningful Use

By Deane Morrison, RPh
Chief Information Officer
Capital Region Health Care

Capital Region Health Care, anchored by Concord Hospital, has approached the road to meaningful use very deliberately. Achieving meaningful use is not an IT project — it's a care transformation project that will affect virtually every aspect of operations.

We have shared our comprehensive approach at several forums, where it resonated with attendees. Any organization can follow these 10 steps to get going sooner rather than later.

Understand the HITECH Act.
Even though summaries are available, first-hand knowledge of the entire HITECH Act and CMS rules is essential.

  Select three or four individuals in your organization to review the Act and final
    rule documents.

  Ask them to compare conclusions, reach consensus and identify areas of ambiguity, such
    as the national reporting measures.
Calculate and communicate the financial impact.
Many organizations have calculated the amount of stimulus incentives they stand to gain, but it's now becoming apparent that the penalties may be the more significant motivator over time.

  If you haven't already done so, develop inpatient (eligible hospital) and outpatient (eligible
    provider) estimates of dollars at stake (maximum incentives to maximum penalties) from
    2011-2019. Our calculations showed a maximum swing of +/-$26 million on the inpatient
    side and +/-$10 million swing on the outpatient side.

  Once you're confident in your calculations, educate the senior management team, your
    finance and planning board committees, and your physicians.
Perform a gap analysis.
A gap analysis can point to where you need to focus your efforts.

  Tap the same individuals who reviewed the proposed and final rules to evaluate the
    meaningful use criteria against your organization's readiness. We developed a
    spreadsheet when we started that replicated Table 2 from the proposed rule (page 25),
    which outlines the proposed criteria. To indicate our readiness, we shaded the cells red,
    yellow or green. We also included details about the corresponding software requirements.

  Again, ask your team to compare interpretations and develop consensus on actions that
    need to be taken.
Estimate future capital requirements.
Based on your gap analysis:

  Estimate the capital requirements for any software systems that need to be purchased to
    meet Stage 1 requirements, as well as your best guess for Stages 2 and 3.

  Estimate the resource requirements (in hours) associated with each project.

  Present your estimates to your CFO and board finance committee.
Establish a governance oversight group.
Strong, visible governance is essential to making sure everyone understands how important this initiative is and why.

  Create a steering committee that meets regularly. Our CEO and CMO co-chair our HITECH
    Steering Committee, which meets monthly. Members include our other executive leaders
    and vice presidents of affected departments.

  Determine target dates for achieving both inpatient and outpatient incentives.

  Establish teams and assign chairs and team members to various projects such as
    reporting, health information exchange, and privacy and security.
Create a program office.
In addition to governance, we established a program office that meets biweekly and is chaired by our director of IT Clinical Applications. The office includes clinical informaticists (chief medical information officers, directors of nurse informatics, pharmacists, and other physicians and nurses) as well as IT and finance representatives. More on their work appears below.
Define each requirement as a project charter.
With a solid structure in place, create a separate project for each criterion and objective. You should also appoint a project leader and determine other necessary resources. Items that we capture include:

  Criteria (project) name
  Description
  Measure
  Subcommittee
  Technology to be used
  Process changes needed
  Barriers/risks
  People affected
  Measurement (numerator/denominator)
  Target date for completion
  Ongoing project status
Develop a comprehensive timeline.
Once all the projects have been defined, it's time to develop a comprehensive timeline.

  Identify inpatient projects vs. outpatient projects.

  Separate certification projects from meaningful use projects.
     – What projects are needed to ensure you have a certified electronic health record (EHR)
        (implementation projects)
     – What projects are needed to prove meaningful use of that EHR (process redesign,
        adoption and reporting projects)

  Plot all projects on a comprehensive calendar, or "swim lane" diagram, and identify any
    necessary prerequisites (e.g., we need to be on release x.x before we can implement
    e-prescribing).

  Be sure you understand your vendors' timelines for certification.
Identify and address anticipated workflow impacts on providers.
Once you've identified provider workflow impacts, review how you will implement meaningful use requirements and achieve behavior change.

  On the inpatient front, who will create and maintain problem lists? For what percentage of
    your patients 13 years or older do you currently record smoking status in a structured
    format? How will you integrate discharge instructions into provider workflow?

  On the outpatient front, who will create visit summaries? Electronically capture smoking
    status? Document medication reconciliation?

  Communicate without overwhelming. Emphasize that meaningful use is about improving
    patient care — and that significant dollars are also at stake.

  Identify gaps between current state and meaningful use. Modify processes and workflow to
    close any gaps, and train staff as appropriate.

  Include ARRA-related financial incentives in upcoming physician contracts, and track
    individual physician progress using dashboards.
Monitor progress

  The governance committee should review progress at each meeting and keep the
    organization moving forward.

  Use governance to address organizational barriers that may impact your success.

Get Started Now!
Reading through these steps may be daunting. But like any challenge with a deadline, the sooner you begin, the more time you have to reach your goal. A methodical approach will help you make solid progress toward reaching your goal of achieving meaningful use.

Deane Morrison, RPh, has more than 25 years experience in the information technology industry, including thirteen years as the Chief Information Officer for Capital Region Health Care. He has strong background in all aspects of the IT industry, including telecommunications, data networking, application implementation, interface development, data center operations, web development, bio-medical engineering and vendor management. He has aligned his IT organization with ITIL best practices. As a member of CRHC's senior leadership team and his CEO's core strategic advisory team, he participates in setting short and long-term strategic and tactical directions for the system
at large.


	healthsystemCIO.com Podcast: One-to-One with CIO Deane Morrison, Chapter 1 HHS: Final Rule for Meaningful Use CMS: Official Site for EHR Incentive Programs ONC: Health IT Home

	HealthEast leverages its quality efforts to address meaningful use. It's using the same three- pronged approach — process adherence, hardwiring quality and physician engagement.

	The key to achieving the goal of meaningful use lies in creating a roadmap. You need a systematic process that tells you where you are and what you need to do.

	For small practices, meaning- ful use may seem like a daunting challenge. To be successful, physician practices should make creative use of the resources already at hand.

	Electronic health records hold promise for helping health- care organizations improve quality while managing the clinical and financial risk emanating via health reform.

	ARRA offers providers incent- ives to adopt EHRs and will financially penalize those that don't. Beyond installing the EHR is achieving meaningful use and proving it.
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