Electronic Health Records – The First Handhold on the Climb to Optimum Care Delivery By Richard A. Correll
President and CEO
CHIME Foundation Executive Director College of Healthcare Information Management Executives (CHIME)
After many years of preparation and anticipation, it appears the healthcare industry has reached the tipping point for digitizing health records.
Federal agencies have focused significant attention and resources on electronic health records (EHRs), and the national stimulus funding program has jump-started providers’ efforts to take the plunge into the digital age. As providers take these initial steps, it is exciting, almost exhilarating for those of us in the industry.
For the past year, the College of Healthcare Information Management Executives (CHIME) has been tracking members’ expectations for achieving meaningful use of EHRs and receiving stimulus funding through a series of surveys. These surveys have shown guarded optimism among CHIME members. Representing CIOs and other senior healthcare IT leaders, CHIME members are at the forefront of implementing EHRs at provider organizations across the country.
Reasons for Optimism
The latest CHIME survey, conducted in September, found notable progress among respondents’ organizations in implementing EHRs. Some 26% percent of respondents said their organizations have qualified to receive stimulus funding under the HITECH portion of the American Recovery and Reinvestment Act (ARRA) within the first full year of the program. More than half of all respondents (53%) said their organizations have registered for the stimulus funding program, a precursor for attesting that meaningful use objectives have been achieved and qualifying to receive funds.
CHIME’s survey noted variations by bed size groups, and a downward shift in short-term expectations from March to September among respondents in various bed size groups (see Graph 1 below).
Other recent surveys have corroborated the positive trend found by CHIME’s surveys. For example, a report released Oct. 31, 2011, by KLAS, a healthcare IT research organization, found that sales of electronic health records systems “exploded” to community hospitals in 2010. The Community Hospitals Accelerating CIS Adoption: Community Hospital Clinical Market Share Report 2011 finds that more than half of the sales are coming from hospitals that had no previous clinical information system. More community hospitals will be making decisions to buy clinical systems in the coming months, KLAS predicts.
It’s heady progress for a nation that has struggled to get providers to implement electronic systems in the last decade, even after President George W. Bush in 2004 set the goal of every citizen having a digital electronic health record by 2014.
Federal HIT executives also appear increasingly optimistic. At a summit hosted in mid-November by the Office of the National Coordinator for Health IT (ONC), officials said they believe that EHRs will become the norm, sooner rather than later, in response to growing consumer demand.
“The patient is the copilot,” with his or her healthcare provider, said Farzad Mostashari, MD, the current National Coordinator for Health IT. “Increasingly, we’ll hear patients, consumers, people expecting more out of their interactions with others. So we’re going to see all of the pieces come together for this.”
It makes sense that the initial focus of the nation needs to be on getting electronic health records widely adopted. To meet this need, last year CHIME released The CIO’s Guide to Implementing EHRs in the HITECH Era, a step-by-step resource on the implementation of electronic records systems for HIT executives.
Only a First Step
CHIME’s Guide, and most of our industry’s experience, suggests that selecting and installing a computer system to capture health information is only a first step in achieving the advantages that EHRs could bring to the American healthcare system. Deriving the full potential value of such systems will take significant time and effort.
Developers of the federal stimulus program seem to understand the progression that needs to take place in this country with EHRs. The stimulus funding approach sets out three stages for the program, with the intention of raising the level of meaningful use objectives for each stage. The intent is to incentivize installation of the systems and then to increasingly use them in ways that enhance care processes and improve care delivery.
More Challenges Ahead
However, having the systems in place in healthcare organizations will not automatically improve care. System implementation is only the first step in a process. EHRs should be seen as a tool that has to be used and mastered in order to bring growing benefits to healthcare providers and their patients. To optimize HIT investments, a number of things still have to happen.
Clinical information systems must be easy to use, so usability issues don’t stand in the way of
front-line providers.
Workflows and processes must be adapted so that the right information can be accessed by
patients’ caregivers, when and where it’s needed.
Patients must be able to access their medical information so they can become informed
participants in their own care.
Essential patient information must be easily shared between clinical information systems and
biomedical equipment within an organization. More broadly, health information exchange
must be facilitated between organizations to better coordinate care, improve the patient
experience and save money.
Beyond just collecting information in databases, clinical systems must be able to utilize the
data to improve care delivery, personalize care for patients and conduct research that can
make care safer and more cost-efficient.
These are lofty and challenging goals, but ones that are critical to improving the value of healthcare delivery and restraining healthcare costs for our country. We’ve only got a handhold on the first plateau — collectively, we have a long way to go, and we need to help each other make progress as quickly as possible.
Richard A. Correll is President and CEO of the College of Healthcare Information Management Executives (CHIME). Correll is responsible for leading the development of CHIME. He worked with CHIME’s founding Board of Trustees in 1992 to get the organization started, and since then has helped CHIME build membership and associated member services. Today CHIME enables CIOs and other healthcare IT leaders to collaborate, exchange ideas, develop professionally, and advocate the effective use of information management to improve the health and healthcare in the communities they serve. He earned an MBA from Wayne State University and a BSE from the University of Michigan.
Healthcare leaders featured in this issue have identified the strategies and tactics below that
they employed to meet Stage 1 meaningful use requirements under the American
Reinvestment and Recovery Act (ARRA).
Secure engagement and commitment from your Board, administration, department managers and medical staff
Set and understand key timelines for software updates, testing, validation and reporting
Prioritize the work effort, including time to implement and criticality of each measure
Find the right meaningful use leader. Consider someone that is not an “IT insider”
Involve staff in system design and the review effect on workflow
Determine your education and deployment strategies
Communicate often to all stakeholders in the organization
Learn to cope with constant criticism and pressure without burning out
Treat your vendor like a partner
Create energy and excitement around the change — exert your leadership
Create an atmosphere of transparency, honesty and collaboration
Have department managers sign off on staff proficiency with health IT
Provide 24/7 end-user support
Monitor your metrics daily and celebrate successes
Today Centra’s focus is
on meaningful use and
ICD-10, but the ultimate goal
is a longitudinal record for
each patient it services in
central Virginia.
A survivor of Hurricane
Katrina, Memorial Gulfport
has tackled meaningful use
with executive buy-in,
clinician IT support, and
physician alignment.
OakBend met the meaningful
use challenge head-on as an
opportunity to improve its
organization’s performance —
from CMS core measure
scores to chart completion.
Despite obstacles commonly
associated with EHR
implementation in small, rural
hospitals, Renville County
Hospital forges ahead and
attests in 19 months.
McKesson’s Freed says with
so many mandates coming
down in rapid succession,
having a clear roadmap toward
a unified destination will
make the journey easier.
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Clinical information systems must be easy to use, so usability issues don’t stand in the way of
