In fiscal year 2014, hospitals can start attesting for meaningful use stage 2, through which they can enhance their health IT capabilities and receive incentive payments from CMS. While stage 1 focuses on capturing and reporting information, stage 2 focuses on health information exchange. Beyond gaining incentive payments, health information exchange can help healthcare providers coordinate patient care and improve efficiencies. Here, industry leaders offer five tips to work toward meaningful use stage 2.
1. Include meaningful use in the organization's vision. Meaningful use should be more than an IT initiative to
receive payments; it should be part of a system-wide vision for more efficient, high-quality care, according to Rod Piechowski, senior director of healthcare information systems at Healthcare Information and Management Systems Society. "My advice is to take a longer-term view of how electronic medical records fit into [organizations'] bigger strategy. Meaningful use is just one phase of a larger transformation of how we move information around in healthcare with a goal of being paperless with more efficient workflows and safer outcomes," he says.
Including meaningful use in a hospital's or health system's strategic plan can help leaders, physicians and employees understand how HIT fits into other strategic goals, such as quality improvement and cost reduction. If organizations view meaningful use only as a way to receive incentive payments, employee and patient engagement to new technology is likely to be low. However, if hospitals understand and share HIT's potential to facilitate communication between providers and patients, streamline workflows and reduce errors, meaningful use efforts are likely to have more buy-in and more success.
"If this is part of an organization's long-term vision and the organization believes this is the right thing to do forpatients, [the organization's] enthusiasm and ability to see the value in doing this will be easily translated to [its] patient base," Mr. Piechowski says. "It's quite a different approach to say 'We're implementing information technology because everyone is doing it,' vs. 'Here's our vision of the future, and here's how information technology can help us get there.'"
It's important not to perceive meaningful use as solely an IT project, Mr. Piechowski says. "It's all about process improvement and cultural change; it's a once-in-a-lifetime opportunity to change the way everything is done for the better."
2. Promote collaboration between IT and clinical staff. Since meaningful use stage 2 criteria impacts an entire organization, everyone, from IT to clinical staff, needs to be involved and engaged in efforts to meet the requirements. University of Iowa Health Care in Iowa City has promoted collaboration between IT and clinical staff by proactively seeking clinician input on IT projects and providing salary support for clinicians to work on IT-related projects. Several nurses with direct patient experience work for the CMIO and several physicians give partial time commitments to help the CMIO integrate IT systems into clinical workflows, according to Lee Carmen, associate vice president for IT and CIO of the health system.
The physicians help IT staff identify the particular EMR needs of different specialties and act as advocates with their peers to ensure clinicians understand the need for new workflows. Similarly, the nurses under the CMIO work alongside front-line clinicians to help them use new IT systems most efficiently. For example, the nurses can show peer clinicians how to complete a process in two clicks instead of five, and can ensure users are documenting their activity appropriately so they get credit for using the tools required for stage 2, Mr. Carmen says.
The clinical-IT relationship has been crucial to the system's and the majority of physicians' successfully attesting for stage 1 meaningful use, according to Mr. Carmen. "It's a very important bidirectional partnership. We could not have [met stage 1] without the clinical IT team and their support working on the front line with the clinicians," he says.
3. Change workflows to complement new systems. Meeting meaningful use requirements are more about adopting certified EMRs and new technology systems, although they are necessary. Hospitals and health systems need to change workflows to ensure the EMRs and other systems are used correctly and effectively. "It is not just about technology, it is about changing the organization and how information flows," Mr. Piechowski says. If workflows do not change, organizations run the risk of automating or simply speeding up inefficient processes. "The danger of just putting in computers and declaring you're finished is that you would computerize what are potentially inefficient or outmoded processes," he says.
Hospital and health system leaders will have to work closely with both IT and clinical staff to identify new or altered processes that will make best use of EMRs and other technology systems. For example, the way providers and patients interact may change dramatically due to new IT systems. One requirement of meaningful use stage 2 is offering patients the opportunity to view, download and share their information. Providers will no longer have to call or mail patients information, but can make information available on a patient portal through which patients can make appointments, ask questions and access their records.
Establishing new workflows will therefore require education of both providers and patients. "You have to educate your patients and change their expectations about how they interact with your organization," Mr. Piechowski notes.
4. Educate and train providers. Educating physicians and other staff about meaningful use and training them on new IT systems are critical for gaining buy-in and successfully transitioning from a paper to an electronic organization. One of the challenges of gaining buy-in for meaningful use is conveying the importance of HIT in relation to the plethora of other initiatives hospitals, and particularly physicians, are under pressure to implement. "There are a number of initiatives at the federal level, the state level and local level that are hitting clinicians. They were busy to begin with, so one of the challenges is working with clinicians to help them prioritize where they should be giving their time and working as an organization to not take on as many initiatives at once so you can increase the chances of being successful of the initiatives you are pursuing," Mr. Carmen says.
Hospitals can help fit meaningful use objectives into their priorities by including physicians in leadership positions. "You need to have physicians in leadership roles to ensure that you have people who understand what the life of a physician is like defining the priorities; you don't [want] someone who has never seen patients making decisions on how physicians should focus their time," Mr. Carmen says. For example, at University of Iowa Health Care, the CMIO, CMO, chief quality officer, chief safety officer and vice president are physicians.
In addition to placing meaningful use in context as a strategic goal, healthcare organizations need to provide easy access to technical support to encourage physicians and other staff to use EMRs and meet stage 2 requirements. Mr. Carmen suggests having a "help desk" staffed at all hours so that if a clinician needs assistance with an EMR at 2 a.m., he or she can immediately contact someone who can help. "You have to have those foundational elements in place to really help clinicians through those changes," he says.
5. Communicate clearly and often. Education and training are part of the larger necessity of clear and constant communication during meaningful use initiatives. Healthcare leaders need to communicate how meaningful use fits in the vision for the organization, and they need to be open to communication from physicians and staff about concerns and ideas for adopting new technology. Importantly, leaders need to communicate not only when the organization begins efforts to meet meaningful use, but throughout the entire project. "It's not a one-step process," Mr. Carmen says. "You have to, at every opportunity, recite the same message the same way so everybody can hear it and can hear it consistently so it sinks in and is accepted by the clinical team."
Leaders should communicate with clinicians about their progress on meaningful use. This communication not only serves as a reminder of the meaningful use initiative, it also demonstrates leaders' commitment to the effort and to helping clinicians meet their goals. University of Iowa Health Care shares system reports that show where physicians are on the path toward stage 2. "We use that data to heighten their awareness of what the rules are and where they stand," Mr. Carmen says.
Similarly, Mike Warden, CIO of Phoenix-based Banner Health, suggests using enterprise-wide "dashboards" that are visible across the organization to ensure everyone is aware of progress toward meaningful use.
"Successful strategies [to meet stage 2] include integration into clinical workflows, education, actionable reports, clear and frequent communication of status and progress to the stakeholders and regular monitoring and proactive escalation, where needed," says William Holland, MD, senior director of physician informatics at Banner Health.
By including meaningful use in an organization's overall vision, promoting collaboration between IT and clinical staff, changing workflows to support new technology, providing education and communicating with stakeholders, hospitals and health systems can position themselves strongly for meeting meaningful use stage 2.
ONC Launches Stage 2 Meaningful Use Education Module
Medical Societies Urge HHS to Delay Drafting Stage 3 Meaningful Use Criteria
1. Include meaningful use in the organization's vision. Meaningful use should be more than an IT initiative to
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| Lee Carmen |
Including meaningful use in a hospital's or health system's strategic plan can help leaders, physicians and employees understand how HIT fits into other strategic goals, such as quality improvement and cost reduction. If organizations view meaningful use only as a way to receive incentive payments, employee and patient engagement to new technology is likely to be low. However, if hospitals understand and share HIT's potential to facilitate communication between providers and patients, streamline workflows and reduce errors, meaningful use efforts are likely to have more buy-in and more success.
"If this is part of an organization's long-term vision and the organization believes this is the right thing to do forpatients, [the organization's] enthusiasm and ability to see the value in doing this will be easily translated to [its] patient base," Mr. Piechowski says. "It's quite a different approach to say 'We're implementing information technology because everyone is doing it,' vs. 'Here's our vision of the future, and here's how information technology can help us get there.'"
It's important not to perceive meaningful use as solely an IT project, Mr. Piechowski says. "It's all about process improvement and cultural change; it's a once-in-a-lifetime opportunity to change the way everything is done for the better."
 |
| Dr. William Holland |
The physicians help IT staff identify the particular EMR needs of different specialties and act as advocates with their peers to ensure clinicians understand the need for new workflows. Similarly, the nurses under the CMIO work alongside front-line clinicians to help them use new IT systems most efficiently. For example, the nurses can show peer clinicians how to complete a process in two clicks instead of five, and can ensure users are documenting their activity appropriately so they get credit for using the tools required for stage 2, Mr. Carmen says.
The clinical-IT relationship has been crucial to the system's and the majority of physicians' successfully attesting for stage 1 meaningful use, according to Mr. Carmen. "It's a very important bidirectional partnership. We could not have [met stage 1] without the clinical IT team and their support working on the front line with the clinicians," he says.
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| Rod Piechowski |
Hospital and health system leaders will have to work closely with both IT and clinical staff to identify new or altered processes that will make best use of EMRs and other technology systems. For example, the way providers and patients interact may change dramatically due to new IT systems. One requirement of meaningful use stage 2 is offering patients the opportunity to view, download and share their information. Providers will no longer have to call or mail patients information, but can make information available on a patient portal through which patients can make appointments, ask questions and access their records.
Establishing new workflows will therefore require education of both providers and patients. "You have to educate your patients and change their expectations about how they interact with your organization," Mr. Piechowski notes.
 |
| Mike Warden |
Hospitals can help fit meaningful use objectives into their priorities by including physicians in leadership positions. "You need to have physicians in leadership roles to ensure that you have people who understand what the life of a physician is like defining the priorities; you don't [want] someone who has never seen patients making decisions on how physicians should focus their time," Mr. Carmen says. For example, at University of Iowa Health Care, the CMIO, CMO, chief quality officer, chief safety officer and vice president are physicians.
In addition to placing meaningful use in context as a strategic goal, healthcare organizations need to provide easy access to technical support to encourage physicians and other staff to use EMRs and meet stage 2 requirements. Mr. Carmen suggests having a "help desk" staffed at all hours so that if a clinician needs assistance with an EMR at 2 a.m., he or she can immediately contact someone who can help. "You have to have those foundational elements in place to really help clinicians through those changes," he says.
5. Communicate clearly and often. Education and training are part of the larger necessity of clear and constant communication during meaningful use initiatives. Healthcare leaders need to communicate how meaningful use fits in the vision for the organization, and they need to be open to communication from physicians and staff about concerns and ideas for adopting new technology. Importantly, leaders need to communicate not only when the organization begins efforts to meet meaningful use, but throughout the entire project. "It's not a one-step process," Mr. Carmen says. "You have to, at every opportunity, recite the same message the same way so everybody can hear it and can hear it consistently so it sinks in and is accepted by the clinical team."
Leaders should communicate with clinicians about their progress on meaningful use. This communication not only serves as a reminder of the meaningful use initiative, it also demonstrates leaders' commitment to the effort and to helping clinicians meet their goals. University of Iowa Health Care shares system reports that show where physicians are on the path toward stage 2. "We use that data to heighten their awareness of what the rules are and where they stand," Mr. Carmen says.
Similarly, Mike Warden, CIO of Phoenix-based Banner Health, suggests using enterprise-wide "dashboards" that are visible across the organization to ensure everyone is aware of progress toward meaningful use.
"Successful strategies [to meet stage 2] include integration into clinical workflows, education, actionable reports, clear and frequent communication of status and progress to the stakeholders and regular monitoring and proactive escalation, where needed," says William Holland, MD, senior director of physician informatics at Banner Health.
By including meaningful use in an organization's overall vision, promoting collaboration between IT and clinical staff, changing workflows to support new technology, providing education and communicating with stakeholders, hospitals and health systems can position themselves strongly for meeting meaningful use stage 2.
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Medical Societies Urge HHS to Delay Drafting Stage 3 Meaningful Use Criteria