As you look at the long term requirements being driven by HITECH, what are some of the challenges you are working on to meet the data exchange requirements with both physicians and patients? 

Mover:  Operationally, a clear challenge for us is how to get information to physicians at the point of care, in a meaningful way. Many systems and processes are not designed to get that data to the point of care when the physician is with the patient. When you look at the current physician systems, a lot of the documentation takes place after the fact. The challenge becomes, how can we get the data a physician may need in order to provide the best care possible, at the moment they are making important treatment decisions? The answer to this challenge is how we meet the overall HITECH intent of enhancing quality and patient outcomes.

For us, the integration engine technology is an instrumental part of the solution. Currently, we have 102 interfaces between about 30 core clinical systems. If we didn’t have that integration platform, we would have to enter patient data, insurance data, orders and charges multiple times.

Having this infrastructure in place provides significant leverage for us in our Meaningful Use plans and initiatives. It gives any hospital the right foundation in which to better meet the requirements. Additionally, the right infrastructure will deliver a more balanced and efficient way to meet the Meaningful Use requirements.

We have also addressed some issues regarding the data requirements to physicians’ EMRs. We currently send data to larger physician practices using an integration engine which facilitates secure data exchange through VPNs. For larger practices, that has worked fairly well. However, our experience with smaller practices has been rather limited and it certainly begs the question how that will work in the future on the smaller physician practices who don’t have an IT staff. How are we going to get them our data and how are they going to get us theirs?

For the patient PHRs, we have interpreted the Meaningful Use criteria stating that, “you must provide electronic patient data on demand,” to be just that. Our current plan is to provide patients electronic access to results and other information by putting it on a DVD or CD initially.

How is this impacting your strategic and operational plans?

Mover:  Currently, a large percentage of my time is spent clearing up issues and conducting gap analyses in order to meet the Meaningful Use and HITECH requirements. One of the major challenges we face is figuring out ways to gather the information from our systems to demonstrate that we meet the criteria and quality indicators, such as PQRI, without a data warehouse. Our challenge regarding Meaningful Use is bringing that data together to deliver the metrics and indicators as required.

Our strategic and operational plans at the hospital management and IT levels have accelerated immensely because of Meaningful Use. It has accelerated the demand to replace and refresh computers, because we now need to have better work stations for our employees. It has accelerated our plans for migrating to the latest version on applications, because we will have to be on the latest release to qualify for Meaningful Use. Across the board it has forced us to accomplish these strategic and operational goals much more quickly than we would have otherwise.

How is this impacting your IT staff?

Mover:  We are spending time educating everyone on the Meaningful Use criteria and requirements. We have our spreadsheet of requirements which we share and discuss. Everyone is attuned to the work ahead.

Right now, we do not have much flexibility in hiring new IT team members. Our reimbursements are down, so we have to manage our resources carefully. We have to be able to do our work more efficiently and, fortunately, we have some solutions which enable us to do just this. It will be a constant challenge though to manage over the next five plus years.

What advice would you give to other hospital CIOs and IT departments as they undertake initiatives to meet Meaningful Use?

Mover:  As Meaningful Use requirements are discussed further, I would encourage other hospital CIOs and IT departments to reach out to your chief nursing officer and chief medical officer and other hospital executives early in the process. Make sure they are on board, and that they must understand and ultimately agree on the importance of your organization meeting the 2011 criteria.

In those discussions, I would encourage other CIOs and IT departments to ask if meaningful use is important for your organization. Whatever you are going to do for Stage 1 needs to be done by July 1 to qualify for 2011. One way or another, it will have a dramatic affect on the operational and strategic workflow of your organization throughout the next few years. 

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