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I appreciated all the dialogue that my recent post on KevinMD’s blog, “The emergency department in an ACO world,” has generated over the past week or so – the number of comments is a great indicator that ED physicians are not just letting this topic go by. I’ve compiled the following post to address as many as I can:
In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.
Coming off of a pivotal year in healthcare and gearing up for an exciting 2011 – with HIMSS around the corner – meaningful use continues to be on the tip of everyone’s tongue. Whether it’s vendors achieving certification or hospitals striving to get there, these two words have secured their place in the world of healthcare IT.
Hospitals continue to evaluate where they stand when it comes to meeting meaningful use regulations today and in the long-term, and are faced with some tough decisions about the right systems to implement and, in many cases, replace. Hear what execs and clinicians from a few key hospitals, including Exempla St. Joseph Hospital and Alegent Health System, have to say when facing the meaningful use challenge:
For 2011, we hope you meet a resolution of preparing your hospital with the technology that is the best fit for it and its patients. It is bound to be another exciting year in healthcare so stay tuned!
- Dr. Mark Crockett
I don’t know about you, but I was thrilled to hear about today’s launch of MEDS-ED Link, a project of the Northern Virginia Regional Health Information Organization (NoVaRHIO) in conjunction with Inova Health System and GE Healthcare.
Health care leaders and policy makers should be commended for making several smart moves in this week’s delivery of the final rule for the meaningful use (MU) criteria, but one of the most critical is the committee’s decision to include the emergency department (ED) as a viable place of service.
For the past several months, several of my colleagues and I have been part of the ongoing effort, working directly with legislators and other industry leaders to ensure that the ED “gets its due” in the MU final rule. One of the most cost and care intensive areas of every health system, but neglected in the initial rounds of MU criteria, the ED is where the flow of patient care most often begins and consistently feeds patients throughout the rest of the hospital – and I’m thrilled that policy makers have now shown that they agree.
A recent Wall Street Journal Health Blog post addressed a growing complaint in the industry: that deadlines for digitizing medical records are “too much, too soon.” I’ve worked hand in hand with a range of hospitals – from some of the country’s largest IDNs to smaller, community-based hospitals – that are knee-deep in preparations for the myriad of “meaningful use” requirements set in 2011, and while I can report that healthcare organizations are at varying degrees of readiness, that is not my utmost concern.
Most likely, the meaningful use deadlines as they stand today will be met in part by some, missed by others. However, while the deadline debate is certainly part of the story, the oversight of the emergency department (ED) within the guidelines is criminal. Take the following information into account:
One of the most important aspects of any emergency department (ED) is risk management. Unfortunately, with tort reform hot on everyone’s mind, many people associate risk management strictly with hospitals and physicians doing everything they can to “CYA” – translation, avoid malpractice lawsuits. But that couldn’t be further from the truth. With the passing of the healthcare reform bill, risk management will continue to play a critical role in supporting our nation’s physicians and the clinical decisions they need to make to ensure patients receive the best possible care.
The newly-insured are going to soon flood today’s already overcrowded EDs, and pressure on each individual physician is only going to continue to mount. For many ED clinicians, the day starts out with a worried look out onto a crowded waiting room – so many patients to see, with more to come. Whether they want to admit it or not, the fear that runs constantly through every physician’s mind is, “What if, in the chaos that surrounds me, I miss something?” Every physician will take every possible opportunity to ensure that they don’t. But of the dozens of patients in that waiting room, a handful of them likely have high-risk conditions, and no matter how skilled you are, the trouble is identifying them where you least expect it. Enter the support of risk management.
While the meaningful use debate rages on, the Centers for Medicare & Medicaid Services (CMS) have opened the proposed rule on the EHR incentive programs – which includes the definition of meaningful use and other requirements for qualifying for incentive payments – for public comments. The deadline for comments is Monday, March 15th, and we’re encouraging folks to weigh in on the good, the bad and the ugly. The more industry can shape how this rule should be shaped, the closer we come to putting the real “meaning” behind meaningful use.
For more information and to submit a comment on the proposed rule, visit the Regulations.gov website. For additional information on the proposed rule, visit http://www.cms.hhs.gov/Recovery/11_HealthIT.asp.
- Mark Crockett, M.D.
Standing in the Interoperability Showcase at HIMSS10 is frankly amazing. We are participating in the Emergency Department interoperability scenarios, passing clinical documentation to and from other systems, using IHE standards for information exchange. I was standing with a friend and CMIO who is a practicing physician, and when he saw how easy it was to get information regardless of source, his comment was, ”This is how it is supposed to work, how it was always supposed to work.” I agree. And more vendors than ever are participating.
Talking with the HIMSS folks that orchestrated the impressive setup, I come to find that the numbers of folks “interoperating” in this display have more than doubled in the past two years, now demoing nearly 60 use cases and 28 clinical scenarios. Similar to the IHE show in January, the interest in interoperability and move to embrace standards at HIMSS is palpable. And it’s not just on the show floor – I have been talking to vendors all over that are now delivering or planning to deliver shortly to their customers this type of technology.
The transition of patient care and documentation from one provider to another has always been a challenge for the healthcare industry — disconnected hospital systems can lead to a game of “telephone” with important patient data (on paper or verbally,) which is both inefficient and risky. I have been involved for years in connecting systems together, and the complex interfaces that have been used to do this in the past have been a headache — plus, they have not achieved the seamless “plug and play” that we have seen from other industries. Nobody worries about what brand of mouse or keyboard they purchase anymore, they plug it in and it works. When will we see this kind of Valhalla for medical systems?
Soon, hopefully. Government organizations are now getting involved in setting standards for healthcare systems to work together. I have never seen so much progress and I couldn’t be more excited about it. A lot of this effort is around something called a CCD, or continuity of care document. There are different forms and different names, but they all boil down to a document that summarizes an episode of care, with structured data around things like medications, allergies and a problems list, which can be consumed and used in any system that touches the patient. There is a central “library” that these documents are submitted to, and then can be “checked out” at any time so that the most accurate information is always available to the physician.
