While you might think a HIMSS Analytics Stage Six hospital sees the interim MU regulation as child’s play, think again. That’s because even though the hospital may be able to handle what’s being required, helping the local docs meet their criteria is looking to be a very tall order. The most troubling aspect of MU to Frederick Memorial Hospital CIO David Quirke — the 80 percent CPOE requirement for ambulatory practices. To learn more about how MU is playing on the street, healthsystemCIO.com editor Anthony Guerra caught up with the Maryland-based CIO.
I really think, when we look from my small view here in Maryland, I would look to remove CPOE from stage one in the ambulatory setting.
I think we may find ourselves with more CIOs with law degrees. Our hospital is requiring a law degree as part of the CIO requirement moving forward. (J)
My advice to any CIO looking at entering into this revised state of play is to get some of the basic documents down first before you go into the nitty-gritty of a contract, and don’t assume that they will come along and that those documents will be signed.
GUERRA: Let’s start talking about what everybody’s most interested in, which is the interim final regulation that came out on Meaningful Use. What are your thoughts?
QUIRKE: I think, from an overall perspective, from a hospital perspective, the interim ruling seems very reasonable. I know a lot of hospitals haven’t achieved the level of EMR adoption that we have here at Frederick Memorial Hospital. Certainly, from the physician ambulatory setting, we have some comments and concerns related to some of the adoption rates in the stage one elements, particularly related to order entry. We will not be presenting a comment on behalf of the hospital; we will be participating in comment feedback from Maryland HIMSS, for which I serve on the board.
GUERRA: You said the ambulatory side is a little more disconcerting, can you go into a little more detail?
QUIRKE: I think, when we look at the scope of the initial stage one EMR adoption, and the amount of order entry they’re looking for — 80 percent — that was surprising from our perspective. Even when we looked at some of our owned physician practices here at the hospital and the rate of EMR adoption we have there and the cost associated with getting to that level of CPOE in an ambulatory setting, it’s extremely difficult. You juxtapose a private practice that’s capital constrained — specifically here in Maryland that’s a rate-regulated state — and you see their lack of capital and their lack of ability to make the investment required to get to this level. Eighty percent is a very steep goal for stage one, particularly when you compare that to the hospital EMR levels of 10 percent CPOE.
GUERRA: Why are you so concerned about the practices, since you work for the hospital?
QUIRKE: We certainly have owned physician practices and we have concerns about getting them up to be meaningful users, and we also have one of our larger owned practices as part of the CMS demonstration project initiative. That was set up, obviously, prior to HITECH. But as a hospital in our community, since we’re the only hospital for about 20 miles, the physician community looks to us for direction, support, and guidance in terms of how they adopt EMRs. We have a coop organization, an MSO half owned by the hospital and physician community, that supports physicians in making these kinds of decisions. So we really have a big stake in supporting our physicians, and even supporting the non-owned physician community.
GUERRA: Would you be more comfortable with a number lower than 80 percent?
QUIRKE: I really think, when we look from my small view here in Maryland, I would look to remove CPOE from stage one in the ambulatory setting. We should just focus on the basic adoption rules for getting the meds, the problems list, the allergies, the e-prescribing and then focus on ambulatory CPOE during stage two.
GUERRA: David Muntz, CIO of Baylor, is concerned about the security issues around providing patients electronic copies of their records. Do you also think this could be a problem area?
QUIRKE: Yes. We were just looking at the opening of our patient portal and we’re struggling with some of the security and privacy implications associated with that, particularly around the guardian relationship where you’ve got a care giver involved. So whether it’s an elderly person or a pediatric, how we manage access and care in that setting.
GUERRA: Is that something you bring in HIPAA and privacy lawyers to help you work through?
QUIRKE: Very much so. With the HIE we’re looking to deploy in the coming year, I’ve probably spent a good 20 percent of my time for the last 2.5 months with our contract and privacy lawyers, and also our director of patient privacy. So that’s certainly a foremost concern of ours.
GUERRA: Do you think CIOs will be spending more time with lawyers dealing with privacy issues around HIE?
QUIRKE: I think we may find ourselves with more CIOs with law degrees. Our hospital is requiring a law degree as part of the CIO requirement moving forward. :)
GUERRA: The liability implications of a privacy breech are huge.
QUIRKE: They’re massive, and we’re finding even in the contracting that we’re doing now, the vendors are becoming acutely aware of that. The days when a business associate agreement was a pretty mild exchange of documents are gone. Now, it’s quite the tug of war between the hospital and vendor – certainly between us and some of the vendors we’ve been contracting with lately. The indemnification components and requirements for business associates are significantly greater than they have ever been, and vendors are becoming increasingly aware of the risks associated with signing BAAs and the exposure that they open themselves up to.
GUERRA: And having gone through some of these, do you have any advice or best practices for navigating these issues with vendors?
QUIRKE: Well, certainly, we spent about the last four months in a very engaged vendor negotiation which we successfully closed Dec. 31. My advice to any CIO looking at entering into this revised state of play is to get some of the basic documents down first before you go into the nitty-gritty of a contract, and don’t assume that they will come along and that those documents will be signed.
In our case, we had an extreme example where the BAA was not signed until 7 p.m. on Dec. 31, which was the deadline for the contract. Get the essentials out of the way first before you invest a significant amount of time and effort in negotiations, because you could find that you may not be able to get to a signed BAA with the vendor, and it may be months and months of work for naught.