Feature: Challenges of achieving meaningful use daunting, yet plausible
Achieving meaningful use for EHR systems won’t be easy--but is possible, according to a report published in September by the Computer Science Corporation, “Meaningful Use for Hospitals: The Top Ten Challenges.”

The Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) provide an estimated $22 billion dollars for the adoption and use of health IT by Medicare and Medicaid providers over the next ten years. Eligible physicians and hospitals must achieve meaningful use of an EHR to receive financial incentives. Physicians and hospitals not engaging in meaningful use by 2015 will incur penalties to their Medicare reimbursement.

However, with unclear mandates and expectations, meaningful use faces a daunting task of being implemented and standardized nationwide. Undoubtedly, many challenges will arise as the requirements become clearer and divergent practices attempt to converge during the reformation period.

The HIT Policy Committee presented a potential definition for meaningful use in July. An interim final rule from the Centers for Medicare & Medicaid Services (CMS) will be released by the end of December. The requirements are tied to five U.S. health policy priorities which attempt to improve care coordination, public health, safety, quality and reduce health disparities. The requirements also seek to ensure privacy and security for personal health information.

The plan is scheduled to be implemented via three increments in 2011, 2013 and 2015.

The goals for 2011 are focused on fine tuning the clinical information system with EHR data capturing. While adding fewer new modules to the system, 2013’s requirements begin with the incorporation of the EHR into transforming processes. The emphasis for 2015 is on improved outcomes with new care processes enabled by the EHR.

“Hospitals and ambulatory clinics of all sizes and services can use a standardized EHR system when delivering care to patients,” Beverly Bell, co-author of the article and EHR implementation leader and partner at CSC Healthcare Group, said in an email. “Most of the EHR systems on the market today can accommodate site-specific modifications to take into consideration regional variances."

CSC said that 1.5 percent of U.S. hospitals have implemented a comprehensive use on all units of EHRs.

Objectives and measures are currently most detailed for the 2011 increment. The HIT Policy Committee has just begun focusing on 2013 and 2015’s requirements, according to the report. The direction and intention to build off of 2011 goals are "uncertain at this moment."

The 2011 requirements are beyond current use for most hospitals, according to the report. Additionally, the intended changes presume that new processes deliver better outcomes. A higher standard is held up to the intended changed standards. Finally, the goals and requirements are expected to be achieved within a tight, compressed timeframe. According to the report, a typical 18-month hospital-wide rollout of computerized provider order entry (CPOE) will not be fast enough.

Bell, with co-authors Jane Metzger and Erica Drazen, outlined the top challenges in the report for meaningful use and offered some guidance to how to achieve it.

Among the main challenges is convincing physicians of meaningful use’s merits on the hospital floor.

“I think many physicians are concerned about the initial funding for purchasing and implementing an EHR system,” stated Bell. “They also are concerned about ongoing costs such as PC or device replacement and licensing fees.

“Additionally, for many physicians, it is an unknown as to how their daily processes will change to accommodate the EHR.  They have concerns it will slow their productivity down which may lead to patient dissatisfaction if they have to wait for longer periods of time,” she noted.

Financing and the implementation of EHRs are clear concerns for some hospitals, according to Bell. However, the financial initiatives in ARRA are generous enough to cover a substantial portion of the financial burden that the reform requires, according to the report.

“Hospitals have options for saving overall project costs by choosing to have an external organization host the EHR system or outsource the EHR to an external organization,” stated Bell.

Managing new systems, standardizing practices and meeting new standards of privacy will also be among the top challenges, according to the report.

“The hospital needs to have a plan of how they want to use the EHR system to achieve meaningful use,” Bell said. 

For standardization to occur, a leadership team united to achieve meaningful use is necessary, according to Bell.

“The leadership team needs to develop a roadmap or plan that will get them to meaningful use," she stated. "This roadmap needs to accommodate specific goals for the organization. It is also instrumental to select an EHR system that is appropriate for their culture.”