By  |  February 25, 2011 | 

Like a UN cargo plane dropping a crate of rice into a Sudanese refugee camp, so goes the conundrum of the ARRA payment for EHR meaningful use. The rush to grab the dough will result in some casualties. For the ARRA program, those yet to be known casualties may result in rethinking whether dropping the crate was a good idea in the first place.

When To Err Is Human came out in 1999, CPOE technology was still in its infancy. However, many Hospitals made the investment in new software, attempting to modernize, streamline, and enhance care. Twelve years later, less than 10% of hospitals utilize CPOE. Those software purchases from the early 2000’s weren’t as slick as we thought. And, like the human brain, much of that software went unused due to prohibitive upstart, maintenance and support costs.

As a data repository, the EMR enhanced practice. I can’t imagine practicing in a hospital still using lab printouts or written MARs. But a clunky, ill conceived CPOE platform? Not if you paid me….

Then comes “ARRA payment for meaningful use.”  As if patient safety, work-flow efficiency, and record retrieval weren’t enough of a reason to brush the dust off that CPOE application years ago, now we have a better reason -money.

Those of you who have survived a CPOE go-live and roll-out know that CPOE is the most transformative event in the modern hospital’s life (I’ve lived through several).  And even the most judicious roll outs, on the slickest applications take years to execute. Yet with the end of the fiscal year approaching and ARRA deadlines looming,  hospitals are trying to deploy their CPOE applications over a very compact timeline.

A perfect storm? Well, in this economy, who would blame a hospital for trying to capitalize on meaningful use dollars? And this is the point: EHR/CPOE adoption needs to be done for the right reasons; doing it for ARRA payment alone could result in some bad outcomes. Those bad outcomes might cost more than the ARRA payment itself.

A poorly planned, poorly executed CPOE implementation will impact every patient, provider and employee in a hospital.  Worst case scenario, a patient dies. Best case scenario, the Docs refuse to use the product and lose faith in the implementation team. Either way, resources, magnitudes greater than what would have been gained by the ARRA payment, are at risk.

So what does this have to do with Hospitalist Leaders? Everything!!

Who is the default “pilot” group for CPOE? The hospitalists.

Who is the default committee member for CPOE? The hospitalist.

Whose productivity suffers from a bad deployment (or even a good one)? The hospitalists’.

And, most importantly, who has the most to lose? OUR patients.

Our healthcare system needs to convert to an electronic platform as soon as possible. And CPOE, if implemented correctly, will greatly enhance patient care and hospital efficiencies. If done poorly or for the wrong reasons, patient care will suffer the most.

Please put these words to meaningful use.

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