Journal of AHIMA - October 2011

“There was nothing we were asked to do…that we thought was a waste
of our time or a bad thing to do.” —Tom Smith

“Being a specialty practice a lot of the summaries are very
similar,” Sunderman says. “You are overweight, you are proper
weight, you are or aren’t changing drugs. So those statements
we were able to put into very quick lists that the doctor could
simply click the key statements he needs for the summary.”
This information was added to other standard clinical sum-
mary information such as prescriptions or test orders and then
handed to the patient at checkout.

Program Achieves Balance

Rahman believes that stage 1 strikes the intended balance between difficult but not discouraging—he has heard from clients that the measures were too easy and too hard.

“I think it does as good a job as possible, and it is a very complex environment in trying to get a lot of people on a level playing field,” he says.

The carrot and stick approach in the Medicare program seems to be working for larger hospital systems. Realizing they must become meaningful users by 2015 or face payment reductions, they have joined early to take advantage of the incentives.

While the incentives for hospitals do have a limit, the penalties that come after 2015 are uncapped.

“Because the penalties are uncapped and based on admis-

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sions, the bigger hospitals have bigger potential penalties,” Rah-
man says. They quickly realized, “‘I could gain $8 million, [or] I
could lose $16 million.’”
NorthShore started tracking the stage 1 measures in the sum-
mer of 2010 to ensure it could meet the measures in January, the
start of the 90-day attestation period for those attesting in April.

While the health system was already meeting several of the thresholds, tracking its work on things like medication reconciliation and problem lists did lead to improved processes that will ultimately improve care, Smith says.

The problem lists went from general statements to more specific information, and medication reconciliation was done more robustly. While not very difficult, the program did improve care processes at NorthShore and many other early attesters.

This is the intent behind the meaningful use of health IT. But the bigger improvements to care are to come in later stages, once providers have passed their voyage’s first milestone with stage 1.

Care Impact Comes Later

Many providers have been reacting favorably to the program, even if they are delaying their entry.

“This program was supposed to accelerate the adoption, and
it certainly is doing that,” Drazen says. “I haven’t heard many
people say that this requirement isn’t important, or that this
isn’t going to have an impact.”
Stage 1 is about getting the systems implemented and provid-
ers using them effectively, Drazen says. Stage 2 will have provid-
ers begin to use the information to find gaps in care, and im-
provements to care processes will come in later stages.

“It wouldn’t be an expectation that you would see a big dif-
ference right now,” Drazen says. “CPOE has the potential to im-
prove medication management and avoid errors in medication,
but the stage 1 requirement that requires clinical decision sup-
port is really only on allergies and interactions. And that is not
where the problems are occurring in hospitals now with medi-
cal errors. Only in the future stages... will we see the benefits.”
Wellmont, NorthShore, and several other hospital officials
agreed that the meaningful use program is a great thing for the
industry.

“I think it is important to understand from our perspective that even the [measures] we had difficulty with, nobody questions the overall legitimacy of them,” NorthShore’s Smith says. “There was nothing we were asked to do…that we thought was a waste of our time or a bad thing to do. The same is true for stage 2.