CHIME Time: Hitting the wall on meaningful use

Change and challenges are a way of life in healthcare. Holy Spirit Health System, Camp Hill, Pa., which just celebrated 50 years of service to our community a year ago, signed a letter of intent last October to affiliate with another central Pennsylvania system, Geisinger Health System—we're deep into the due-diligence process now. For the past two quarters, our system has experienced an anticipated decline in inpatient admissions, significant enough to precipitate changes in staffing and budget models.

However, these recent events pale compared with the energy and attention we're giving to achieve Stage 2 meaningful-use incentives for electronic health-record systems. We are discovering vendor interoperability issues daily.

Like most community-based systems, our organization has one EHR vendor for the hospital, another for primary care and a third for a specialty practice. We want to provide a single portal rather than three separate portals from each vendor, so we selected a health information exchange solution that has both provider and patient portals.

Unfortunately, we actually may hit the wall with Stage 2. This is despite years of due diligence selecting the right vendors, hiring the right talent, building out space to accommodate talent and technology, maintaining competitive salaries, and honing processes and methodologies to respond quickly to project demands.

As we resolve one vendor issue, we identify another. That prompts a debate between certified vendors on which owns the interoperability problem and the concern that software customization may adversely affect certification status or introduce unintended consequences. Of the larger vendor issues we've identified so far:

  • One vendor requires a specific operating system version (not standard to the corporation) to support its certified software.
  • The HIE vendor doesn't satisfy the secure messaging requirements standardized under the Direct Project, a private initiative that has established a simple, secure and scalable approach to enable participants to send authenticated, encrypted health information directly to known trusted recipients over the Internet. The federal government has endorsed the project.
  • One EHR offers messaging using Direct Project standards only when its patient portal is purchased, for a cost exceeding $60,000.
  • One vendor offers messaging using standards from the Direct Project through a certified add-on for about $20,000.
  • The one certified release currently tested has a known bug on a critical MU feature.

There are more challenges to come—we have not yet received the remaining upgrades for the two ambulatory EHRs so that we can test them with the portal.

The contracting process alone is complex, time-consuming and costly. Software modules receive separate CMS certification, and we discover that we need additional vendor purchases well into our implementations. This additional activity needs to be baked into our aggressive timelines.

Time is getting short. We need to resolve the issues related to the hospital EHR/HIE by the end of June so we can begin our 90-day attestation period on July 1. If we can't, we will file for a hardship exemption based on vendor preparedness.

HIE enrollment, patient authorization opt-in/opt-out, more complex patient matching and information sharing workflow processes are changing rapidly throughout the health system. Without the luxury of time, clinical leaders create new workflow absent the ability see new systems, let alone understanding how the system interacts with current processes and workflow. Many new processes are completely manual; there's no audit tool to ensure accuracy or way to identify staff who need coaching.

Information and changes are flying at us as if thrown by a tennis ball machine gone haywire. We have to make quick sense of CMS, vendor, corporate, user and technical jargon before developing an action plan.

My applications director and I both have more than 20 years of experience in healthcare IT, have worked with multiple vendors and health systems, and one of us has a clinical background. Even so, we are hard-pressed to absorb this constantly shifting terrain and create strategy and project timelines. Would it be easier if we didn't know what we know?

Nevertheless, we remain determined and committed to meet and overcome these challenges.

Edith Dees
Holy Spirit Hospital
Camp Hill, Pa.



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