Meaningful Use: All Stick and No Carrot

Carrie Vaughan, for HealthLeaders Media , June 23, 2009

For his part, Basch says that implementing CPOE in the outpatient setting in the 2011 timeframe is a doable goal. The inpatient setting is a different story, however. "For those of us in medical field, we are a little gun shy of pushing CPOE too quickly when we haven't gotten other pieces of the loop complete—medication administration and barcoding—and done sufficient workflow analysis first to make sure there will not be unintended consequences," he says.

MedStar Health, which has been working on an accelerated timeline to have all of their physicians in the outpatient setting up on EHRs, is on target to achieve meaningful use under the proposed recommendations and timeline, Basch says. The organization decided to move on the outpatient setting first because it is "easier, far less expensive to do, and the technology was more shovel ready," says Basch. In the inpatient arena, however, MedStar had barcoding and CPOE flipped in its schedule of adoption. If CPOE stays in the 2011 timeframe, the organization may have to alter its strategy. "We will have to reconsider the impact and size of federal incentives on our existing roadmap and make a decision at the leadership level as to whether we keep to the roadmap or adjust it," says Basch.

Bruno is concerned about implementing this amount of change at all six of EMHS' hospitals under the current timeline. She says their tertiary referral hospital, Eastern Maine Medical Center, will likely be able to meet the 2011 and 2013 objectives because 93% of orders are created using CPOE and they already have most of the other functionality planned. However, the same cannot be said for their smaller hospitals, which do not have CPOE yet. The organization plans to implement CPOE at the other facilities over the next three years. But with the 2013 requirement for barcode medication administration, it will be taxing, Bruno says, because pharmacy expertise is needed for both projects.

"A significant part of CPOE is medication ordering, dose range alerts, allergy alerts, and drug interaction alerts. The barcode medication administration also requires pharmacy expertise," she says. "It will be difficult for all six of our eligible hospitals to meet the 2013 objectives."

PHR surprise
Many healthcare executives were shocked to see the emphasis on personal health records in the 2011 objectives. But Mitry was not one of them. "We are a believer that everyone should have the opportunity to access their personal health record online at anytime of the day or night," he says.

Glen Tullman, CEO of software vendor Allscripts, is also supportive of PHRs being included in the 2011 objectives. "We cannot create an electronic healthcare highway and not have onramp for patients," he says. "Right now PHRs aren’t connected and nobody wants to use it, but who wanted to be the first fax users?"

Basch, however, is not convinced that forcing providers to adopt PHR technology at this point is the right approach given the limited adoption rates. "I’m not saying that having a dimension of meaningful use that includes engaging patients and families is a mistake. I think that is correct," he says. The language should be altered to include "patient portals, PHRs, or some other means of sharing data securely with patient and families," he says.

Do you think the HIT Policy is being too aggressive including CPOE and PHRs in the 2011 goals? Do you think the timeline for other functions and objectives should be altered? These recommendations are just a first draft and you still have time weigh in. Comments are due by June 26, 2009, and should be no more than 2,000 words in length.

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Carrie Vaughan is a senior editor with HealthLeaders magazine. She can be reached at

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