Meaningful Use: Marathon vs. Sprint to the Finish Line? The Case for a Marathon Mentality

Meaningful use of electronic health records is far more than an exercise where healthcare organizations check off regulatory boxes in the hope of earning promised incentives and avoiding onerous penalties. Instead, MU is a strategy, discipline and process that facilitates healthcare transformation and eases the transition to innovations like population health management, full patient engagement and value-based, accountable care. Healthcare organizations need to evaluate multiple pathways to MU, including likely pitfalls and short and long-term consequences. In most cases, they need to adopt a marathon mentality to address new and emerging trends and developments, and best position their organization for success.  


While the majority of organizations focus on MU deadlines and incentives, their approach to MU varies dramatically. Some choose to run a 50-yard dash — the equivalent of checking off a series of boxes that reflect multiple regulatory requirements. Others choose to run a courageous 26.2-mile marathon. They mirror the discipline, training and commitment of marathon runners as they mobilize the people, processes and technologies needed to comply with MU and build a transformed healthcare system.  


In the marathon scenario, MU can be an opportunity and an invitation to experience a journey that will ultimately improve care quality, safety and efficiency and secure a future for promising developments like mobile health, remote monitoring, care collaboration, medical home, population health management and accountable care.  

 

Meaningful use by 50-yard dash        
Healthcare organizations have made progress. More than 85 percent of eligible hospitals participate in Medicare and Medicaid EHR incentive programs, while more than 75 percent have received incentive payments for meaningfully using EHR technology as of March 2013, according to the CMS and the Office of the National Coordinator for Health Information Technology.

 
But problems remain. Among them are confusion and/or ambiguity about MU regulations (29 percent), according to a survey of HIMSS13 participants by Stoltenberg Consulting. Other concerns include competing health IT projects (23 percent) and lack of resources such as funding, IT skill, talent and time (17 percent). The result: Not all hospitals are prepared to run a marathon to MU and beyond.  


Nonteaching, rural hospitals are especially vulnerable. They tend to lag behind larger hospitals in EHR adoption, according to a 2012 article in Health Affairs. Barriers include funding, lack of information technology experience and expertise, and limited experience in implementing large-scale HIT projects.  


While larger organizations are able to tweak finances and operations to access required funding, resources and expertise, smaller healthcare organizations lack the flexibility, agility and speed to make necessary changes. That's why smaller organization are often locked in a dilemma: How can they balance compliance with regulatory requirements against the planning, resource mobilization and implementation savvy needed to enhance care quality, safety and efficiency, exchange information, engage patients and generate positive patient outcomes?     


MU challenges can seem overwhelming and unending to executives of small and rural HCOs. Like leaders of larger teaching hospitals, they hope that promised MU incentives will cover their initial investments in technology, people and process re-engineering. Unfortunately, small and rural executives often end up focusing more on penalty avoidance and keeping their doors open to patients and providers.


Dashed by the dash
The 50-yard dash to MU is a blueprint for lost opportunity, if not failure. While MU deadlines are essential, healthcare organizations that focus exclusively on dates fail to appreciate that MU has no finish line. If and when organizations fulfill every MU requirement within stages 1-3, they will still grapple with challenges related to quality, safety and efficiency, care coordination and collaboration, information exchange, patient engagement and outcomes management.   


If healthcare organizations focus on checking off boxes and requirements, they will find it difficult to migrate from current MU requirements to requirements of the short and long-term future. They will also fall short in creating the infrastructure and flexibility needed to integrate blue-sky changes like gene therapy, big data analytics, behavioral targeting and personalized medicine.


Organizations that engage in a 50-yard dash rather than a marathon cover significant ground in a limited amount of time. But the organization and its professionals often pay the price in sky high levels of stress and burnout. The pressure to sprint and pull back only to be rallied to sprint again is exhausting and demoralizing to staff, managers, executives and clinicians.


Small wonder that one-third of healthcare workers plan to look for a new job in 2013, according to a survey from CareerBuilder. Sixty percent of the 500 healthcare workers surveyed said they were burned out on their jobs, while 21 percent claimed that they always or often felt burned out. Of workers who felt always or often burned out, 67 percent plan to look for a new job this year.   


Healthcare organizations pay another price for choosing a sprint to meaningful use. Professionals in finance operations and clinical care end up with tools, technologies and processes that fail to fit their needs, priorities and preferences. As a result, users feel alienated, frustrated and angry. They insist on fixes supported by added investment in technology, a development that taxes the already strapped budgets of HCOs.  


Running an MU marathon takes a different approach. Rather than developing a good-for-now EHR, organizations focus on the development, implementation and use of a 24/7 EHR that invites patients and consumers into enhanced involvement with their care, including partnering with providers to make sound, informed, evidence-based decisions.


Viewing MU use as a series of stops along a marathon route or steps on a journey to healthcare transformation benefits the organization. Like marathon runners, healthcare professionals have the time to invest in training, education, mentoring and practice. Because they know what to expect and what they'll gain, they're less likely to be traumatized by periodic requests to run a 50-yard dash. They can plan ahead, prepare and pace themselves and more easily embrace, internalize and apply the organization's strategic vision to new and emerging projects and programs.


When new challenges like audits emerge, a marathon mindset can prevent panic and disillusionment. One in 20 MU attesters will face audits, according to an interview with a CMS official reported in Modern Healthcare. Among the likely audit focal points are data security risk assessments and inadequate documentation in response to questions on MU requirements.     


From dash to marathon thinking
Healthcare organizations can act to close the gap between 50-yard dash and marathon thinking. Among the suggestions: 

 

  • Identify trusted external experts and consultants with the perspective and experience to find "low-hanging fruit" in the form of measures, goals, plans, programs and projects. Doing so will prevent the wearing down of financial, human and technology resources as the healthcare organization strives to reap major dividends and position itself for subsequent stages of MU and healthcare transformation.
     
  • Cooperate, compromise and collaborate. Involve players from finance, operations and clinical care in MU discussions, decisions and short- and long-term planning. Practice the values of learning, collaboration and compromise already on display in ventures like NYC Reach, an MU learning collaborative of the New York Department of Health and Mental Hygiene. Also, network with other providers to discuss best practices.  

  • Promote the significance of MU. Help professionals understand that MU is not another HIT project, tool or fad, but a long-term, organization-wide initiative and national movement aimed at data capture and sharing, information exchange among providers, patient engagement and improved outcomes. Fulfilling MU requirements will help the organization deliver high quality, safe and efficient care with positive patient outcomes.

  • Focus on the big picture, but remember the milestones. Help professionals rise above thorny discussions of final and proposed rules, objectives and comments to understand the function and scope of each MU stage and MU as a whole. Explain that while stage 1 focused on basic EHR functionalities, stage 2 turns to advanced clinical processes like patient engagement and information exchange. Improving patient outcomes is on deck for stage 3. But be sure to circle back and re-emphasize the importance of specific deadlines and milestones.

  • Play up the relationship between the stages of MU and HIMSS stages 1-7. The Electronic Medical Record Adoption Model from HIMSS Analytics allows healthcare organizations to chart their accomplishments and compare "progress toward paperless" with other providers. Some organizations rely on HIMSS EHR adoption data to justify plans and programs to the C-suite and report MU accomplishments.

  • Draw upon industry resources. Among the organizations leading the MU bandwagon are HIMSS, American Hospital Association, American Medical Association and College for Health Information Management Executives. MU is also covered within webinars and conferences sponsored by CMS, National eHealth Collaborative, HL7, HIMSS, HITECH Answers and multiple vendors. Smaller hospitals should consider working with Regional Extension Centers to facilitate the MU transition.

  • MU isn't the only challenge healthcare organizations will face as the industry moves toward 2020. Adopting a marathon mentality, mindset and attitude will support these organizations in tackling new and emerging trends, developments and crises.           

 


With over 22 years of clinical experience and 13 years of healthcare IT experience, Shane Pilcher is responsible for coordination efforts around PR, marketing, sales, web development and client relations. His background in HIT focuses on Soarian Clinical Access, Soarian Common Clinicals, Soarian Clinical Team, and Soarian CPOE. 

 

More Articles on Meaningful Use:
Deadline to Begin Reporting Period for Demonstrating MU in 2013 is July 3
ONC Opens Comment Period for Meaningful Use Stage 3
Meaningful Use Measures Available on Online Database

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