Most Wired

'No Physician Left Behind'

By Douglas Page

It's an IT priority for hospitals

Integrating clinical information technology with physician workflow is a major mile marker on the road to meaningful use compliance under the Health Information Technology for Economic and Clinical Health Act, commonly known as HITECH.

The process is becoming easier as physician attitudes toward clinical IT evolve.

"There's been a sea change during the last year and a half, as physicians have come to accept that this is just the way that medicine is going to be practiced going forward," says Philip Loftus, vice president of information technology and chief information officer at Aurora Health Care in Milwaukee. Aurora is among hospital leaders in physician-clinical IT integration.

Getting physician buy-in on clinical IT projects is often a matter of choosing the right project leaders. "To get clinical acceptance, you have to have clinical leadership," Loftus says.

Aurora's HITECH projects are led by a troika of C-level executives—chief medical officer, chief nursing officer and chief administrative officer. The CMO is important because things like computerized provider order entry change the way physicians practice medicine. Likewise for nurses, who use clinical IT systems the most.

"When you get the CMO, CNO and CAO as active champions, it's much easier to drive these projects," Loftus says.

HITECH, however, should not be the sole driver of implementation strategies. "Our strategy is driven by delivering fully integrated care across the care continuum," Loftus says. HITECH merely provides the incentive dollars that accelerate the process.

Gary Kalkut, M.D., senior vice president and chief medical officer at Montefiore Medical Center in New York, says it's important to involve physicians at all levels, from steering committees that decide the order of rollout to work groups fine-tuning documentation templates. "Use experienced staff who can bring best practices that you may have overlooked," he says. "Don't just automate the current workflow."

During the rollout, expect that physicians' productivity will be affected for a couple of weeks. Be sensitive to busy seasons, which vary by specialty. "Then, ask for feedback from clinicians, and listen," Kalkut says.

Jim Jirjis, M.D., chief medical information officer at Vanderbilt Medical Center in Nashville, Tenn., says it's important to concentrate on why you are implementing HITECH technologies. "If you're focused on quality of care, meaningful use will be a great accelerator," he says.

Relaxing the Rules

The government also has attempted to smooth the road to physician-clinical IT integration. Under certain conditions, Stark law relaxations provide hospitals a way to subsidize physician HIT practices. Hospitals may choose to donate or subsidize technology for electronic health records for physicians to expedite EHR adoption. Types and amounts of assistance depend in part on whether the hospital employs the clinician.

Hospitals have less flexibility subsidizing independent physicians. The parties will most likely be limited to structuring any EHR assistance to comply with the Stark law exception and anti-kickback safe harbor that are specifically directed to donations of EHR technologies.

"Hardware is generally excluded from EHR exceptions, plus the recipient of donated technology must pay 15 percent of the donor costs of technology and training prior to receiving these items and services," says Nashville health law attorney Claire Miley, of Bass Berry & Sims.

Montefiore offers to link independent physician offices to the hospital EHR system. "For those that do not have an EHR, we prescreened vendor products that integrate with our systems," Kalkut says.

Miley cautions that Stark law exceptions generally expire at the end of 2013.

The relaxation of some rules may remove obstacles to integration, but the time frames for adoptions have not changed. "Hospitals that do not adopt and show meaningful use of certified EHR technology will face reduced Medicare payments beginning in 2015," Miley says.

Moreover, standards for achieving meaningful use are lower in Stage 1 of HITECH's incentive payment structure, letting hospitals ramp up in a more orderly fashion. Meaningful use becomes more stringent in Stages II and III. "Hospitals that wait until later years to adopt and show meaningful use will face steeper learning curves and greater costs," Miley says.

Douglas Page is a writer in Pine Mountain, Calif.

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