Comments on: All I want for Christmas is ARRA answers

By: hospitalcio

hospitalcio — Sat, 17 Jul 2010 19:37:23 +0000

This was an incorrect statement at the time of posting. But, with the Final Rule it is possible to meet Stage 1 CPOE requirements with an ED system.

By: hospitalcio

hospitalcio — Tue, 26 Jan 2010 15:15:58 +0000

Firstly, that seems very difficult. Secondly, there are NO meaningful use requirements for the Emergency Department. Specifically, the interim final rule explicitly states that the CPOE meaningful use standard only applies to inpatients. I am not buying.

By: Michael Hubert

Michael Hubert — Tue, 26 Jan 2010 14:55:28 +0000

Meeting the Meaningful Use rules in the Emergency Department (ED) is not as difficult as some vendors would lead you to believe. Our customers often leverage the benefits of their existing CPOE and HIS vendor’s ED system. The hospital then installs the Forerun ED Physician System for physician documentation, patient discharge and more. It is interoperable with MEDITECH EDM and other systems. Our Patient View screen has a “hot button” link to MEDITECH’s CPOE. When clicked, the MEDITECH OE screen is opened and the same patient is automatically identified. Orders are entered and the physician then returns to the Forerun screen. There is no need to create a new CPOE just for ED physicians.

With this solution, the implementation is faster and costs are reduced. (Reduction in transcription fees often pays for the system.) Meaningful Use rules focus on “…electronically capturing health information in a coded format”. Hospital focus should be on an ED system that the ED physicians will want to use for patient documentation.

By: Bill Bingham

Bill Bingham — Fri, 22 Jan 2010 15:59:34 +0000

I wonder about which technologies, which user interfaces, which processes and procedures allow for the MDs, DOs, NPs, PAs to focus on the patient, the treatment and ordering the right course of treatment rather than the mouse and key board. I know in 15 years most of the professionals will have great computer/typing skills but that’s a long time.

Is it scanning, voice recording, touch screens, tablets, what empowers the professionals rather than shackles them?

I have a feeling that this is to Health Care what No Child Left Behind is to Education.

B2 (;->

By: Art_Vandelay

Art_Vandelay — Tue, 19 Jan 2010 11:55:07 +0000

Re: Detailed RFPs – this is why I have been an advocate for a Creative Commons-based repository for health care and health care technology-based content such as RFPs, RFP features matrices, policies and procedures, job descriptions, process flows, test cases, test plans, QA checklists, project plans and management templates, order sets, orderable definitions, care plans, clinical documentation templates, flowsheets, and the like. When I was on the vendor side of the business, my company had a goal of over 30% re-use of deliverables. We could save each other some real money by doing this. The two false starts I’ve had in this capacity have always been due to the day job. It definitely takes time. That is why I respect the active bloggers with day jobs.

You are very correct that writing requirements that are 3-5 years out is much more of an “art form”. It really involves breaking-down the requirement into more granular components and then looking at how they would be reassembled. The latter usually links into application architecture and directional questions. I like to separate these into scenarios and have the vendors answer how they would recommend fulfilling the requirement in the current state, interim state and some future state. It needs to be linked to a development roadmap. This exercise has never failed to show holes in the vendors’ roadmaps and differences of opinion among vendor resources. It is also interesting to hear how many different ways there are to solve a problem, again sometimes from the same vendor. I also enjoy joking with the vendor that their free consulting should knock another 5-10% of the discount they are offering on both initial and on-going costs.

By: Paul Roemer

Paul Roemer — Sat, 09 Jan 2010 18:38:40 +0000

Well written Art. That’s why I’m such an advocate of a very detailed RFP, one that is attached as a part of the contract. With the uncertainty surrounding everything from meaningful use to moving the business model from 0.2 to 2.0, I think the trick is forcing the RFP to look at requirements 3-5 years out, and being creative enough to take soft requirements like ‘flexibility’ and write them into the RFP.

By: Art_Vandelay

Art_Vandelay — Sat, 09 Jan 2010 12:16:28 +0000

Paul – I’d agree with a few caveats. If you are just getting started on the inpatient side and you have any size, scale and complexity, you have a very difficult road ahead of you. I find the keys to be:

1. Do they have the clinical content?
2. Do they have the proper business rules and UI to make the system usable?
3. Can they really interface with the systems you need?
4. Do they have an integrated analytics platform that takes information from 1-2-3?
5. Do they have the implementation expertise or enough partners so you can augment your Team to make it happen?

There is a little more opportunity for EP’s connected to stronger hospitals and health systems. Independent EPs are going to have a difficult time complying and affording the technology.

By: Paul Roemer

Paul Roemer — Wed, 06 Jan 2010 16:57:30 +0000

Curious to get your thoughts as to whether the organization should know it will surpass the meaningful use requirements at the time they sign with the EHR vendor. It seems to me that those who are risk are those who did not place enough emphasis and rigor in the definition of their requirements.

By: dibbsolutions

dibbsolutions — Fri, 01 Jan 2010 12:26:13 +0000

I’ve just started reading a 700 page document about meaningful use and it’s requirements. Hope to get even more knowledge about exactly what it means for HCIT.

By: Cathleen

Cathleen — Thu, 31 Dec 2009 12:49:12 +0000

With all this talk about multimillion dollar incentives for potentially employing a complicated point and click EMR/EHR (which impedes good patient care IMHO) I wonder what would happen if everyone knew that the answer is so simple and so inexpensive that we can eliminate all these vampire squid vendors who want to get all of that free money.