Meaningful use is not just another IT project – it has the potential to be a significant driver of organizational change, one in which healthcare executives play a major role.
When healthcare leaders hear the term, "meaningfuluse," it is typically looked at as an IT project that the CIO is responsible for managing to successful closure. However, meaningful use is also one of the greatest steps towards changing the culture of a healthcare organization and the precursor to larger policy issues under the Patient Protection Affordable Care Act – facts that tend to be downplayed by executives. Meaningful use is not just another IT project – it has the potential to be a significant driver of organizational change, one in which healthcare executives play a major role.
When terms like "pay for performance" or "quality initiatives" first hit the industry, hospital administrators and practicing physicians were constantly at odds over the validity of the data produced. Furthermore, that data was billing data. It was not clinical in nature, nor was it arranged in a fashion that clinicians could use for clinical improvement. Physicians did not interact directly with computerized systems but through intermediaries — usually nurses or administrative clerks — further defeating the purpose of computerized systems supporting clinical care. In effect, the finance department drove health systems, not the physicians who were responsible for the administration of care.
This situation created incredible internal stress for healthcare organizations, leading to the formation of the federal government's Office of the National Coordinator for Health Information Technology (more commonly known as ONCHIT or ONC). Its first appointee was a physician, continuing the tradition of physician leadership — knowing that physicians need to be the drivers of change in the healthcare sphere when it comes to patient care.
During the 1990s and early 2000s, computerized physician order entry typically resided under CIO leadership. Expensive and lengthy implementations suffered a failure rate of more than 90 percent. Physicians, and even employed practitioners, did not buy into the disruption it created in their clinical lives. In some cases, they even boycotted the institution where CPOE was mandated.
A major change in physician approach was needed. As a result, the meaningful use program was created. In many ways, meaningful use poses greater challenges to health organizations than any other initiative or requirement facing healthcare today. It fundamentally changes the way physicians interact with patients, staff and even each other.
This change needed to come about incrementally and as a result meaningful use was delineated into three stages:
Stage 1 — initiated in 2009 — Meaningful use stage I was a commitment, one that held some risk but overall was a reasonable and obtainable goal. Through the introduction of technology, physicians had to demonstrate a minimum level of commitment — to record clinically important information and then attest online that the system was utilized as stated. To use an analogy, for many it was like landing on the beach of a foreign, yet intriguing land, with minimal capital and resource investment. If you didn't like the adventure, you could always return to the prior state of affairs.
Stage 2— Initiated in mid-2012 — This stage demands a much higher commitment to technology in the application of care. In some cases, it requires clinicians to demonstrate that more than 80 percent of their clinical interactions (patients) are on computerized systems; a significant jump from 50 percent with stage 1. Stage 2 is looking for a demonstrated commitment to the use of healthcare IT that predicates a significant cultural change in organizations. With its much higher level of commitment, stage 2 typically requires organizational restructuring. For example, new high-level positions like chief medical information officers are appearing in healthcare organizations and report to the chief medical officer, with dotted lines to the CIO. The cultural transformation is now underway.
It is important to note that the driving thrust of stage 2 is not only culture change, but an entrée into the areas of interoperability and quality analytics. Clinician participation and technological expansion propel this change by offering Health Information Exchanges and patient portals. At this stage, the organization truly becomes transparent as patients gain access to pertinent information surrounding their care. In addition, the added dimension of clinical quality now brings to the forefront measurements that previously were not part of the reimbursement cycle. The financial implications are significant with traditional reimbursement patterns shifting dramatically from inpatient to community health.
With the introduction of stage 2, meaningful use becomes a "disruptive technology" and the result is an organization that either adapts and thrives or succumbs. At this stage, as a healthcare executive, you begin to realize that "you can't go back." You'll need to make this culture change successful or your organization will not survive. Meaningful use is not an IT project; it is an organizational initiative that will change your basic business model. Similar to organizational behavior programs (e.g., Studer or Baldwin), Meaningful use will require capital and operating investments to change the way your organization operates. It may change your revenue and reimbursement streams as "quality" becomes a factor in determining reimbursement. As you become part of health exchanges, it may drive your organization into becoming part of an ACO, sharing risk in a community care model where compliance may mean a downturn in inpatient revenues.
So what is the role of the healthcare executive in meaningful use? Executives need to understand the impact of this program on their organizations. What will be the ongoing training expenses to maintain the cultural changes that are initiated? How will IT security costs increase to maintain an easily accessible yet secure patient portal? What about the investment in technology and talent to develop quality analytics? What are the shared costs of a HIE that may not demonstrate a direct ROI but is required as part of this new model?
Meaningful use has plunged healthcare down a path with great promise at the end but many risks along the way. Healthcare executives will be crucial in this transformation, as their experience and ability to discern the best approaches and least disruptive/costly compromises become critical.
Nicholas Christiano is currently a regional healthcare leader at Tatum, a leading management and advisory services firm offering hands-on strategic, financial and technology solutions to improve business performance. Tatum is an operating company of Randstad.