EHR Implementation is Slow around the Country

by webadmin on January 28, 2013

In talking with numerous healthcare executives each month, HCE is able to get a pretty good idea of how the average organization is adapting to EHR and why 47 percent of hospital executives are uncertain as to whether their organization can reach Meaningful Use stage 2.

Simply put, it’s a process that often moves slower than executives want and is more cumbersome than they originally expected. EHR implementation also involves an overhaul of the entire hospital network that is difficult to thoroughly plan in advance.

An article by Ken Terry at InformationWeek confirms our anecdotal findings. Terry reports, “A survey by HIMSS Analytics, the research arm of the Health Information Management and Systems Society, indicates that during the five quarters ended in September 2012, the number of U.S. acute-care hospitals achieving EMRAM stage 5 or 6 increased by more than 80 percent; the number of facilities in stage 7 rose 63 percent.”

The reason advanced EHR use is increasing has to with the federal government’s EHR incentive program, he writes, but don’t let these increases deceive you. When the numbers are broken down into actual hospitals that are in these advanced stages, the percentages are pretty low.

According to Terry, “In the fourth quarter of 2012, HIMSS Analytics figures show, just 1.9 percent of hospitals had reached stage 7; 8.2 percent, stage 6, and 14 percent, stage 5. Three-quarters of the hospitals were not yet in stage 5.”

It’s important to note that there is no connection in the incentive program between EMRAM stages and Meaningful Use stages. However, Terry wonders if hospitals are really able to meet Meaningful Use stage 2 if they’re struggling to journey through the EMRAM stages.

However, it is also important to emphasize that stages 5 through 7 are advanced. When a hospital is at stage 4, they have CPOE and clinical-decision support, “both of which are required in Meaningful Use stages 1 and 2,” Terry writes, adding that these organizations also “have nursing documentation, error checking, and other capabilities.”

What they don’t have is stage 5’s closed-loop medication administration, stage 6’s physician documentation and full clinical decision support, and stage 7’s “ability to exchange standardized summary documents with other providers… All of these are required in Meaningful Use stage 2 except for physician documentation, which is an optional menu item for eligible professionals,” Terry explains.

What’s the “biggest hurdle” in all of this? According to John Hoyt, executive VP of HIMSS Analytics, it’s “getting physicians to enter data on their keyboards. Of course, that’s required for stage 1 of Meaningful Use.”

Hoyt then delineated some solid reasons why progress in implementing advanced EHR is so cumbersome and slow, telling Terry, “It’s really difficult to implement these systems with voluntary medical staffs.”

He added that the expense and time it takes to implement these systems is also a factor. “It’s not just a matter of buying software, it’s about process redesign,” he said. “It takes leadership and access to capital. That’s clearly a problem, especially for small hospitals — not leadership, but access to capital.”

How is EHR implementation progressing with your organization? What lessons have you learned along the way? What hurdles have you overcome? How prepared are you for Meaningful Use stage 2? Where do you stand with HIMSS?

-by Pete Fernbaugh

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