Rome Wasn’t Built in a Day

In my last EMR Straight Talk post (Stage 2 Clinical Quality Measures—More Is Not Better), I maintained that simply adding a large number of new quality measures without addressing the underlying flaws in the reporting process will do little to advance the program towards its goals. So I was very interested in reading Joseph Goedert’s blog the following week in Health Data Management: “Why Must CMS Overreach on Rules?”

In discussing the proposed rule regarding Accountable Care Organizations (ACOs), Joe makes a similar argument to mine. He questions CMS’s proposal that, to share in an ACO’s savings, providers would have to report on 65 quality measures—including 28 new measures—when CMS will not even be ready in 2012 to electronically accept the considerably smaller number of quality measures associated with meaningful use.

In both cases, CMS is trying desperately to accomplish a long-term vision, albeit a noble one, in too short a timeframe. While formulating its proposal for Stage 2 meaningful use, the HIT Policy Committee had several intense discussions about the trade-off between (1) aggressively moving toward the end goal and losing people along the way because they were overwhelmed and feared failure, and (2) accepting a slower pace, but with a greater chance of success. The foundation of the programs have to be solid, or real progress will not be achieved.

———————————————

Reader’s Correction/Clarification:

In my EMR Straight Talk post on August 10, (“HIE’s and Information Sharing—Physicians Feel the Pressure”), I incorrectly stated that without membership in NYU’s UPN (University Physicians Network), “physicians do not have access to the group’s favorably negotiated reimbursement rates.” I received a comment from Robert Goff, Executive Director of NYU’s UPN, stating that “UPN does not negotiate with any payer or health plan outside of fully compliant shared risk arrangements,” and that the requirement regarding physician information technology “is part of a broad initiative to promote enhanced quality and the delivery of more efficient health care.”

I apologize for the misstatement.

Physicians: Don’t Count on EHR Support from Hospitals

Anthony Guerra, noted HIT industry blogger and editor of HealthSystemCIO, has written extensively about the pressures and stresses facing hospital Chief Information Officers (CIOs) due to the myriad government programs making demands on their skills and their time. His recent survey revealed that a mere 16% of CIOs manage to maintain a relatively normal workweek of 40–49 hours, while 35% report working over 60 hours per week. In my opinion, the current level of stress extends throughout all levels of the IT staff—a sentiment echoed at today’s HIT Policy Committee meeting as they evaluated the recommendations for Stage 2 meaningful use.

This is not surprising. In the midst of upgrading to meet meaningful use requirements—a bigger challenge for many hospitals than originally anticipated—IT departments are expected to simultaneously prepare their facilities to comply with the impending 5010 requirements and convert their systems from ICD-9 to ICD-10. Also looming in the not-too-distant future are the newly defined Accountable Care Organizations (ACOs), which will require significant and expanded data and reporting capabilities. All of this is compounded by a shortage of IT professionals in the healthcare arena.

So how does this relate to private-practice physicians—the constituency on whom I typically focus? I’ve cautioned in a previous post, One Size Does Not Fit All, about the mismatch between the EHR needs of hospitals and of physicians in private practice. Physicians should also be wary of adopting their hospital’s EHR if they are doing so with the expectation that the hospital’s IT resources will be at their disposal. They will be sadly disappointed—supporting private practice physicians, particularly specialists, will be low on the list of priorities for IT staff when their plates are already overflowing.