Amid a continuing weak economy and volatile financial markets, hospital executives are facing shrinking revenues, increasing patient demand and staffing shortages. Add to those the federal mandate of implementing electronic health records (EHRs) and demonstrating “meaningful use” of those systems beginning next year, and hospital administrators are more concerned than ever before about what their operational priorities should be in the next several months, and how they will meet the current requirements placed on the industry.
The promise of stimulus funding has accelerated EHR adoption, moving it to the top of the priority list, as hospitals and physicians across the country race to meet meaningful use eligibility requirements. Adoption and meaningful use of EHRs is expected to improve the quality of care, support providers in the delivery of care, empower patients and reduce costs in the overall system. According to the Health Information Technology for Economic and Clinical Health (HITECH) Act, a typical 500-bed hospital demonstrating meaningful use of EHRs by 2011 could receive more than $6 million in Medicare incentive payments1 — softening the financial blow of EHR systems, which can run as high as $20 million to $100 million.
Although the incentives represent one of the government’s largest investments in health IT, barriers could make the road to meaningful use longer and more expensive for some. According to a PwC survey conducted in spring 2010, eight in 10 hospital chief information officers (CIOs) said they are concerned or very concerned they will not be able to demonstrate meaningful use of EHRs within the federally established deadline of 2015. Furthermore, only half of hospital CIOs surveyed said they would be ready to apply for meaningful use incentives in 2011, the first year they become available.2
By many accounts, small, rural hospitals, as well as the most sophisticated hospitals in the country, are behind the curve and are struggling to qualify for the stimulus payments. Not only do they lack sufficient funds to invest in costly EHR systems, they are facing a number of obstacles on the complex road to meaningful use, which are slowing down progress:
Lack of Clarity of Meaningful Use Standards
The final meaningful use requirements were released in July 2010 by the Centers for Medicare and Medicaid Services to more clearly spell out how hospitals, physicians and other medical professionals use EHRs to improve care, in order to be eligible for financial incentives. Before the ruling was issued, PwC’s survey found that 94 percent of CIOs were concerned they would not be able to meet government requirements about how to report meaningful use, and 92 percent were concerned about the lack of clarity in meaningful use criteria.
Shortage of Skilled Staff
There is a shortage of professionals, such as clinical informaticists, in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices.3 Hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills, while some are using existing internal resources or bringing on temporary staff to achieve meaningful use.
More than one-third of CIOs surveyed by PwC said they are concerned or very concerned about EHR vendor readiness overall. In particular, 44 percent of CIOs said they are concerned that the external vendors they rely on in health information exchanges are not prepared for meaningful use implementation. Like the rest of the industry, they are trying to understand what the options and solutions are.
Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow 24X7, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the existing IT infrastructure — not yet a national health information superhighway — go down and they have to revert to paper records.
As troublesome as these obstacles are, the meaningful use regulations are here and all hospitals and physicians will, at some point, comply with meaningful use within the timeframe outlined by the government (see Figure 1: Three Stages of Meaningful Use). The health organizations that will be successful are those that view EHRs not as a solution in and of themselves, but as enablers to improve the quality of clinical care and become more patient centric.
Strategies to Achieving Meaningful Use of EHRs
As they rush to implement healthcare information technology, many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage. Thus, providers might miss crucial steps to get the most from their systems and best re-engineer care processes to provide higher quality and better value.
Meaningful use of EHRs requires transformational clinical, operational and cultural changes. Because these changes touch every part of the organization, senior executives should send a clear message that the use of information technology — and the meaningful use of information — improves the future prospects of their systems, for their employees and, most importantly, for their patients.
Because achieving meaningful use influences so many overlapping parts of the organization, it is essential to begin planning immediately. Health systems can accelerate their progress by incorporating five milestones into their overall strategy.
1. Establish meaningful use governance. If organizations don’t treat meaningful use as a transformational effort and designate responsibility to the right people early on, the adoption process will be needlessly long and ineffective. When asked who has responsibility for the organization’s achievement of meaningful use, most CIOs PwC interviewed said this is an area their executive teams have not yet discussed. Where responsibility falls determines the weight of the message to the organization and, ultimately, the commitment level. More importantly, the message needs to be clear in its directive that achieving meaningful use is a transformational effort that touches every facet of the organization, and is focused on improving care delivery to patients. Governance models must acknowledge this and engage health leaders and implementers, as well as users of EHR systems, to ensure that patients see an impact.
2. Integrate meaningful use initiatives to overall business strategy. The new federal mandates in the HITECH Act are impacting organizations’ ability to balance competing priorities. Nearly half of the CIOs who responded to the PwC survey about meaningful use said they were delaying nonclinical IT projects or the start of new IT projects. To address this, health systems should identify synergies by mapping meaningful use initiatives to other, ongoing programs such as quality, physician and cost initiatives. The organization can then decide whether to delay clinical or nonclinical IT projects and operations projects.
3. Forge new public-private and community partnerships. The later stages of meaningful use compliance will require data to be exchanged with external partners, outside of the walls of health systems. In addition, they will need to identify outside resources to facilitate achievement of meaningful use initiatives. For example, a health organization may align itself with an entity that has received funding for the Health IT Workforce Development Program. Therefore, systems should soon begin to consider partnership opportunities with private health insurers, regional extension centers, community colleges and state governments.
4. Incorporate patient input. Despite the benefits, some hospitals are not incorporating patient input into their meaningful use initiatives. To truly engage patients in meaningful use, hospitals ought to supply the right tools along with the EHRs for them to be used effectively. Through the use of traditional feedback mechanisms, such as focus groups and surveys, providers will be able to identify patients’ demands and incorporate them into meaningful use efforts.
5. Join forces with physicians and health insurers. According to the PwC survey, 63 percent of CIOs said they are assisting physicians around meaningful use or they plan to within the next 6 months. For physicians, one of the big challenges to fulfilling the meaningful use requirement is taking time away from practicing medicine. Therefore, it is important for providers to help physicians link meaningful use to improvements in quality of care for patients and to reductions in administrative tasks.
Success in achieving meaningful use standards hinges on closer integration with key constituents — payers, providers and patients. Meaningful use has the potential to better connect providers and payers by fostering seamless data exchange and collaboration across the healthcare continuum. Using the same or interoperable EHRs, providers and payers can more easily exchange clinical, financial and benefits information. Of course, patient rights and privacy standards must be considered in that respect.
By coordinating information among various providers and payers, patients will have better access to their health information. And, by engaging them with information, patients will not only make better health choices, they will also work with providers to seek healthcare services with quality and cost in mind.
The bottom line is improved quality of care and patient safety, delivered more efficiently.
1. PwC Health Research Institute. Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding. Published April 2009. Retrieved from: www.pwc.com/us/en/healthcare/publications/rock-and-a-hard-place.jhtml
2. PwC Health Research Institute. Ready or not: On the road to meaningful use of EHRs and health IT. Published June 2010. Retrieved from: www.pwc.com/us/meaningfuluse.
3. Department of Health and Human Services. HITECH Priority Grants Program: Health IT Workforce Development Plan, Facts at a Glance. Accessed June 16, 2010 from the World Wide Web: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1432&mode=2
Daniel Garrett is principal and leader of PwC’s Healthcare Information Technology Practice. With more than 27 years of experience in both technology and healthcare enterprises, Garrett has worked in strategic planning for emerging health information technologies and has developed IT initiatives to improve performance, effectiveness and quality for large payers and providers.