Last week, KLAS issued a 93-page report based on results from its own survey of provider organizations using electronic health-record systems. The report tries to determine which vendors systems might give their provider customers the best chance at meeting Gales own estimate of what the meaningful-use standard might require. (An official HHS description of meaningful use, which is expected to supplement the one already included in the stimulus bill, is due to be released soon.)
We got bombarded by people who asked us: What do you think the requirements will be and, assuming they will be what you think they will be, what products will be able to get me there? said Gale, the lead author of the report Meaningful Use Leading to Improved Outcomes. About 80% of the report is based on the acute-care hospital IT market, where KLAS has a pretty good handle on the penetration and use rates of systems from a fairly small group of major clinical IT system vendors. The ambulatory-care side of the market makes up the balance of the report and, with an estimated 200 or so vendors throwing elbows trying to gain market share, the data is a lot more diffuse and harder to peg, he said.
To me, its important for provider organizations, and were basically talking about acute care, that they sit down and talk about what they have and what theyre going to have to do to meet the hurdle, Gale said.
Among those concerns are whether their vendors system is even capable of doing the tasks needed to meet the meaningful-use standard and, if not, does their vendor have products available to make the system compliant with an upgrade? Another problem to consider is whether the vendor will be capable of installing the new product, even if it is available, given the likelihood that some vendors will be stretched to meet the 2011 payment year startup deadline for the first subsidy payments under the stimulus act.
One of the assumptions Gale said he made about what meaningful use might entail is that it is probable that physician usage of their hospitals EHRs will be key. Usage is likely to include, sooner or later, the number of orders physicians actually placed on their EHRs computerized physician order-entry systems. Since adoption of CPOE is low across the industry and full physician usage is even lower, both are likely to be big lifts for hospitals seeking to meet the stimulus standard. Another couple of metrics that might be included in demonstrating meaningful use involve the presence and use of a computerized and bar code-based, bedside-medication tracking system.
Youve got about 300 hospitals in the U.S. right now that are doing whats going to be required of a typical meaningful use, so thats less than 10%, Gale said. Some hospitals have been able to implement a full clinical IT system in a single year, he said, but that is not the norm. It could get even harder to do such fast-paced installations in the future, Gale said, as the pool of experienced system installers gets stretched by the expected rush to adopt EHRs.
The question is: Are there enough people around the country to spread around? Gale said. No, there are not.
So, we are facing a national conundrum. In a crisis mode, we are a very creative nation and can come up with something, and if we extend the deadline, well use every minute. We dont want to set a goal that the vendors cant meet or the providers cant meet.
From the people Ive talked to who are involved are very thoughtful about how to do this, they are very concerned about the rural hospitals, Gale said. Without some very thoughtful set up, this could be a disaster.
I think theyll start with a bar that will be a real stretch for some, a bit of a stretch for others and not a stretch at all for the 300, Gale said.
One problem vendors and providers alike will face is upgrades from older, legacy systems that, if providers stick with them, will be less likely to make the grade to meaningful use, according to Gale. These vendors, in which the bulk of their client base is being served by these older systems, have an opportunity for upselling to newer, more modern systems, but also a problem, getting multiple upgrades done in time to have their customers meet the 2011 payment year deadline set in the stimulus law.
Meditech, headquartered in Westwood, Mass., is a poster child for vendors in this position, with its older, Magic product line being used by many of its clients, but with its newest, slickest Meditech Client/Server Version 6.0 in use by far fewer.
If you have a Meditech Magic site, your end-users use it, its clunky, but its second nature for them, Gale said.
According to the KLAS report, the disparity in the number of live hospitals using Meditech clinical information systems verses the relatively low number of clinicians at those hospitals using the system indicates that the Meditech solutions are not easily adopted by physicians; this observation is corroborated by commentary from Meditech clients.
For Meditech hospital executives seeking IT bonus payments under the stimulus bill thats a huge problem," Gale said. "Meditech has come out with version six, which has this beautiful front end on it, but how do you move 1,500 customers? Typically, a vendor moves 50 a year. Well, thats 15 years worth.
For Meditech customers, The first thing you try to do is get to the head of the line, Gale said.
Siemens and its customers face a similar challenge, Gale said, converting its large body of legacy systems, including Envision users, to its most advanced Soarian C6 system.
Eclipsys Systems Corp. customers have broad and deep use by physicians of its CPOE component, but Eclipsys doesnt have any sites with bedside medication, Gale said. Whether thats part of meaningful use or not I dont know, but Gale advises, if you are an Eclipsys customer, you might put pressure on them to speed things up filling that gap in its product offering.