A friend’s grandfather was the first person living on his street to own a car. Parking was never a problem, it was easy to get around town, and he thought it was a great convenience over the subways, trollies, and buses running in New York City at the time. But he never chose to drive his car all the way to Boston, instead he took the train. Without interstate highways, traveling long distances in a car was rarely a “meaningful” option. Back then, that trip took more than eight hours, longer than it took by train.
To receive Federal stimulus money (American Reinvestment and Recovery Act, 2009) for the implementation of electronic medical records (EMRs), hospitals and physicians must satisfy the “meaningful use” criteria as defined by the Department of Health and Human Services (DHHS). Although Stage 1 criteria appear to be more of a checklist of how to use these systems, subsequent stages will be more complex and difficult to satisfy, thereby putting into jeopardy the continued qualification for these funds by hospitals and physicians.
A great deal of the buzz during the late February HIMSS 2011 Conference in Orlando focused on “meaningful use.” Hospitals and physician leaders shared their challenges meeting “meaningful use” as they worked to get their EMRs implemented and adopted by the physicians, nurses, and other clinicians who were now required to use them. In addition, many discussions turned to the real value of EMRs, as a few recent reports noted that instead of improving quality and reducing costs, they actually caused the opposite to occur.
Now, what does this all have to do with owning an automobile so many years ago in New York City? Without the proper infrastructure, the utility of owning a car in the 1930s waned in comparison to owning one today. Interstate highways with their overpasses and traffic-light-free rights of way allow drivers to take advantage of the speed, reliability, and comfort inherent in today’s automobiles.
Similarly, a hospital that deploys an EMR without the proper infrastructure will struggle accessing the inherent value of the technology. A new modern desktop infrastructure encourages adoption while facilitating clinical workflow. Effective workflow allows clinicians to achieve desired levels of clinical outcomes and resource consumption.
Clinicians faced with technology that is an obstacle to patient care develop workarounds that reduce productivity, expose personal health information to unauthorized access, and severely limit the value of the deployed health information technology. Failure to recognize and address workflow issues when implementing EMRs greatly threatens the success of an entire health information technology initiative. In addition, failed projects not only waste enormous resources but also severely injure the reputation of the institution. Organizations cannot hope to satisfy the criteria for “meaningful use,” and in turn qualify for stimulus funds, without deploying effective workflows associated with high levels of clinician adoption.
Infrastructure critical to the deployment of effective workflows and the meaningful use of EMRs includes technology that:
Anyone who has struggled with remembering usernames and passwords while trying to access different websites recognizes the difficulty in managing multiple authentication credentials. The challenge grows exponentially in healthcare as clinicians need to access different EMRs and other health information systems continually throughout the day. In addition, they share their computer workstations with other clinicians while moving from patient room to patient room.
Adding to this complexity, most health information technology systems utilize their own access management approach - requiring clinicians to remember even more usernames and passwords. Without a means to efficiently manage this authentication — allowing simple and automatic sign-on to multiple applications using just one set of authentication factors, and accessing a clinician-driven desktop that roams with the clinician from point of care to point of care -- EMRs present an unacceptable obstacle to effective and efficient care delivery.
Organizations that truly want to achieve a level of “meaningful use” of EMRs must look beyond the criteria set by the DHSS and focus on utilizing technologies that encourage technology adoption and facilitate workflows attractive to clinicians. This approach provides the means to secure the benefits available from EMR systems.
Dr. Barry Chaiken is the chief medical officer at Imprivata and served as the 2009-2010 chair of HIMSS. With more than 20 years of experience in medical research, epidemiology, clinical information technology, and patient safety, Chaiken is board certified in general preventive medicine and public health. Christopher Young is the vice president and general manager for VMware's End-User Computing business unit. Prior to joining VMware, Young served as the Senior Vice President, Products at RSA, the Security Division of EMC.
Christopher Young is the vice president and general manager for VMware's End-User Computing business unit. Prior to joining VMware, Young served as the Senior Vice President, Products at RSA, the Security Division of EMC.