Mary P. Griskewicz

Selecting Software to Meet Meaningful Use

Considering the implications going forward, one of the most critical decisions a healthcare organization will make is the selection of a software system to drive its administrative and clinical functions. Long before installation, however, the real work begins. (See related story "Tapping Into Available Resources" at the end of this article.)

Mary P. Griskewicz, MS, FHIMSS, senior director of Ambulatory Health Information Systems for the Healthcare Information & Management Systems Society (HIMSS), said two of the biggest mistakes providers and administrators make are underestimating the effort required to select a system and not understanding that health information technology is truly part of the business plan. Edna Boone, MA, CPHIMS, senior director of Healthcare Information Systems with HIMSS, added another key mistake is not bringing the full care team into the process from the very beginning.

Boone defined the team as not just physicians and nurses but unit secretaries and those in ancillary departments ... everyone on the front lines. "Often, they are brought in a little too late. They should be at the table from the very beginning," Boone said. She added that without these voices, a hospital or practice is apt to leave out critical components of the workflow process and wind up with a system that doesn't live up to its full functionality.

Griskewicz stressed that HITECH's push toward the electronic health record (EHR) and subsequent emphasis on meaningful use represents an opportunity for providers to really look at the way they practice medicine and to re-engineer their workflow "from soup to nuts."

Boone, who focuses her expertise in the hospital arena, noted much of the process for selection and implementation is the same whether it's a private practice or large hospital system. She said it's important along the way to pay attention to the people, process and technology. "The goal of meaningful use is really to transform healthcare. When you say 'transform,' it's going to involve change management at all levels of an organization," Boone pointed out.

Griskewicz echoed her colleague's sentiment, "This is not about a technology implementation. This is an opportunity to improve workflow and to improve patient quality and care. This is about change management."

With great opportunity, however, comes the great need for due diligence. Griskewicz said that when there is a failure of system, the reason for that failure is typically two-fold — not understanding that the project transcends technology and not putting enough resources toward the project.

The first step is to conduct a thorough needs assessment. Griskewicz called this step "critical" and said without it, the vendor's agenda ... not the provider's ... would take center stage. Once a system is selected, she said it was essential that staff training be an important component. "Make sure when you're working with the vendor that you're going to get very comprehensive training built into the contract. It's not something you just do at installation, and then the vendor goes away, and you go live. Training is a constant."

To trouble shoot, Griskewicz suggested a practice should designate power users who participate in vendor-user groups to communicate challenges, problems and opportunities. She also noted that if there is a glitch in the certified EHR software, most good and reliable vendors have a reporting process in place for managing problems and issues. Certified EHR vendors are also responsible for reporting software problems to the Authorized Certifying Testing Bodies (ACTB's), which in turn can report the issue to CMS. It's also wise to find out if the vendor has an active user group ... or 'Ask the Expert' program ... and to make sure the service part of the contract is sound. It's vital to make sure the vendor doesn't just install the system and then disappear.

There are many good vendors across the nation. A legitimate vendor should always provide one or two references. Griskewicz counseled it is wise to go onsite to see the product in action. She also said a practice should verify the EHR product and/or module are certified. On the long checklist, she added, "Make sure electronic health record vendors will be compatible with your patient accounting system and will also be ready for the ICD10 conversion coming Oct. 1, 2013."

Although the process of selecting the right HIT system is similar, a hospital typically has a broader scope of needs than a private practice. Boone said it's most important for hospitals to have, at the baseline, a system that is flexible, secure, has the ability to manage structured data and to track and report.

Since most every hospital has some type of system already in place, she said the first steps would be to assess the effectiveness of the current system and to verify that the system and specific version has been certified. For some hospitals, the right decision will be to customize the system, which may require the hospital facility to certify its 'self-developed' system through one of the established testing bodies.

Boone said it's important to look to stages 2 and 3 of meaningful use while planning for the first stage. The expectation is that several menu set options in stage 1 will become part of the core set in later phases. 'Must have' functionality includes a patient education module, a clinical data repository with a robust reporting module, medication management capabilities, a CPOE module, clinical decision support (also known as rules engines), and the ability to share data across your own organization and with outside systems and health exchanges.

The good news, Boone continued, is that HIMSS analytics has seen the maturity levels of EHR adoption increase each year. "We have about 51 percent of hospitals that are very close to meeting stage 1 criteria," she said. However, the flip side is that 49 percent are still struggling to get there. "If you know you're in that 51 percent, keep doing what you're doing. If not, then you need to look at where in the process you are."

Boone did note that hospitals have a slightly longer window of opportunity to receive incentives than practices. "Their returns decrease in 2014 so that's really still plenty of time for most hospitals to receive the full incentive," she said.

Although change is rarely easy, Boone said most providers and administrators come to truly appreciate the expanded capabilities that come with automation and technology. "Ask anyone six months after they have installed, 'would you go back?' Almost unanimously, they say, 'no.' Once they're accustomed to the richness of data available to them, they don't want to give that up," Boone observed.

Griskewicz said the transition is easier when you keep the big picture objectives in mind and view technology as a means to achieve those objectives. "It's not about HIT or EHR, it's about improving the quality and safety of care. HIT is just a tool to get there."

Related story

Tapping Into Available Resources

As the healthcare industry navigates the digital workplace, industry associations have stepped up to provide numerous resources to demystify meaningful use and help providers learn to embrace the possibilities of HIT. Below are just a few online and in person tools to help with the process.

Healthcare Information & Management Systems Society (HIMSS)

HIMSS Summit of the Southeast, Nashville, Oct. 11-12, 2010: www.summitofthesoutheast.org. HIMSS Virtual Conference & Expo, Nov. 3-4, 2010: www.himssvirtual.org. RFP Sample Documents to assist healthcare organizations in developing a structured approach for the various criteria relevant to their own RFP process: www.himss.org/ASP/topics_FocusDynamic.asp?faid=262. Online Buyer's Guide with a comprehensive list of technology providers. Although HIMSS does not endorse any specific company, the list is comprised of members and companies that have contracted with HIMSS or exhibited at the organization's conferences: http://onlinebuyersguide.himss.org. Meaningful Use Certification Criteria & Standards: www.himss.org/EconomicStimulus. Meaningful Use Final Rules Webinar Series On Demand: www.himss.org/EconomicStimulus/mu_webinars.asp.

American Medical Association (AMA) & Medical Group Management Association (MGMA) Toolkit

To assist physicians in selecting the most appropriate software to run their practices, the AMA and MGMA have developed an online resource, which is free to their members. The "Selecting a Practice Management System" toolkit provides practices with a five-step guide to PMS software selection, a comprehensive checklist of PMS software features and functionalities that physician practices can use to determine what their practice needs, and a sample "request for proposal" that physician practices can employ in their communications with PMS software vendors. By the end of the year, an online directory of PMS software vendors that includes self-reported PMS software features and functionalities will be added to the toolkit. Additional EHR and meaningful use information also is available at: www.mgma.com/ehr and at www.ama-assn.org in the "Solutions for Managing Your Practice" section under "Physician Resources."

American Hospital Association

Implications of "Meaningful Use" with Executive Perspectives from Sentara Healthcare webinar: www.aha-solutions.org/aha-solutions_app/index.jsp. Series of AHA HIT advocacy issue papers: http://www.aha.org/aha/issues/HIT/100226-hit-meaningful.html.

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