While his timing would’ve been a bit off, Joe Biden might have been forgiven if he had smirked and called the October 4th letter asking HHS Secretary Kathleen Sebelius to suspend meaningful use (MU) incentives “malarkey.” In the letter, four Republican congressmen cite an apparent weakening of thresholds from Stage 1 Proposed to Stage 2 Final Rules as well as a lack of established interoperability standards as contributing to wasted taxpayer dollars. On the latter point, the congressmen may be a bit premature as Stage 2 appears to advance data and transfer standards such that we may (finally) expect meaningful exchange in the coming years. On the former point, however, the congressmen might have a legitimate gripe.
The decrease has primarily come during the public comment periods between Proposed and Final rules each time. As with most legislation, this is presumably due to pressure from large trade organizations (e.g., AMA, AHA and the like) representing their constituents’ concerns. Regardless of the drivers for decreased thresholds, one thing is certain – while inroads in interoperability are likely in Stage 2, there still needs to be USE of these interoperable EHRs – there must be data to exchange for interoperability to have maximum effect. This makes the slow march toward 90%+ for certain thresholds a bit curious. Why would a physician want to enter 60% of medication orders electronically but only 30% of lab or radiology orders electronically. That’s a hybrid, inefficient workflow. If you asked physicians which they’d prefer between lower thresholds and hybrid workflows versus efficient systems that help them treat patients, I believe they’d chose the efficient systems.
Ultimately, widespread adoption success will require innovative, disruptive technologies and not just interoperable systems. Applications and services that change the way we use existing technologies will play a key role. It’s not enough to make CPOE “better” – better for whom and how is a key consideration. Traditional desktop CPOE may improve the way a physician places a medication order or they way a lab result is accessed. Those are examples of individual improvements rather than disruption. Unifying all patient data and allowing a physician to re-order a lab directly from a result – all from a mobile device while outside of the hospital – is closer to the disruption that’s required. Simply designing systems that support the way a physician works – non-linear with constant interruptions – is disruptive by healthcare IT standards.
Ultimately, the technologies that break down the silos to create an integrated, physician experience will lead to success – it may even please both sides of congress. OK, maybe that’s a bit TOO ambitious.
I don’t normally write about patient safety or risk management issues directly, but the news in today’s Boston Globe about a potential whistle-blower lawsuit by a fired Jordan Hospital nurse grabbed my attention. I actually think this story is as much or more about transparency than anything else. Fortunately, in this instance, it appears both mother and newborn twins (born premature) are doing well. I choose to believe this is due to a combination of factors including the talent and care provided by the receiving hospital staff (South Shore Hospital), the mother and her infants, and perhaps even grace.
The Infractions in question relate to a federal law that prohibits hospitals from transferring patients without first making sure they are stable and have been examined by a physician. The plaintiff has been a nurse at Jordan for 38 years, most recently as director of occupational health and risk management – so she is presumably intimately aware of federal and state laws attendant to transfers as well as reporting violations to proper authorities when they occur. Nurse O’Connor accuses Jordan Hospital of terminating her employment because she reported a violation of the aforementioned federal law.
What is most concerning about this alleged incident (now that mother and children have recovered) is the focus on fines (of the hospital) and punishment (of the hospital and the nurse, assuming it contributed to her termination) rather than on transparency. The protections afforded to whistle-blowers stand as an important example of the great strides the healthcare industry has made over the last decade toward the issue of transparency. Public reporting of healthcare costs, outcomes and quality improvement by providers (including hospital leadership, example Paul Levy‘s popular blog), payers (including CMS) and vendors (including WebMD) alike will continue contributing to this movement. An environment that celebrates and encourages transparency will ultimately have a far greater impact on quality and safety than fines and punishment.