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Meaningful-use criteria could unintentionally hurt EDs

Meaningful Use Roundup: Part 2 Although the emergency department (ED) generates

70 percent of hospital volume, government regulations downplay the ED’s role in meaningful use. To the extent that they touch on the ED, the rules are confusing and, in some cases, inappropriate. As a result, hospitals burden their EDs with poorly designed, low-performing information systems that are part of enterprise systems. Hospital leaders choosing this path do so because they mistakenly believe that single, integrated applications provide an easier strategy to achieve meaningful use. One reason for this belief is that the Stage 1

regulations tilt toward enterprise systems rather than best-of-breed systems. For example, the meaningful- use criteria for exchange of clinical data apply only to interchanges with providers outside the facility. Data exchange between hospital and ED systems doesn’t qualify, even if those applications come from different vendors. A similar bias exists in the requirements for


a o i

Laurens van der Tang, CEO, VitalHealth Software

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quality reporting: The need for data reconciliation favors single, enterprise systems. Therefore, some hospitals are

purchasing a single HIS product or turning on the ED module of their current enterprise system – even if ED physicians won’t use it. The hospitals can demand that nurses use it, regardless of the negative impact on operational effi ciency or patient safety of using paper and electronic systems simultaneously.

Robert Hitchcock,

M.D., F.A.C.E.P., CMIO, T-System

In short, the meaningful-use rules are hampering efforts to collect accurate and robust data and improve the quality, safety and effi ciency of care in our nation’s EDs. These unintended consequences stand in contrast to the admirable goals of meaningful-use legislation.

Clinicians need tools they can use

There are many barriers to EHR adoption for small practices, but one of the most signifi cant barriers is the ease of deployment and use of EHR solutions. With limited or no IT resources, small practices appreciate the easy accessibility of cloud-based SaaS (Software as a Service) solutions. At the same time, they need a solution that supports and enables their small practice

workfl ow, avoiding the pitfalls of excessive complexity. Today, many organizations are wisely looking beyond MU to understand if they have an EHR that is usable and desirable for a physician to use, so that they can achieve their ultimate goal of improvements to quality, effi ciency

and information sharing. When we partnered with Mayo Clinic to do primary research on the EHR needs of small practices, we shadowed clinicians and administrators in a variety of small practices.

Customization and flexibility in both software and device options are critical to ensuring the EHR complements, rather than disrupts, the highly varied work styles of small practices. Everyone in healthcare facing the challenge of meaningful use needs to look to the greater challenges of sustained efficiency and quality improvement. Bending arms and offering fi nancial incentives can only work for so long. We all need to work toward giving clinicians tools that they want to use; tools they will pick up every day because they help them save time and deliver better care.

Communications enable meaningful use A key area of focus needs to be making EMR systems

more attractive to clinicians so meaningful use can be driven up. One way of achieving this is to build communications into the EMR system. Take the scenario of a doctor looking at a patient’s

X-ray and wanting to talk to the radiologist. A doctor could simply click on the radiologist information in the EMR system, determine availability and then click to start communicating with the radiologist. The two doctors could look at the X-ray together on the video call and collaborate on a diagnosis. A key requirement of Stage 1 meaningful use is patient

14 May 2011

and family outreach: the ability to contact the patient to remind them about appointments and follow- up care. Solutions link into the EMR system that can reach out to patients via preferred mechanism of contact (phone, e-mail, etc.), provide them the information in language of choice and also get interactive responses from patients that can be used for post-care follow up.


Bruce Wallace, group leader,

Avaya Healthcare

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