Published: 5-17-10

The Hard and the Soft of Meaningful Use

In 2008, the KLAS report on Labor and Delivery indicated that 20% of OB units are considering replacement of their L&D EMR, [Electronic Medical Record], systems, 43% of study participants said that their system lacked basic ADT interfaces. Overall, 93% of L&D units were satisfied with the central fetal monitoring systems they had in place at that time.

There are still hospitals and birth centers that have no central fetal monitoring system in place today, in 2010.

Administrators that look at the sizable costs of new IT on Maternal Care Units, may lack reliable yardsticks to measure the true cost of maintaining outdated systems. End users, on the clinical front lines, have to be involved with purchase descisions for institutions to make smart choices about Health IT.

Potential financial incentives from the ARRA, (American Recovery and Reinvestment Act), are being tied to "meaningful use" of Information Technology. The new descriptor of "meaningful use" refers to IT employed to improve the quality and accessability of healthcare on a national scale.

“We recommend that the ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system. The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities. This "north star" must guide our key policy objectives… use of information technology that will enable the desired outcomes, and our ability to monitor them. …key information generated in the delivery of care (vital signs, problem lists, medications, procedures, lab tests) must be digitized and queriable. We recognize that changing products and changing workflows will be an evolving process, but providing a clear roadmap of the future …linked to achieving measurable outcomes in patient engagement, care coordination, and population health.“

The "meta" process of deciding what "meaningful" means, begins to dilute practical application to clinical situations when it becomes semantic jargon that sidetracks progress with debate. The government continues to evolve the legal definition of Meaningful Use into a measurable set of criteria on which to base monetary compensation. Clinicians must continue to define what works in terms of most efficient delivery of care.

Many OB EMR, (Electronic Medical Record), systems now in place, particularly before HIPPA and NICHD guidelines, do not meet the criteria for meaningful use.

CPOE, (Computerized Physician Order Entry), is a new star on the HIT horizon. Hospital administrators are confident that there will be a return on their investment in CPOE. Evidence based research shows that transcription errors are a primary source of medication errors. CPOE can reduce these errors, and improve patient outcomes.

In clinical areas such as Labor&Delivery, Emergency Departments, and Operating Rooms, verbal orders are frquently given on the fly while physicians are occupied delivering a baby, running a code, or scrubbed in on a case. Physicians can not always physically write orders down, much less sit at a computer, during emergent procedures.

Emergent situations can make CPOE cumbersome to implement. If a nurse is forced to write an order down as TORB, (Telephone Order Read Back), to expediate patient care, while the physician is engaged in a procedure, a "reality gap" in documentation is created. A question could arise later about the whereabouts of the physician, or the ethics of the nurse involved.

With payouts starting in 2011, the pressure is on to get CPOE operational. Some IT Solution vendors now offer guarantees for a piece of the financial stimulus pie.

All vendors do not deliver peaches with cream. Software and Hardware problems have plagued ambitious Maternity EMR systems in the past. On occasion OB units have been left without tech support for outdated fetal monitoring systems, or bought into new features on fetal monitors that led to faulty data collection. When it comes to Hardware and Software installations, like with any remodel, there is always potential for a bad contractor experience.

Access to EMRs varies in different clinical settings, and often depends on how well integrated different electronic charting systems are with each other. Good interfaces improve access to information. On an OB unit, immediate access to pregnancy risk factors, blood type and GBS culture results, et cetera, all impact the Obstetrical plan of care, and often dictate the appropriateness of Newborn care.

In his October 2009 address on Health IT, Samuel J. Palmisano, IBM CEO, compared Healthcare to other industries that have adopted uniform IT protocols:

“Fewer than one in ten American hospitals have implemented any kind of electronic patient record system. And more than 20 percent of lab tests are repeated unnecessarily, because patients' medical records are not available at the point of care. This isn't just a colossal waste of time and money. It also introduces inconsistencies in quality and multiple opportunities for error… If the healthcare system were a patient, and we were its doctors, we would be unable to read its vital signs.”