Joseph G Seay, Former SVP & CIO, Community Health Systems
After Stage Two, What Next?
Congratulations! You have survived 18 to 24 months of medical staff upheaval, hundreds of thousands or millions dollars investment for software, hardware, content, training, “change management” and a hit to operating performance from lost productivity, medical staff anxiety and a host of other headaches. The American Reinvestment and Recovery Act sponsored forced modernization of health care delivery is a thinhg of the past.. 2015 may have been a welcome respite from the change. A chance to catch a breath, restore confidences, heal broken workflows and take stock of the new, tech enabled landscape of post Meaningful Use Stages One and Two health care deliveries.
“It is time for medical staff to embrace and support clinical operating improvement”
So now what? The Office of Management and Budget said that Meaningful Use compliance would be a poor investment for compliant providers, as no significant Return on Investment would result from achievement of program goals. Compromises with Medical Staff to build adoption may have diluted any quality or cost value that could accrue from tool enabled practice improvement and discipline. Expectations of improved outcomes, “value based” compensation practice compliance, support for compensation bundling (which increases operating risk/pressure to deliver end-to-end care for a single price) pose as great challenges as it cannot be provided without some tool and metric based support.
Maybe some compromises have to be made to build medical staff adoption. Order and charting content continues to be based on current, local medical practices. Individual physician preferences were supported to make acceptance easier. Messaging for clinical alerts was reduced to absolute minimum to eliminate “alert fatigue”. Case Mix indexes may be slipping as complex ICD-10 coding requirements are supported by relaxed charting requirements. Pharmaceutical costs remain at pre order entry tool level as physicians continue personal medication preferences, using expensive brand names, instead of equally effective generic alternatives. Physician productivity may have recovered, but at the cost of adding clinical scribes to a stretched payroll.
Now, comes ongoing costs and management challenges of maintaining Computerized Physician Order Entry and Charting tools, evidenced-based clinical content and demonstrations of interoperability for Stage Three!
So what to do? Hospital and Practice leadership must have a serious discussion with Medical Staff leadership, and, ultimately, with Medical Staff about embracing change. What are the evidenced based best practices for each clinical specialty? What bodies are definitive, objective “gold standard” source of sound, current practice? How much does local practice vary from these standards? How much “diversity” has been introduced by individual physicians as personal preferences or broadened clinical content?