As chair of the CHIME Advocacy Leadership Team, David Muntz is as plugged into the Meaningful Use saga as any non-government employee can be. And to hear him tell it, the interim final definition of MU needs to be significantly tempered if the majority of healthcare organizations are to have the slightest shot at qualifying for HITECH funds. Recently, healthsystemCIO.com editor Anthony Guerra talked with Muntz about what’s wrong with Meaningful Use, and how the government can make it right.
‘Do not put the benefits into the forecast until we can understand what the chances are we will or won’t meet them.’
I’ve been very honest about when I think we will actually be ready and when I think we can expect to see some monies — and it is not in October 2010.
The advantage of letting people do things at their own pace was that you could train resources with more time, but the compressed timeline means you’re going to introduce change more quickly than people can adapt to it.
GUERRA: How important do you think it is that people comment on the meaningful use regulation?
MUNTZ: Oh my gosh, I can’t even encourage people enough. The fact is we always complain about the government providing unfunded mandates and telling us what we need to do. Now we have a funded mandate, and we have an opportunity to provide feedback. I can’t think of a time in history when we’ve had such great opportunity. And so I think we need to speak as individuals to help people understand precisely what the impact will be on us and try to come up with manageable and realistic expectations and goals.
I think everybody should be replying as part of a professional organization where you’re trying to address the global issues. It’s critical people understand the anecdotal impact these things will have as they’re put into place. So I beg people to comment.
GUERRA: How important is it for CIOs to let their CEOs and CFOs know how tough it might be to get the money? I’ve always felt CIOs were on the hook to bring this cash home.
MUNTZ: I completely agree with your supposition. There is no question you should have, if you haven’t already, educated your constituencies about what will and won’t happen. We’re in the midst of our budget preparation and my comments are, ‘Do not put the benefits into the forecast until we can understand what the chances are we will or won’t meet them.’ I’ve been pretty honest about sharing, for example, AHA statistics that show not one hospital in America is prepared to receive the money. The AHA did a survey of more than 3,000 hospitals to make that determination. And so it’s not that we’re unique. We also remind them what we’ve been working on before the stimulus package came out, and it’s very consistent with what we’re working on now. The only thing that’s going to change is perhaps the timeline and the focus they have on what we’re doing. And so, in that regard, it’s probably favorable, but I’ve been very honest about when I think we will actually be ready and when I think we can expect to see some monies — and it is not in October 2010.
But I think they all are pretty realistic about this, speaking for my organization. It’s been my experience that the physicians are aware, but not well-informed, about what the options are, and are concerned about paying attention to ongoing activities rather than trying to change their focus. The big challenge to CIOs, from my perspective, is trying to get the attention of their medical staffs — whether employed or not — to make sure that they have what they need. The truth is, in order to be successful, it’s not only the affiliated but the unaffiliated physicians that must participate, because we’ll never have a true view of a patient’s comprehensive medical history unless everybody participates. It would be like looking at a credit report and half of the people with whom you have credit didn’t contribute to that report.
GUERRA: I’ve talked to many people who feel a little frustrated because they had a good plan in place and were moving along nicely. Some feel this has disrupted good work that was being done. What do you think of that sentiment?
MUNTZ: I think that’s a valid viewpoint. A lot of it depends on where you were in your journey and how far you’ve come and how far you think you have to go. Frankly though, I think the reason the legislature put it together was to do what it said — to stimulate the speed at which the change was going to happen. We are not famous for our nimbleness as it relates to the implementation of healthcare IT. If anything it has increased a sense of urgency which not many people had.
Going back to the difference I mentioned between transition and change, if the transition is too long, the pain continues longer than it should. We’ve seen this in every situation where we’ve done an implementation. Before it starts, people are excited about doing it. And the day before we swap out their old system, that system is enjoying its highest popularity. A couple of weeks after implementation, people are thrilled about the change, and if you ask them, they couldn’t think about going back. You wait another three weeks, they figure out what it can do and what it should be doing and their satisfaction increases.
And in about two months after go live, they have returned to their productivity measurements or are exceeding them, and can give you anecdotal evidence, as well as group evidence, of how much better they are than they were. But if they weren’t forced to go through that, I’m not so sure it would occur as quickly as we want it to. As much as I don’t like it, sometimes external pressure to do the right thing is helpful.
GUERRA: You mentioned that vendors may be reaching their capacity. How can CIOs ensure they get the right level of service?
MUNTZ: And that’s the greatest problem we face. The advantage of letting people do things at their own pace was that you could train resources with more time, but the compressed timeline means you’re going to introduce change more quickly than people can adapt to it.
The only solution I can see is not to recruit and train independent consultants, but nurses and respiratory therapists, PTs, laboratory people inside our own institution who know our culture and who we can train on the vendor products. Those people are more sensitive to the clinical and operational implications of what they’re installing, rather than the features and functions.
GUERRA: Might the clinical side of the house start to resent IT poaching?
MUNTZ: Well, actually, we have that problem today. What we try to do is point out that if the nurse or other person has gotten to the point where they’re just not satisfied in their current role, they would have been attracted away by the vendors or by somebody else, and we are far better off retaining them inside the Baylor institution. And frankly, as the population ages and people are a little more weary or would like to get a little bit of rest from the physical demands of the job, we offer them an extraordinary outlet, because IT is not as physically demanding as turning patients. This is a good place for people to finish their career, as opposed to finishing it in a consulting firm.
Also, people working at the bedside get to touch half a dozen people a day, in terms of the difference you can make, and those differences are inestimable in terms of value. But if you work in IT, you can help every patient in every bed every day, and the value of that shouldn’t be underestimated. Healthcare IT allows you to still help the people you used to touch.