A few weeks ago, I had a hissy fit at our IS Steering Committee. I didn’t quite break down into a childish tantrum, but I was visibly upset when the Committee failed to make a decision on whether to squeeze in a few projects before our EMR vendor becomes certified for Meaningful Use. They “didn’t have enough information to decide,” and “wanted more analysis put into options.”
Nevermind that the last time we gave them options we were, “jamming it down their throat and not letting them participate.” I don’t lose my cool very often, but I opted out of the Corporate Compliance meeting that afternoon, went home, ran three miles, and then played basketball with our son.
Our team spent the bulk of the past two years implementing our corporate revenue cycle system. Near the end of last year I managed to come up with some resources to do a Meaningful Use gap analysis and presented the needs to our Executive Management Team. They were quick to appropriate some of the needed capital for MU projects. In early summer this year, we had our first Meaningful Use Steering Committee chaired by the hospital CMO and CNO. Things were lining up nicely – we had a technical plan and funding, executives were educated and top clinical leaders were to champion the actual meaningful use by physicians and nurses.
Back to the day after the IS Steering Committee meeting. I met with my boss (hospital COO and Chair of the Committee) to review the meeting and to strategize next steps. “What were you trying to accomplish in the meeting?” he asked. I told him I was trying to get the committee to pick two of the six uncompleted projects I’ve been clobbered about the last couple of years. Our analysis showed that we might have some time to get them out of the way before we were consumed by the MU tidal wave. “I’m not sure that was clear,” he said. “Fair enough,” I told him, “we can always do a better job with our presentation materials.”
I was angry though, and I decided to vent. Why wasn’t Meaningful Use listed as part of the FY11 hospital goals? (We have five pillars – Service, People, Quality, Finance and Growth upon which the annual hospital goals are organized. Each leader develops goals supporting those pillars and is held accountable). If the government has mandated a quality focus through use of electronic health records that includes a carrot followed by a very large stick, shouldn’t that be front and center for staff focus?
Furthermore, did this set a tone of disrespect for the entire IS Steering Committee prioritization process? If the most important information systems projects were not part of the hospital’s annual goals, why wouldn’t other leaders assume their rehab documentation or perioperative system wasn’t the most important next project? Our Clinical Informatics group (under nursing) had proposed a redesign of all nursing documentation. While this project would not utilize IS resources, it would consume training resources and significant operating dollars to pull nurses off line for training. If we were going to do that, wouldn’t we want to make sure we include any necessary MU data elements as part of the redesign? Yet, there had been no conversations between Nursing and IS about this project. Like many of you experience, we had siloed thinking that was going to thwart progress on MU and perhaps put stimulus money at risk.
Why did we spend the last six months meeting together with the Clinical Informatics group planning our MU projects and trying to see how we could support other critical upgrades in between? Why do we always have to cater to their schedule? You know the scene — some clinicians seemingly try to avoid EMR adoption until they are incented by regulation or monetary withholds. When they become convinced they have to move forward, they are upset that the system doesn’t support their workflow and that we didn’t “plan well enough.”
My boss was taken aback. I’m usually known as being thoughtful and level headed. I hadn’t shown such anger and frustration during my four year tenure at the hospital. “What do you want me to do?” he asked. I replied, “I want MU on the pillar goals for FY11. I want people to understand that we have a government mandate that has filled up our IS agenda for several years. I want people to work on those projects rather than coming up with things they want to do that don’t help us achieve MU!”
I remained professional throughout the IS Steering Committee and this conversation with the COO, but I had really come to the end of my patience with the situation. When I reviewed everything in my mind, I knew there were many things I could have done better. I should have spoken up to my boss earlier. I needed to be more out amongst the clinical chiefs and nursing leaders to explain my case. Our IS Steering presentation wasn’t pre-processed enough and it didn’t give clear options. Still, I was exhausted from the two year revenue cycle implementation and really just wanted the hospital to get the MU thing.
Ironically, I think some of this came about because of the deep respect our Executive Management Team has for me and my team. While the CMO and CNO were in charge of the MU Steering Committee, and we told them that achieving Meaningful Use wasn’t an IS project (we can put in the systems, but clinicians have to become meaningful users), they were relying on IS getting the job done. My expression of frustration to the COO put Meaningful Use on the pillar goals and front and center for the hospital staff.
Several weeks later, I received this email from the COO. “At goal setting, we talked about Meaningful Use and how it is important that we, as an executive team, take responsibility for this goal. i.e. that it is not an IT goal. We made the commitment to get there for the quality and safety reasons and also for the ROI.” I had got my point across. Hospital and practice leaders across the country need to understand the resource and cultural implications of MU. This CIO had to have a hissy fit to get leadership in gear. I’m hoping that’s more because of my failure to make the case earlier, but it’s just possible you’ll also need a hissy fit to get MU where it belongs — front and center.
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