“Early certification and attestation were critical,” she said. And while Vanderbilt was an early adopter of health IT, according to Head, the federal meaningful-use program provided the incentive to push for more efficient, effective and universal use of their EHR system.
Just because Vanderbilt had an EHR doesn't mean that everyone used it, Head explained, adding that being “completely electronic” didn't necessarily equate with meaningful use. Also, she said, the homegrown nature of the EHR led to department customization and wide variation in workflows and use. So, along with timing and technological challenges, there were also cultural challenges to obtaining meaningful use. Those included distrust between providers and informaticists, and arguments over physician autonomy and the need for standardization.
Danny Bonn, Vanderbilt Medical Group administrative director, noted that different doctors had built their own clinical summary application and many of these summaries had difficulty being printed. Also, the switch to a structured problem list required a cultural change for doctors used to entering that information in free text.
“That was a shock to our physicians,” Bonn said. “We got it to where 80% of the people were happy.”
As the effort moved forward, Bonn said, there was a general rule that was followed: You can't increase efficiency in workflow if you're adding steps.
The effort included standardizing work at 120 different locations. Bonn said that he first sought to get the “high-volume surgeons” onboard because they were seen as the most challenging group to recruit to the cause.
“If I can get them, I can get anybody,” Bonn said.
Ultimately, according to Head, there was a surprising 50-50 split between the 700 eligible professionals: roughly half qualified for the meaningful use Medicaid payment, which pays out $64,000 over six years, and the other half qualified for the Medicare payment, which pays $44,000 over five years.
While there was resistance to the EHR standardization process, she said there were others who were seeking these changes. Head likened the force of the meaningful-use program to the way NASA engineers use a planet's gravitational pull to accelerate the speed of a satellite or spacecraft.
It was like “slingshotting us around the moon,” she said. “If I didn't have that driver, I don't think we could have driven that organizational change so rapidly.”