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GEN i Discussion – Discovery & Debates
 08.27.2010
In a previous article, we highlighted Stephen Covey’s time-tested book 7 Habits of Highly Effective People and discussed how it can be applied to leading healthcare interoperability initiatives.
With all the activities occurring on Meaningful Use, it may be a good time to focus more on Habit 3 - Put First Things First. This is always a tough one, especially when it comes to managing multiple projects plus doing the normal daily activities required of each of us. What do you do first? What can wait?
A way to think about selecting the first things to do is with the following two-by-two illustration. 
Essentially, the two dimensions define: - What is really important given my organization’s mission and my role in achieving it?
- What really needs to be done right now?
Based on answering these two questions, the activities can be placed in one of four quadrants. Think about each quadrant in the following way: - Trivia – This is an easy one to get stuck in, and it causes the most distractions and wasted time. Simply stated, these are interruptions which constantly come our way. It sucks the time away from the top half of the quadrant and places us in a meaningless waste pool of activities. One word – stop, most if not all in this category.
- Interruptions – These are the non-value added emergencies which come up during a day. “Something terrible has happened in the break room which needs your attention!” It is these types of calls to action which should be ignored or handled by someone else. Delegate and/or empower!
- Necessity – We do need to spend time in this quadrant to address the issues which arise during a day or week. These items have importance for daily operations, keeping processes moving forward or un-stalling certain initiatives. Spend the right amount of time here, but not all your time. Remember, you have team members and managers who can solve problems, too.
- Opportunity – We should spend more time in this quadrant, but are too often distracted. This is the planning quadrant or, put a better way, getting to the next level of performance and effectiveness quadrant. If we want to move a mission, organization, initiative, or project forward, it is critical to develop and evolve the plan; define and act on the right metrics; and hire, retain, and inspire the people involved.
Many of us get stuck in the lower half. We need to shake it off and set aside time to spend in the opportunity quadrant. It is what leaders do, and it is the art of saying “yes” to the right things and saying “no” to the distractions. Time management is a central part of achieving this habit. At the core, it is the only way to convert ideas and missions into action.
In the tangled mix of meaningful use, workflows, quality patient care, and health IT, there are many projects to balance and connect. Doing this right is the difference between stalling out at Stage 1 and moving successfully through all three stages of meeting the meaningful use requirements. If there is ever a time for bringing your leadership skills up a notch, it is now.
In each organization, we need to think more about delivering meaningful leadership rather than meaningful use. The first will facilitate getting to the second. It is time to put first things first.
Key start points: - For a week, keep careful notes of where you spend your time each day. Jot down the amount of time spent on each activity and then categorize it into one of the four quadrants. Do this at the end of each day and then look at the overall picture at the end of the week.
- See where your time is spent and then think and plan of how you can spend more time in the top half of the quadrant and, specifically, more time in the opportunity space.
For an Integration Generation perspective on the 7 habits, please read our white paper.
08.12.2010
Last week, the Integration Generation (GENi) blog posted an article identifying two sides to the ‘meaningful use debate’ regarding the release of the meaningful use and standards final rules. One side of the issue agreed that the meaningful use standards are the right solution for EHR adoption. The opposing perspective asserted that the guidelines are not in line with America’s healthcare needs and still need improvement. In addition to the two perspectives acknowledged in the ‘meaningful use debate’ post, there is alternative perspective that has received a good deal of popularity online. The perspective suggests that congressmen may be fundamentally unaware of the true nature of health IT and, therefore, may need some time to enhance their insights on the necessary components which make health IT work – from patients to physicians to hospitals, etc. Barbara Duck, acclaimed author of The Medical Quack blog, had a recent post addressing the level of understanding current decision makers have regarding the true nature of healthcare information technology. The following quote was a part of a reaction to the questions asked following a legislative presentation on EMRs and PHRs: "We have the technology to connect and bring the world of electronic medical records and personal health records together and just need the funds... it was interesting to see inquiries on the committee asking "what is it" [PHR and EHRs]. It just somewhat caught me off guard… " - Barbara Duck, Investing in Health IT: US Senate Testimonies
This perspective adds an entirely new element to the ‘meaningful use debate’: education. In order to become educated on current events, trends and concerns within the healthcare IT community, one must research and listen to a variety of opinions from thought leaders throughout the industry. Thankfully, there are a number of resources available online at no cost to anyone interested in learning more about healthcare IT, HITECH and meaningful use. There are a number of government sponsored websites for primary information on healthcare, official documents and other detailed information. A few key websites are listed below: Website information aggregators such as Healthcare IT News, iHealthBeat and Health Data Management, are also great sources to consult for information on current events. Blogs by thought leaders within an industry are another option to consider when wanting to become educated on a particular issue. Blogs are popular sources of opinion and can also act as aggregators for up-to-date information. The Corepoint Health sponsored HL7Standards.com website includes links to pertinent information as well as a weekly blog discussing trends in healthcare integration and HL7. As many of the health IT training programs are being developed to support Meaningful Use, it is essential all involved parties – legislators to implementers – stay informed on what it will take to make all the moving pieces in a connected healthcare system to work efficiently and effectively.
07.27.2010
Last week The Office of the National Coordinator for Health Information Technology (ONC) announced the release of the meaningful use and standards final rules establishing the incentive program and standards guidelines for the meaningful use of electronic medical records. Initial reactions to the final rule were mixed with some lauding the pace, metrics and future impact on the quality of patient care, while other distinct and contrasting views painted a less than enthusiastic picture of the meaningful use guidelines and their affect on the healthcare industry. The debate: Are the meaningful use and standards final rules the right solution for EHR adoption? View 1: Yes. They are in line with America’s healthcare needs. Prior to the release of the final rule, there was a good deal of feedback (over 2,000 comments) on the interim final rules’ guidelines as being unachievable and too strict on healthcare organizations. Feedback the DHHS received regarding the interim final rule included the following concerns: - the pace and scope of implementation of meaningful use that allows practices and hospitals to qualify for incentive payments;
- the approach requiring 100% compliance with a broad set of objectives was too demanding and inflexible, an “all-or-nothing”
- test that too few providers would likely pass; the complexity of the quality reporting process.
These comments were well received by law makers and clearly influential to the edits made on the final rules’ guidelines. One of the main voices advocating for the perspective that the final rules are in line with America’s healthcare needs is the National Coordinator for Health Information Technology, David Blumenthal, M.D., M.P.P. His article, “The “Meaningful Use” Regulation for Electronic Health Records,” with the help of Marilyn Tavenner, R.N., M.H.A., responded to the meaningful use and standards final rules and was optimistic regarding the future of healthcare in America. “The meaningful use rule strikes a balance between acknowledging the urgency of adopting EHRs to improve our health care system and recognizing the challenges that adoption will pose to health care providers. The regulation must be both ambitious and achievable.” (The New England Journal of Medicine) View 2: No. They need improvement. While it seems the majority of the initial reactions to the final rule were positive, there remain a tangible number of organizations and individuals who do not believe that the final rule is as realistic enough to implement, as Dr. Blumenthal suggests. The American Medical Association (AMA), in particular, has expressed a deep concern for the process of incentive payments. “The [AMA] believes that it will be challenging for many physicians to participate successfully in the program. Especially for those physicians in solo or small group practices who have not previously utilized an EHR,” said the CEO of the AMA, Michael Maves. The key issues with the final rule according to the AMA were nicely outlined in the iHealthBeat article, “AMA Cites Multiple Problems with Final ‘Meaningful Use’ Rule.” Concerns identified by the AMA regarding the final rules include: - Not enough time for health care providers to comply with the requirements prior to the program's January 2011 start date;
- The total number of measures -- 20 -- that the rule requires physicians to meet is too high;
- The exclusion of incentives for health care providers who see at least 90% of their patients in an inpatient or emergency department setting;
- Short time frames for electronically furnishing patient information;
- The lack of an appeals process for physicians to challenge any aspect of the incentive program (CMIO, 7/21); and
- A dearth of any EHRs currently available that meet all of the requirements.
The AMA is not the only group expressing concern. On July 20, TheHill.com published an article, “Republicans attack new HIT ‘meaningful use’ rules,” recognizing a group of republicans and their concerns with the meaningful use final rule. The article pointed out that the main concern for this group regarding the final rule is that the final rules “aren’t strict enough to promote quick adoption of the equipment.” Rep. Wally Herger (Calif.), senior Republican on the Ways and Means Health Subcommittee suggested that the leniency with the final rules could ultimately affect patient care. Herger suggests the DHHS’s final rules are essentially standards for physicians to ensure that they are using the tools available to improve patient services, and therefore must be considered as standards for the industry. “’So each of the practices that experts have told this subcommittee are vital to improving patient safety and eliminating waste, are optional,’ Herger said. The lesser requirements, he warned, could lead to ‘a lower standard and lower compliance rates.’” (TheHill.com)
For healthcare IT organizations, these opinions and viewpoints will have a dramatic effect on the rate of adoption of EHRs by healthcare organizations, regardless of incentives and estimated timelines by the ONC.
What do you think about the meaningful use and standards final rules?
07.14.2010
The New England Journal of Medicine published an article by David Blumenthal, M.D., M.P.P. – the national coordinator for health information technology at the Department of Health and Human Services, and Marilyn Tavenner, R.N., M.H.A. – the principal deputy administrator of the Centers for Medicare and Medicaid Services; the article was issued in parallel with the announcement of the final regulations. The article – The "Meaningful Use" Regulation for Electronic Health Records – provides an excellent summary of the essential elements of what to do to meet Stage 1 Meaningful Use requirements.
The most valuable piece to the article is the table entitled Summary Overview of Meaningful Use Objectives. This table should be printed as a poster and hung in every hospital and clinic pursuing the Meaningful Use requirements. If there is one page you read, this table should be it.
Remember, however, this is only for Stage 1 requirements to be achieved in 2011 and 2012. Stage 2 requirements will not be issued until the end of 2011.
The final regulation has a blend of Core requirements and a menu of requirements in which a provider can select five. This is the Core plus Choice approach taken which attempts to make the objectives “ambitious and achievable."
As stated in the article:
“In the final regulation, we have divided these elements into two groups: a set of core objectives that constitute an essential starting point for meaningful use of EHRs and a separate menu of additional important activities from which providers will choose several to implement in the first 2 years."
“Core objectives comprise basic functions that enable EHRs to support improved health care. As a start, these include the tasks essential to creating any medical record, including the entry of basic data: patients' vital signs and demographics, active medications and allergies, up-to-date problem lists of current and active diagnoses, and smoking status."
“In addition to the core elements, the rule creates a second group: a menu of 10 additional tasks, from which providers can choose any 5 to implement in 2011–2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use."
The reason for this approach is to address the comments and concerns about the “pace and scope" of the preliminary rule. Many of the percentages for achievement in the various categories were lowered in Stage 1 so that it is more “achievable by average practices and providers in the early years." To read through an overview, Inga at HISTalk provides a good comparison of the changes.
All in all, there is more balance and flexibility in the approach to achieve Meaningful Use and the goals of HITECH. The unknown is what escalation of requirements will occur in Stages 2 and 3. Regardless, this approach may get more providers and hospitals on board initially. Most would agree there is an absolute need to bring healthcare into a more electronic age and usher in an integrated healthcare generation.
The goal is reiterated over and over again:
“Equally important, HITECH's goal is not adoption alone but "meaningful use" of EHRs — that is, their use by providers to achieve significant improvements in care. The legislation ties payments specifically to the achievement of advances in health care processes and outcomes."
07.13.2010
John D. Halamka MD in his Life as a CIO Blog, provides a good summary and commentary on the Final Rules issued for Meaningful Use and Standards. His two posts are: With his latter post as a guide, below is a summary table of the healthcare standards contained in the regulations which support achieving Stage 1 Meaningful Use for eligible professionals and eligible hospitals, including critical access hospitals. | Category / Type | Standards | | Content Standards | | | Patient Summary Record | - HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document (CCD)
- Implementation specifications - The Healthcare Information Technology Standards Panel (HITSP) Summary Documents Using HL7 CCD Component HITSP/C32
Or - ASTM E2369 Standard Specification for Continuity of Care Record (CCR) and Adjunct to ASTM E2369
| | Electronic Prescribing | - National Council for the Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard, Implementation Guide Version 8, Release 1 (Version 8.1) October 2005
Or - NCPDP SCRIPT Standard, Implementation Guide, Version 10.6
| | Electronic Submission of Lab Results to Public Agencies | - HL7 2.5.1
- Implementation specifications - HL7 Version 2.5.1 Implementation Guide: Electronic Laboratory Reporting to Public Health, Release 1
| | Electronic Submission to Public Health Agencies for Surveillance or Reporting | Or - HL7 2.5.1
- Implementation specifications - Public Health Information Network HL7 Version 2.5 Message Structure Specification for National Condition Reporting Final Version 1.0 and Errata and Clarifications National Notification Message Structural Specification
| | Electronic Submission to Immunization Registries | - HL7 2.3.1
- Implementation specifications - Implementation Guide for Immunization Data Transactions using Version 2.3.1 of the Health Level Seven (HL7) Standard Protocol Implementation Guide Version 2.2
Or - HL7 2.5.1
- Implementation specifications - HL7 2.5.1 Implementation Guide for Immunization Messaging Release 1.0
| | Quality Reporting | - The CMS Physician Quality Reporting Initiative (PQRI) 2009 Registry XML Specification (incorporated by reference in §170.299)
- Implementation specifications - Physician Quality Reporting Initiative Measure Specifications Manual for Claims and Registry
| | Vocabulary Standards | | | Problem List | - The code set specified at 45 CFR 162.1002(a)(1) for the indicated conditions (i.e. ICD9-CM)
Or - International Health Terminology Standards Development Organization (IHTSDO) Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT®) July 2009 version
| | Procedures | - The code set specified at 45 CFR 162.1002(a)(2)
- The code set specified at 45 CFR 162.1002(a)(5) (i.e. CPT-4)
| | Laboratory Test Results | - Logical Observation Identifiers Names and Codes (LOINC®) version 2.27
| | Medications | - Any source vocabulary that is included in RxNorm, a standardized nomenclature for clinical drugs produced by the United States National Library of Medicine
| | Immunizations | - HL7 Standard Code Set CVX - Vaccines Administered, July 30, 2009 version
| | Race and Ethnicity | - The Office of Management and Budget (OMB) Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, October 30, 1997
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