The Meaningful Use “Gold Rush”

Published on Healthcare Innovation News

By Andy Nieto, health IT strategist, DataMotion

andyThe term “Gold Rush” is one that evokes visions of wealth and simultaneous despair. While there were individuals who succeeded in their quest for gold, the majority of people were lucky to break even as they followed alongside the thousands of others migrating west. An entire economy, supply chain and infrastructure were built around these prospectors. So what does this have to do with healthcare? The Gold Rush can also be used to describe the rush of vendors looking to “cash in” on meaningful use dollars.

Enter the HITECH Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides for the improvement of healthcare quality and efficiency through the promotion of healthcare IT. The HITECH Act measurement periods for hospitals and providers are referred to as Meaningful Use Stages (I, II, III) and each stage represents a more advanced integration of technology into the care setting. This seems like a logical approach, so why refer to it as a Gold Rush?

In 2008, prior to the HITECH Act, the average cost of an Electronic Health Records (EHR) system was around $2,500 per provider. In 2010, after the HITECH Act was enacted, that average had risen to $37,000. The legislation’s reimbursement estimates were the driver for such a dramatic price increase, reaching approximately $44,000/provider. Not to mention, those costs only accounted for the EHR software. Hardware, networking, additional software and peripherals accounted for nearly $7,000/provider.

The second wave of the EHR Gold Rush is now upon us in the form of Meaningful Use stage II (MU2), which requires additional infrastructure and technology resources. This new health IT landscape brings with it new standards, new features and new functionality requirements. A swell of additional vendors have been drawn to these new requirements, as they seek their very own “Sutter’s Mill” (the first discovery of gold in 1848, which subsequently triggered the Gold Rush). So is the HITECH Act a boom or a bust choice?

Boom or Bust and the 4 Cs

All purchase decisions can be measured with the “4 Cs model.”  The Cs are Care, Cost, Compliance and Compatibility.

Care, the first “C,” is an evaluation of the role the purchase will play in delivering care to the patient. How will it be implemented? Is it patient-facing? How is it used to help the patient? Direct Secure Messaging (Direct) is a communication tool used in achieving MU2 requirements for transitions of care. Members of a care team can rely on it to communicate internally. Additionally, it can be used by the patient to communicate with the provider.

The art of delivering healthcare is often overlooked. All patients, in fact all people are unique. The way that each patient is cared for and the needs of each situation are often as unique. As a result, the versatility of a solution must be a consideration of care. Multiple solutions may offer one primary solution, such as the ability to send a Continuity of Care Document (CCD). It is the product’s ability to also send other components like images, labs, pictures and more, that can make a product more versatile than a competing product. Having the versatility to care for a patient’s unique needs supports a provider’s ability to deliver exceptional care.

Cost is the second “C.” All aspects of the cost of a product or service must be evaluated, including hardware, software, network infrastructure, peripherals, training and lost revenue during adoption. A team approach by users and support personnel is often necessary for this purchase decision to succeed, similar to the gold rush prospectors, who would have to determine a number of factors such as the required depth to dig, the necessary tools and more.
Like many of the prospectors who traveled west during the Gold Rush, numerous technology vendors have been short-lived and without true substance. The second key action to take to avoid the boom/bust scenario is to look at the business with which the practice or hospital is contracting. Simply purchasing by price is not a good solution. For example, a Direct Secure Messaging provider in the early stages of MU2 was winning business by being the cheapest. It was later discovered that he was operating from a cable modem in his apartment. Cheapest does not always mean better and rarely does it mean quality or sustainability.

The third “C” is Compliance. This is a large term and is not limited to government or regulatory compliance. It is important to verify that the purchase is compliant with your internal expectations and standards, the company has a comprehensive understanding and role in HIPAA, PCI, FDASIA, and that there are not social ramifications from the selection. In a recent meeting with a hospital executive, the topic of smoking was discussed. This particular hospital had a 100% tobacco-free policy which included their staff. No one who worked there could use tobacco. Would they purchase from a company who was funded by or supported tobacco use? This is an internal compliance standard.

The final “C” is Compatibility. The argument could be made that this is the most important one. Evaluating the functionality and usability of a product in relation to the goals and the users is an important step. One early EHR was a series of “text blocks” and the provider would type in all of the data. The creator claimed it was the most versatile EHR on the market. But the provider would have to be a skilled typist. Would this EHR be the best fit for a poor typing provider?

Compatibility is both objectively and subjectively measured. Does the product or service address the original goal? Is it easy to use? Are there additional features or uses which the evaluators can envision?  Is it easy to learn? This checklist must include user feedback from evaluation. Does this product help achieve the mission and vision of the practice or hospital?

Healthcare is in the midst of the most radical and impressive industry evolution in history. It is easy to get caught up in the waves of excitement of this gold rush.  The shortened timeframes for decision making combined with heavy handed marketing and sales tactics have pressured many decision makers into unwise decisions and unsatisfactory purchase outcomes. Taking the time to pause and evaluate using the “4 Cs” can lead to the boom and avoid the BUST!

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