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It’s about the network, not the app

Jonathan Hare, chairman and founder, Resilient Network Systems

One of the primary goals of HITECH’s meaningful-use incentives was to motivate providers to go beyond simply adopting EHRs and connect them to a network capable of sharing and coordinating with other providers and the patient. In spite of this, the fi nal rule adopted for Stage 1 meaningful use required only minimal “push” connectivity – basically the

electronic equivalent of faxing a record to a patient or other provider. The only requirement for “pulling” records is a single test of the ability to generate an electronic document that can be uploaded by another EHR. Moreover, this can be performed using a “fi ctitious patient and fake data” to “avoid security and privacy concerns.” In other words, you don’t actually need to be connected. Think of it as a halfway house to real meaningful use. This watered-down requirement was not what CMS or the ONC wanted. The rationale was that no one had demonstrated a way of overcoming the legal, technical

and privacy obstacles to exchanging data at scale. As Dr. Blumenthal testifi ed at a Congressional hearing, “we live in a world with virtually no information exchange going on at all.” At the same time, Dr. Blumenthal put industry on notice that the Stage 2 requirement beginning in 2013 would require much more robust exchange. More recently, the President’s Council of Advisors on Science and Technology (PCAST) turned up the heat by releasing a provocative report on health IT. The PCAST report makes a compelling case that traditional HIT – both existing EHRs and mechanisms for enabling exchange – is fundamentally incapable of supporting healthcare transformation. They call for a network-centric approach organized around patient data, with mechanisms for rigorously enforcing security and privacy linked to the data itself. I believe the PCAST report should not be ignored. It’s time to stop dodging the obstacles that have prevented patients from benefiting from the IT revolution. We need innovation that enables what healthcare transformation requires, instead of limiting ourselves to what traditional approaches can deliver.

A proactive plan for showing meaningful use

Forrest General Hospital, which has had a computerized patient record from QuadraMed since 1996, is leveraging a dual path to meaningful use rather than the single path many other hospitals are taking. Prior to receiving the ONC-ATB-certifi ed version of our EHR, we started using our EHR to develop our meaningful-use capabilities. For example, one of the largest challenges for any hospital is getting the medical staff to use the newly required problem list. This is due to each practitioner having his or her own approach to diagnosis and terminology. We pulled together people from across Forrest General and worked with them to gain consensus on the problem-list design.

By emulating what we believe the new version of the EHR will support, we’ve been able to educate our staff and prepare them for the changes that will occur with the certifi ed version of the EHR. Now that we have received the certifi ed EHR, we’re confi dent that we’ll have the relevant parts of the workfl ow ready to go, thus requiring less effort for clinical adoption of

practice changes. If we had not done this, we would not be able to anticipate achieving meaningful use as soon as we are. To take advantage of the functionality we already have established with our EHR, we are working with QuadraMed on developing interfaces with the state public health department so we can report lab results for meaningful-use compliance. And to provide patients with electronic copies of their records, we’ve given our medical records department preliminary capability to generate electronic fi les containing EHR data. The staff can now save fi les – such as H&Ps or discharge summaries – to fl ash drives or burn them to CDs, and they will use the same methods to provide clinical care summaries generated by our new EHR once we move the certifi ed EHR to production.

Rod Walker, interim CIO of Forrest General Hospital, Hattiesburg, Miss.; principal,

consulting fi rm of Negley, Ott & Associates Inc. HEALTH MANAGEMENT TECHNOLOGY

May 2011 15 Continued on page 31

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