Healthcare // Electronic Health Records
Commentary
5/27/2014
11:25 AM
David F Carr
David F Carr
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Meaningful Use Deadlines Clash With Software Best Practices

Hospitals find themselves implementing new releases of EHR software, certified to 2014 standards, almost as soon as vendors release certified versions. That's almost like implementing Windows 8 immediately after release.

participating in the Meaningful Use program find themselves on and how different that is from how an enterprise normally deploys technology.

"We got our 2014 certified software, but we've also gotten five major patch fix updates since that was originally released," he told me a few weeks ago. With each of those releases, his staff has to go through a cycle of testing, so "we're busy constantly doing that."

Many of the patches from Meditech, St. Claire's EHR vendor, were also driven by regulatory requirements -- even after securing certification, Meditech continued to get feedback that the way its developers had implemented certain requirements didn't match the regulators' intent, forcing further revisions, McCleese said.

Most CIOs have something close to a hard-and-fast rule against being the first to deploy a new version of any piece of software -- better to let someone else go first and be the one to find all the bugs. If they install new software at all, most prefer to do so first in a test environment where they can debug the back-end interfaces and allow their early adopters to experiment with the user interface so they can help with the rollout and training when the time comes. That's why so many organizations always seem to be running the last version of Windows, or SharePoint, or most any on-premises installed software you can name.

Of course, this is one of the arguments in favor of cloud software in which the vendor takes turnkey responsibility for the back end, and all users can be kept up to speed on the latest and greatest front-end features. That's a great argument in favor of using cloud software for something like enterprise social networking, where user expectations are shaped by the latest features added by Facebook. However, although cloud EHR software is gaining popularity among medical practices, it has yet to make a dent in the hospital market. Given that errors in medical records data can lead to life-and-death consequences, the conservatism of hospital IT leaders is understandable. But the architects of the Meaningful Use program, in their impatience for change, have tended to force a cloud-like implementation schedule on an industry that's not ready for the cloud -- at least not for core EHR functions.

Hospitals found themselves implementing new releases of software, certified to the 2014 standards, almost as soon as the vendors released the certified versions. That's almost like implementing Windows 8 immediately after it was released.

As the CIO of a midsized Kentucky hospital, McCleese would have been unlikely to rush a new release of an EHR into production and endure the flurry of patches that followed, if not for the looming Meaningful Use deadlines. In contrast, St. Claire is likely to adopt a Web-based practice management product that Meditech plans to release in 2015 "but we've already said it will be at least 2017 before we install that," he told me. "With the regulatory requirements, we don't have a choice."

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, our latest digital issue.

David F. Carr oversees InformationWeek's coverage of government and healthcare IT. He previously led coverage of social business and education technologies and continues to contribute in those areas. He is the editor of Social Collaboration for Dummies (Wiley, Oct. 2013) and ... View Full Bio
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SteveRobbin
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SteveRobbin,
User Rank: Apprentice
6/10/2014 | 9:19:24 PM
Personal experience
I am working as an EHR consultant with an EHR Vendor Nortec Software Inc. I completely agree with the author because i know personally that how much problems are going to be arrive due to this clash. Because the most imprtant factor is also the most time gainning,training. Tranning of human resource to use the software properly.
batye
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batye,
User Rank: Ninja
6/2/2014 | 2:47:09 AM
Re: John Halamka on Meaningful Use Extension, need for further simplification
thanks for a link, interesting to know... 
David F. Carr
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David F. Carr,
User Rank: Author
5/29/2014 | 11:09:42 AM
John Halamka on Meaningful Use Extension, need for further simplification
Noted health IT CIO John Halamka has posted his analysis of the schedule change and the reaction from his peers here:

http://geekdoctor.blogspot.com/2014/05/early-reaction-to-electronic-health.html

Key observation: "layering fixes on top of existing Meaningful Use regulation, some of which was written by CMS and some of which was written by ONC creates too much complexity.   I have direct access to the authors of the regulations and email them on a daily basis.   It's getting to the point that even the authors cannot answer questions about the regulations because there are too many layers."
fpoggio600
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fpoggio600,
User Rank: Apprentice
5/28/2014 | 9:22:27 PM
MU Deadlines and buggy software
I have two observations:

1) It makes absolutely no difference whether you deploy software on the cloud or turnkey. If your product is buggy on a turnkey deployment you nick only one client. On a cloud you nick all clients. Buggy apps know no difference in platform.

2) The certification proces (of which I have been through over 30) is constantly watching for buggy software and unstable product. If the tester sees this happen more than once they can 'flunk' you immediately. So if you make it thru the certificatin process your code must be stable. If after you deliver it, it is not stable then you must have made additional revisions after certification that can't be blamed on the certification process.

Frank Poggio

The Kelzon Group

KelzonGroup.com
ThemosPentakalos
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ThemosPentakalos,
User Rank: Apprentice
5/28/2014 | 7:17:43 PM
Re: Regarding the recent proposed changes
David, we have to go by the numbers already posted. As of  May 1'st, CMS published that only 4 hospitals and 50 providers had attested for stage 2. It's still early but those numbers paint a bleak picture.

Let's see how this all plays out!

-Themos
David F. Carr
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David F. Carr,
User Rank: Author
5/28/2014 | 6:19:30 PM
Re: Regarding the recent proposed changes
So how close to the breaking point do you think most healthcare organizations are?
ThemosPentakalos
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ThemosPentakalos,
User Rank: Apprentice
5/28/2014 | 5:50:55 PM
Regarding the recent proposed changes
At ChiroTouch, we have been working on implementing the new 2014 requirements for stage 1 and stage 2 for 8 months and were, in fact, one of very few software companies to get certified in time. To our knowledge, roughly 10% of software vendors are certified thus-far and there are only a few weeks left before the July 1 deadline.

Whether there is a delay or not, this engineering effort had to happen. If we knew of this delay earlier, we would have been postponing the scrambling to next year. Furthermore, the proposal calls for a 60-day review cycle so in a sense people that are attesting for the first time can't really wait. There is always the possibility that they wait and not start on time. If the proposal is declined, these doctors/hospitals would have to incur a penalty as they should, according to the rules, start operating under meaningful use measures no-later-than July 1. The government decision doesn't come out until the end of July.

The biggest risk for the government is that they wind up making this too complicated from an operational and technological perspective, at which point the whole stimulus program falls flat on its face. Clinical offices and hospitals run as businesses. At some point, the pain and cost of compliance outweighs the financial benefit and the program falls apart as a result of non-compliance.
David F. Carr
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David F. Carr,
User Rank: Author
5/28/2014 | 9:37:32 AM
Does enterprise health IT need to move faster?
Healthcare organizations are often rapped for being behind other industries in the use of IT, which is one reason the Meaningful Use program has often prescribed a faster pace. Is it appropriate to expect healthcare organizations to move faster? The Facebook mantra of "Go fast, break things" doesn't sound so great in the context of healthcare. Lagging on information security, as pointed to in our story comparing healthcare to retail, but whether rushing new features into production helps or hurts patient safety / healthcare quality is debatable.
Alison_Diana
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Alison_Diana,
User Rank: Author
5/28/2014 | 9:32:37 AM
Over Reach
While the goals are laudable and hindsight's always simple, I'd imagine CMS now wishes it had created a less ambitious, much more manageable set of schedules for this complex series of rollouts. One thing that struck me over and over is wondering who was involved in recommending these timelines from an IT perspective, what experience did they have in HIT, and how much weight was their insight given into the development of these schedules. From the get-go, it was apparent healthcare providers wouldn't have adequate time for testing; as a result, they'll have expensive fixes (perhaps as costly as ripping and replacing EHRs, which we're seeing already).

However, if the government had not stepped in I sincerely doubt most healthcare orgs would have adopted EHRs. We must be careful about how and who accesses 'deidentified' and 'anonymized' data -- and ensure it truly meets those classifications -- but providing patients with access to their own records is certainly a big step forward in a market that was well behind most, if not all, other verticals in basic IT adoption.
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