The final rule for Stage 2 was released Aug. 23, yet something seemingly simple like test scripts for 2014 certifications for our electronic health records remains undefined. For those of us who must attest to Stage 2 in fiscal 2014, the rule thankfully permits attestation on a quarter’s worth of data (not to be confused with 90 days of data in Stage 2; this requirement corresponds to quarters of the federal fiscal year).
When do we really believe our partners can deliver Stage 2-certified systems? My partner (CPSI) assures me that the next version will get me there, but it is not scheduled for beta testing until mid-2013. As a beta site, I should see it then, but what will my organization have to do to make use of that new tool? Like Stage 1, there are requirements in Stage 2 that necessitate not only the installation, testing and full implementation of a new version of the software, but also require changes in workflows, potentially throughout the organization.
I have written elsewhere about the looming issues surrounding ICD-10, which also requires new versions of the software we all use. Rumor has it that 5010s were a walk in the park compared to ICD-10. I worry not nearly as much about my partners having the products to support our efforts in time as I do about the work process changes that are going to inevitably be required. I am blessed with a fantastic medical staff and dedicated, patient-focused clinicians, but we all will have to change the way we do certain things to pull this off. While I can barely spell SNOMED, I know that my required reporting of labs to my state is going to necessitate its use. My partners say their software will be ready, and I have complete faith in them, but what scares me is what we have to get ready to execute to make use of them.
None of us know what exactly the ACA is going to require of us, but accountable care and population management are likely to be part of it—how to achieve that is not nearly so clear. None of us know what is going to happen with individual states’ response to the Medicaid expansion needed to cover a large portion of the uninsured, but none of us believe that the resolution to that question will leave us unscathed.
While everyone in healthcare fully embraces the concepts of improving patient outcomes, enhancing patient safety, reducing costs overall, and providing the best possible quality of care in accordance with evidenced-based practices and procedures, at the end of the day, it’s clear that the reimbursement for delivering this type of care is not right, fair and in the best interest of all. Value-based purchasing is coming, and while it’s the direction we need to be taking, none of us currently knows exactly what to do, to execute to those objectives in an effective and efficient manner. We are more than willing to drink the Kool-Aid but have no idea what it is really going to taste like. Some are experimenting, but many flavors will likely evolve over time.
I titled this piece “The Perfect Storm” because I see all these factors hitting us soon and in a very tight period of time. The only approach I can take is to make a plan, monitor it, adjust it as necessary and teach. My action plan is as follows:
- Study what is evolving in the market around us and seek knowledge and information passionately. Stay abreast of everything that is developing around us and trust others to assist with this massive undertaking.
- Create awareness for my colleagues and teammates that more change is imminent. Teach, teach and teach.
- Partner more closely than ever with those we have chosen, treat them like partners and expect the same from them. Trust what they tell us, and expect they do the same.
- From items 1 through 3, develop an action plan with dates, even if they are tentative. To use an old pilot saying, “Do not give up runway we cannot get back” and in this case, the runway is time.
When uncertainty is all-encompassing and the only constant is knowledge that we are going to endure significant changes, we must remain pragmatic. Control those things we can to the best of our ability. Remain adaptable and flexible as the uncertainty begins to clear and, inevitably, it will. Adjust plans as necessary. Expect high performance from others and tolerate nothing less, while remaining empathetic to the stress and anxiety this environment will cause. Nothing about this process is contrary to human nature, nor is it personal. Remaining calm, with a firm focus on the evolving vision of the healthcare horizons ahead, will aid in getting through the process.
Above all, lead. Leadership is probably the most important service we can provide at times like these. Form your vision; keep it in front of you; and lead the team in that direction.
In October 1991, the Andrea Gail was lost, a victim of an intersection of forces beyond the crew’s control; its story was depicted in the 2000 film “The Perfect Storm.” The analogy holds for us now, except we have the benefit of knowing it is coming and some time to plan and prepare. We have a choice—do what we can to control our destiny or fall victim to it. I choose the former.
CIOHenry County Health CenterMount Pleasant, Iowa