MU Roadmap: Choices, Mandates, and Decisions in the Age of Meaningful Use

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
 - Roadmap

Detours notwithstanding, radiology is making slow progress toward the demonstration of meaningful use of health IT

The 2014 technology-acquisition roadmap looks a lot like the map from last year, which is to say that it resembles a bare-bones diagram that often fails to show road closures and detours. Many radiology directors in hospitals and private practices have nonetheless navigated the IT/workflow roadblocks, realizing that many of the hurdles have come courtesy of meaningful use. 

For some, the largely perfunctory collection of data for stage 1 of meaningful use has been anything but business as usual, with many radiologists contending that because they never did it in the past, they do not see the logic behind doing it now. Safwan Halabi, MD, director of imaging informatics at Henry Ford Health System (Detroit, Michigan), admits that this attitude initially caused some anxiety stemming from a disagreement as to whether radiologists should attest to stage 1 of meaningful use. 

Preload: Preview
  • The federal meaningful-use program is driving IT acquisition in hospitals and radiology practices.
  • Costs go beyond the price paid for technology: People, processes, and systems are important factors.
  • Interoperability is the filter through which early adopters are vetting investments; deciding which partners to attest for is a key practice decision.
  • Relatively low participation of radiologists, to date, could be attributable to a lack of technology support from their hospitals.

Radiology and health-system administrators at Henry Ford Health System are finalizing the decision for radiologists’ attestation to stage 1 of meaningful use. The plan is to come to a decision by the end of the first quarter of 2014. “It takes 90 days to attest, so we must get on that—because the monies are dwindling for the incentives,” Halabi says. “Pretty soon, the meaningful-use incentive transitions to meaningful-use penalties, beginning in 2015 and 2016. That is why it is becoming more urgent for radiologists to attest to stage 1 of meaningful use.” 

From a raw-technology standpoint, Halabi and his staff members encountered many challenges in their efforts to prepare four hospitals and more than 20 satellite sites for meaningful use. Henry Ford Health System had flourished with a homegrown electronic health record (EHR) for decades, and it served the health system well. As the Health Information Technology for Economic and Clinical Health Act and other legislative actions standardized the EHR for meaningful use, however, the homegrown system needed to be overhauled or enhanced.

“They were going to put modules on top of the homegrown system to be able to certify the EHR and attest to stage 1 of meaningful use,” Halabi recalls. “After some struggles with that, the health system decided to adopt an EHR system that was certified for meaningful use and vetted at other large health-care institutions. Ultimately, the health system opted to forgo further development of the homegrown EHR due to the uncertainty of certifying the system for stage 1 of meaningful use.” 

Henry Ford Health System’s detour on the technology-acquisition road was not inexpensive. Millions of dollars were initially spent on refreshing the storage and server infrastructure of the homegrown EHR and on retrofitting it with modules intended to let it attain meaningful-use certification. 

As that activity proceeded, it became evident that there were still numerous holes to fill before the homegrown system could be certified. This endeavor became insupportable, and the health system decided to replace its EHR with a certified commercial system—at a cost of approximately $350 million. This figure includes additional full-time employees, the necessary operating capital, and training time. 

Denominator Reduction

The occasionally painful transition led to standardization across the health system, and Halabi believes that this will eventually put the system in good stead to collect incentives, avoid penalties, and comply with future meaningful-use requirements for the good of patients. Issues involving appropriate EHR compatibility and technology proved less troublesome at Imaging Healthcare Specialists (IHS), San Diego, California. Jon M. Robins, MD, chair and CEO, oversees an operation with 28 radiologists in San Diego County and South Riverside County. He reports that the 11-location private practice added an integrated meaningful-use module to its existing RIS/PACS. 

The challenge,