The majority of U.S. hospitals have achieved Stage 1 of the federal electronic health records incentive program known as meaningful use, meaning they have installed and activated many basic EHR functions, including electronic prescribing and rudimentary levels of clinical decision support. But few have progressed to Stage 2, which calls on hospitals and physicians to increase their adoption of advanced technologies such as integration with medical devices and interoperability with other healthcare organizations.
As of June 10, just eight hospitals nationwide had attested to meeting Stage 2 requirements for the minimum 90 consecutive days since the second stage began in October, according to the Centers for Medicare and Medicaid Services. Another 447 doctors and other “eligible professionals” had reached Stage 2, CMS reported, even though individuals could not start counting the 90 days until January.
While hospitals still do care about keeping up with meaningful use, earning Medicare and Medicaid incentive payments and avoiding Medicare penalties that kick in next year, some CIOs are turning their attention to “practical use,” leveraging technology to create new care delivery models, reduce readmissions, improve health outcomes, increase revenue and cut costs.
That was the subject of a panel discussion at WTN Media’s the 12th annual Digital Healthcare Conference in Madison last week, which included CIOs from Wisconsin health systems and a major IT vendor.
The “next race” is overcoming workflow and cultural challenges to make technology more usable, said Eric Helsher, executive director of the clinical adoption program at Verona-based Epic.
Helsher said new initiatives at Epic and its customers are about interoperability. “We’re continually trying to create more doorways into Epic,” he said. However, there remain many barriers, usually more related to incompatibility of data or organizational processes than to technology. “What we have problem with is when we get data from outside an Epic EHR,” said Helsher, who called Epic “the most interoperable EHR system in the world,” a claim very much open to debate.
Christine Bessler, CIO and vice president for IT at ProHealth Care, a two-hospital system in Waukesha County, hears complaints about the usability of outside data all the time. When she rounds with clinicians, as soon as she speaks about health information exchange or interoperability, “Their first words are [that] they are terrified of getting more garbage in the EHRs.”
The same goes for analytics. In the brave new world of accountable care organizations, Philip Loftus, CIO of Milwaukee-based Aurora Health Care, is looking at how to bring in data from every partner, then analyze the combined set of data, not in a record but in a “live environment,” Loftus said.
“There’s so much hunger for data,” noted Bruce Quade, CIO of Group Health Cooperative of South Central Wisconsin. However, not all data is good. “You really don’t know what’s going to be valuable until you run some test cases. It’s very much an experiment for us,” he said.
Quade said that mobile is becoming more important because GHC is providing more care outside of the clinic as it tries to be more accountable and reduce hospital admissions. Mobile is key for speed of delivery, according to Quade, though he said he would like to see features that can be added to an EHR without going through a major system upgrade.
At ProHealth, Bessler is working on a program designed to reduce “alert fatigue” for nurses by replacing the standalone nurse call system with one that runs on the smartphones they already carry. The goal, according to Bessler, is: “How can we make their lives better by allowing them to receive appropriate messaging on their phones?”
ProHealth has selected Microsoft subsidiary Vergence as its middleware vendor, though the health system is still looking for an end application to install on nurse phones, she said.