As chair of CHIME’s Policy Steering Committee, Pamela McNutt, SVP & CIO, Methodist Health System, is leading that organization’s response to the Meaningful Use Interim Final Rule (IFR). But McNutt’s dual role as member of the AHA IT Policy Advisory Committee gives her an even more powerful vantage from which to formulate a comment, while coordinating the actions of the two organizations. To learn more about her take on Meaningful Use and get a sense of what in that document is most troubling to CIOs, healthsystemCIO.com editor Anthony Guerra recently caught up with this incredibly busy executive.
… my recommendation to people would be if you’re only shooting for the 10 percent, make sure you pick a pilot that’s isolated enough so it’s very clear to the nurses and the rest of the staff who’s on and who’s off.
It’s not that we don’t want to do things. We want to do things the right way, and that’s what I very much believe in. I do want electronic health records, but I want them done correctly.
Nothing is going to happen in the proper fashion unless people who really know how things work in physician offices and in hospitals get out there and lend their voices.
GUERRA: What will be the effect if the Meaningful Use NPRM becomes law without significant changes?
McNUTT: Then I don’t think you’ll see anyone meeting the criteria. There’s a lot of folks out there who think they’re going to meet the criteria because maybe they’ve looked briefly at the metrics, but many folks I know who had that reaction initially wind up feeling quite differently after they’ve dug deeper and talked to their vendor.
GUERRA: What if I were to say my main concern is people shoving these systems in to get the money without the proper workflow redesign and change management groundwork. Couldn’t there be real patient safety dangers?
McNUTT: A lot of us think that — that if it’s done hastily, there will be patient safety danger. But I even think it’s more likely that people just aren’t going to be able to achieve it in year one. So year one is just a throw away. Very few people are going to achieve it in 2011. So then we’re basically saying we’ve narrowed it down to four years, and that’s ironic given the name of this bill (laughing). It was called the stimulus bill. It wasn’t called the Mandated Healthcare Electronic Records Act of 2009 which it really is, by the way, but that isn’t what it came out as. So if we really want to get money out there, the way to do it is to give people enough of an incentive to get them on the road.
This may not even be much of an incentive for physicians anyway. For physicians, you only get penalized if you accept Medicare or Medicaid, and a lot of people already don’t accept Medicaid anymore. Nowadays people aren’t accepting Medicare if they have any other option at all. So now you say, “Well, do all this, and I’ll give you some money,” but maybe a physician looks at it and says, “Well, I can’t do all this. I can’t operate a patient portal in 2011 or 2012. I can’t do that.” So they’re not going to get the money, and then they turn around and if they really start throwing penalties at them, you get more physicians dropping Medicare or just not participating in the HITECH program.
GUERRA: Let’s talk a little bit about the CPOE measures. Why is the acute requirement so low (10 percent) and ambulatory so high (80 percent)?
McNUTT: Quite frankly, ambulatory is easier. Generally when you put a system in a physician office, that physician is already onboard to use it. Physicians get an office-based system with the expectation they’re going to place their orders in there, because then it self-documents in the chart, you can get connections to reference labs and places like that. And so if someone is going to even buy one, they’re probably going to be doing the orders in it, as well as everything else.
GUERRA: Why so low on the inpatient side?
McNUTT: It’s a whole different ballgame in an inpatient setting. In an inpatient setting, the hospital has to create a way for everybody to order — for a medical staff of 500, 600, 900 people, some that only come here maybe once a week. We have to train all those physicians on our way of ordering with our order sets.
When you’re in your own office and you can create your orders any way you want them to look, who do you have to debate with? But in a hospital, for example, for us to come up with one orthopedic order set — when we have five or six different orthopedic groups practicing here — is very, very difficult.
GUERRA: So is that why you try to satisfy the large physician groups first? I mean, you can’t make everyone happy.
McNUTT: No, you can’t, and that’s what happens — you don’t make everybody happy. But the other thing you can’t do very effectively is, for example, split a nursing unit up and say, “Well Dr. Jones and Dr. Smith do CPOE but 200 others don’t, so you as a nurse have to keep track of knowing whether or not you’re going to see the order in the system or on paper.” That’s very confusing.
So this 10 percent, you know it really just represents a pilot, and my recommendation to people would be if you’re only shooting for the 10 percent, make sure you pick a pilot that’s isolated enough so it’s very clear to the nurses and the rest of the staff who’s on and who’s off.
GUERRA: So you would want to have a whole unit on and just make that your little pilot unit?
McNUTT: Possibly, but it would have to be a very closed unit, like somewhere only certain types of physicians practice, but the problem is that physicians float around too much.
So the way that we’re going to do it is we’ve chosen our hospitalists, because our hospitalists see a whole lot of the patients on our unit and, quite frankly, that’s where the biggest bang for the buck is.
GUERRA: It should also be easier because the hospitalists actually work for you.
McNUTT: Yes, exactly. That makes it easier, but it’s still not perfect.
GUERRA: The real challenge comes with the independent docs, correct, especially the big revenue generators?
McNUTT: Yes. They’d say, “I won’t touch that thing.” But some of them get it, and sometimes you see people talk about using scribes to help the process along. I think that happens in emergency rooms more than any place else.
The bottom line is that some organizations have been successful at getting the whole house to convert, and I do think it’s inevitable. I don’t even think it’ll be a topic for discussion in five, six, seven years, it’ll be the norm. But we’ve got a pretty big gap right now to get from where we are to that future state.
GUERRA: You are extremely active in CHIME and the industry overall. You’re chair of CHIME’s Policy Steering Committee and a member of the AHA IT Policy Advisory Committee. I would imagine that’s something you’re passionate about.
McNUTT: Well, it is a passion. It’s important to effect change whenever we can, like during this comment period, or to get the word out as to the way things really are. It’s not that we don’t want to do things. We want to do things the right way, and that’s what I very much believe in. I do want electronic health records, but I want them done correctly.
GUERRA: So you would encourage your colleagues to get involved.
McNUTT: Yes, especially locally. You need to know what’s going on in your local market with HIEs, regional extension centers and even collaborative efforts that were going on long before this. Lend your voice to it, and you don’t have to be part of a really large health system to do this. I’ve had this passion for over 20 years, even when I was in a different facility. I urge people to make their voices heard. Nothing is going to happen in the proper fashion unless people who really know how things work in physician offices and in hospitals get out there and lend their voices.