July is “take your EHR strategy to lunch month”

Several have written suggesting I toss my hat into the ring to serve as the EHR Strategy wonk or czar. I was in the process of thinking it through when I was awakened from my fuegue state by a loud noise–my ego crashing to the floor.

Some have suggested that a camel is a horse designed by a committee. Their point in saying that has something to do with how committees function less well than individuals–the problem with “group thinking.” Personally, I think the camel design seems rather functional.

Some have asked, what is it about the EHR universe that has you dehorting the EHR process as though you are some sort of savant–nobody really asked that, but I wanted a segue and that’s all I came up with.

It’s the committees. I feel a little like Quasimodo repining about the bells. Raise your hand if you are on an EHR committee. See? Now, if you think that not only has the committee not accomplished much, but believe that it may never accomplish much, lower your hand. Now look around. Not many hands still up.

Please take a look at this for a moment. Don’t try to understand it–it will only make your teeth hurt.

2011 requirements

For hospitals, 10% of all orders (medication, laboratory, procedure, diagnostic imaging, immunization, referral) directly entered by an authorizing physician must be made through a computerized physician order entry process. Individual physicians still must use CPOE for all orders, even if electronic interfaces with receiving entities are not available. The initial draft did not specify the required percentage for hospitals and did not address the electronic interface issue.
Physicians must be able to check insurance eligibility electronically from public and private payers, when possible, and submit claims electronically. This was not in the initial draft.
Patients must receive timely electronic access to their health information, including lab results, medication and problem lists, and allergies. The initial draft did not include the word “timely.”
Physicians must implement one clinical decision rule relevant to specialty or high clinical priority. This was not in the initial draft.
Physicians must record patient smoking status and advance directives. This was not in the initial draft.
Physicians must report ambulatory quality measures to CMS. This was not in the initial draft.
Physicians must maintain an up-to-date list of current and active diagnoses based on ICD-9 or SNOMED. The initial draft did not specify use of the two classification sets.

2013 requirements

Specialists must report to relevant external disease or device registries that are approved by CMS. This was not in the initial draft.
Hospitals must conduct closed-loop medication management, including computer-assisted administration. This was not in the initial draft.
All patients must have access to a personal health record populated in real time with health data. This was moved up from 2015 in the initial draft.

Additional provisions

Patients’ access to EHRs may be provided via a number of secure electronic methods, such as personal health records, patient portals, CDs or USB drives.
CMS will determine how submitting electronic data to immunization registries applies to Medicare and Medicaid meaningful-use requirements.
CMS may withhold federal stimulus payments from any entity that has a confirmed privacy or security violation of the Health Insurance Portability and Accountability Act, but it may reinstate payments once the breach has been resolved.

Source: Health IT Policy Committee

See? Take a few minutes and work this into your EHR task time-line for processes, work flows, change management, training. Need more time? I’d need more time than I have, and when I finished I guarantee I couldn’t explain it to anyone. This is what happens when people get into a room, have a charter, and try to do something helpful. I am sure they are all nice people. But be honest, does this make your day, or does it make you want to punish your neighbor’s cat–you may have to buy them a cat if they don’t already have one.

What to do? Here’s my take on it. Plan. Evaluate the plan. Test the plan. Know before you start that the plan can handle anything any committee tosses your way. Let people who know how to run large projects into the room. Seek their counsel, depend on them for their leadership. If the plan is solid, the result has a better chnace of surviving the next committee meeting

Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy