The real challenge for many organizations will be whether Stage 7 can realistically be achieved with your existing vendors. If you are using a single-vendor approach, like many Epic, Meditech, or Cerner hospitals are, the data elements that need to flow between modules or department clinical applications already exist. The need to use BMV in the ED or have allergy information flowing bi-directionally are already part of an integrated design. If you use a core vendor approach with add-on applications or a best-of-breed environment, you may find it much more difficult — if not impossible — to meet the Stage 7 requirements. Let’s review a few examples in our organization.
The first is that although we are a Meditech 6.x, shop, we decided (for reasons I noted in previous posts) to not use Meditech in our ED. We have the Medhost EDIS product and it has, for the most part, worked well for us over the past 2 years. Stage 7, however, requires the use of BMV in the ED. Since Medhost does not have BMV functionality, we cannot achieve that goal without several workarounds. Our Medhost technical resource graciously pointed us to another hospital that uses Meditech as well as Medhost, and has integrated Meditech BMV into its ED processes.
The problem, though, is that to achieve Stage 7 using their workaround requires yet another Medhost module we don’t own, along with several complicated interfaces, and third-party software. Additionally, that site can only use BMV in non-trauma-related situations since it takes almost 2 minutes for a medication order to process and stack orders. So if the provider included 4 meds on a single order, it would create 4 background orders and require 8 minutes to process them (2 minutes for each order with 4 meds). Such delays on medication orders would be a challenge for us and would likely frustrate providers who are used to more efficient processes.
So where does that leave us? We could go back to Meditech in the ED, which would present other challenges. We could find a best-of-breed EDIS that does support BMV (we don’t even know if one exists without greater exploration), or we could, as in the above example, find complicated workarounds. While I understand the benefits of BMV in the ED, it serves as an example of how the best-of-breed vendors have not been able to keep up with industry demand or integrate systems as seamlessly as needed. Also, in some organizations it will require clinicians to adopt new workflows that may not be as efficient as what they are used to.
Let’s take another example: anesthesia. Meditech does not currently have an anesthesia product. We are in the middle of a selection, and that means factoring bi-directional medication reconciliation, BMV (?), CPOE capability, bi-directional allergy data, and capability to integrated medical devices while sending structured data back to the EMR to include in the CCDA, patient charts, and other data exchanges.
In short, it increases complexity of the installation, cost, and challenges related to achieving Stage 7 or other reporting requirements. But if your existing vendor does not have a solution, what are you to do?
In my opinion, this is an example of why so many organizations and CIOs have moved from the best-of-breed environment of the 80s and 90s to the more common single-vendor approach of today. With all the reporting requirements of MU, CMS, and other initiatives like achieving Stage 7, the difficulty of doing so in a multi-vendor entity is daunting, to say the least. It also points out complexity of health IT, and, as pointed out in Healthcare IT News, some of the “reasons today’s health IT systems don’t integrate well.” Having a Stage 7 gap analysis will serve as a discussion tool to help organizations define both a short and long-term organizational IT strategy.
Even though it may result in countless hours of work, the results of such an assessment provide talking points for a senior leadership team, board, and others to have a meaningful discussion on your organization’s strategic direction as it relates to this goal. It will also function as a basis for obtaining provider and staff input around system replacement, cost (IT and operational budgets), timeframes, and synergistic alignment of organizational initiatives as they relate to IT, and form the first step in a project-based approach.
Additionally, unless you are very close to attaining Stage 7, you will likely find that there is significant discussion and exploration required to progress from Stage 6 to Stage 7. Your team may decide it is not achievable or not a priority, but that should not deter your IT team from doing what they can to get as close as possible to meeting Stage 7, because ultimately, any of the Stage 7 factors will benefit your patients. It is the right thing to do for them and for your organization.