Look, if you had one shot, or one opportunity
To seize everything you ever wanted in one moment
Would you capture it or just let it slip? – “Lose Yourself” by Eminem.
OK, I’m not really into song lyrics and I’m certainly not a huge Eminem fan but the lyrics are relevant to today’s blog. Yesterday I gave a little background on Meaningful Use (MU) and why achieving MU is important from not only a financial perspective but also the perspective of patient safety and outcomes.
There is a trick to being successful with MU and to this point I’ve heard very little talk about it. The only way to successfully implement and achieve MU is through physician partnership and engagement and we, hospitals, only have one shot to do it right – so we’d, and every other hospital, better not screw it up.
There are billions of dollars of incentive pay on the line for those who achieve MU and payment reductions for those who do not. Beyond payment, MU may be the single most important thing hospitals across the country can do to improve patient safety and outcomes.
The only way, and I mean the only way, a hospital will be successful is by partnering with physicians who will use the system and engaging them in the process.
Physicians will face the biggest changes in practice with MU. Most physician documentation is paper but paper will soon go away and be replaced by an electronic order method. CPOE (Computerized Provider Order Entry) is the electronic version and every written physician order will be replaced with the tap of a key or click of a mouse.
Along with new electronic processes, patient care processes will need to change as well. New policies and new operating processes will need to be created. Processes to establish best practice, monitor performance, intervene and improve need to be discovered and implemented.
No physician wants to view him or herself as a typist or data entry clerk but the requirements of MU and the need for structured, coded, data will create an environment in which electronic data entry is the only possible option.
MU is divided by stages and stage 1 requires 30% of all medication orders to be done electronically and most hospitals will be able to meet the requirement but stage 1 is just the beginning. Eventually every inpatient order written by every physician will need to be electronic.
As this process moves forward physicians are going to ask three questions that we must respond to:
1) Is this making it easier for me to do a good job on behalf of my patients?
2) Is the added time expected of me worth the value?
3) Can I practice elsewhere with less hassle, better outcomes?
Answering these questions and our approach to partnering with physicians to achieve MU is crucial. Patient safety expectations and consequences are ratcheting up because of MU and the first thing we have to do is help physicians understand how the electronic health record (EHR) will assist them in helping their patients achieve better outcomes.
We will have to convince physicians that when the system is up and running they will need to adopt it and not use a “hybrid” paper and electronic chart. If an electronic chart helps provide the “safest” care then it can’t be optional for anyone. If the electronic chart is not safer, then we’ve failed.
Here it is, everything hospitals must do for their one shot to get physician buy in: Physicians and IT staff must communicate openly and be joined at the hip. Physicians must be included in all decisions about their EHR supported work. Physicians must understand how to utilize tools in the EHR designed to make tasks easy and they must help to formulate the vision of how the system will positively influence their work.
The physicians must be supported and they must be provided training. Classroom training will be a part of the mix but classroom training alone will not be enough. Hospitals must commit to providing assistance “at the elbow”. Expert help must be available to the physician 24 hours a day 7 days a week during rollout. Coaching must be provided on a regular basis and the system must be up and available 24 x 7 and response time to problems must be superb.
If all of the above are not met, then we miss our one shot to provide our patients the safest possible environment.