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We started down this road about five years ago.
We've done a lot of work on physician adoption,
physician governance, clinical transformation,
enabling change throughout our enterprise,
using technology, and frankly, we did that
without expecting that there would be
any particular governmental incentives
other than anything that was
related to producing better quality.
So when these programs came along, we were delighted.
We had already implemented most of our hospitals.
It really was something that we really felt was very important
for us to engage in, that ultimately it's going to be
kind of the badge of credibility and excellence
in health care delivery
that you're using technology appropriately
to facilitate clinical quality.
The registration process really comes at no cost.
It's fairly straightforward.
You need to make sure you have all the numbers that you need,
whether that's your National Provider ID,
your CMS billing number, your tax ID number,
or Social Security number,
if you're registering as an eligible professional.
So you need to make sure you have all your numbers
before you sit down, but if you do,
the registration process is really very straightforward.
We registered our hospitals, all five hospitals,
I think in less than an hour.
So it really is pretty straightforward,
just going from screen to screen.
On the eligible provider side, working with,
we have about 150 physicians
who are actually part of our EHR enterprise,
many of their work flows really needed to be reanalyzed.
For the most part, that was all for the good.
There were some problematic work flows,
where nonprofessionals
were calling prescriptions in to pharmacies,
that we obviously had to change.
That's just not compliant
with the specific Meaningful Use criteria.
And I think that's actually all to the good.
There were some others that I guess
we could probably argue about whether or not
it really added significant quality
to the care that they were delivering --
such as giving a summary of the visit to every patient
at the conclusion of the visit.
But the physicians pretty rapidly got on board
once they understood the regulations
and what they needed to do to be compliant
and to obtain their incentive payments.
There are some really good resources on the Web,
on the ONC and CMS websites, including one that actually
sort of takes you through
in a series of, I don't know, probably 50 PowerPoint slides,
what each of the screens is going to look like,
how you fill it out, what data you'll need
before you sit down.
You certainly don't want to sit down,
go through half an hour or 45 minutes, only to find out
that you have one or two data elements that are missing
and you don't have them to enter --
because you can't save it.
You have to do it, you know, from start to finish.
But the materials that are out there
really show you what you need,
and if you have all those materials
in front of you when you sit down
in front of the computer and log on,
it's a pretty straightforward process.
I think you have to be really very careful about selecting
an electronic health record for use in your enterprise.
It really has to work for you in terms of your work flows,
your specialty, and so forth.
But it really has to be certified.
So promises that, "Oh, yes, we're about to be certified,"
or, "It's just coming down the road,"
really have to be taken with a grain of salt.
At this point, if an EHR vendor
doesn't have their application certified,
they probably should not be on your short list
to look for a new EHR implementation.
For those that are already live, I think they really
have to sort of look very specifically at the criteria,
what they are, what the percentages are,
and see where their work flows need to change.
There are really none of these criteria
that I feel, in changing your work flows to meet them,
lead to a change for the worse in how care is being delivered.
But in many cases, some changes will need to be made --
if not specifically on how care is delivered,
certainly on how care is documented.
Because, you know, as the saying goes,
if you don't document it, you didn't do it.
And that's certainly true for the Meaningful Use criteria.
I think the rewards far outweigh any conceivable risk,
assuming that appropriate protections
for privacy and confidentiality are taken.
I don't think there's really any question about that.
I think it's really very important, however,
that we make sure that folks understand
that their data were not private --
or, at least, were subject to the same sorts of disclosure
in paper-based days.
That somehow seems to get lost somewhere in the conversation,
that all these data --
although your doctor's chart may have been paper,
that data was all electronified, if I can use that word,
when the bill went out.
And the companies that handled your billing,
the payers that paid your bill, and so forth,
had enormous amounts of information
on you in the past, and we really
didn't pay a whole lot of attention to that
from a privacy and confidentiality perspective,
and now we are.
I think we've really come a long way.
If there is a breach, at least now we know about it,
we can do things about it,
and I think that's going to stand us in good stead
as we go forward.
Meaningful Use, especially Stage One of Meaningful Use,
is clearly the first step on the journey.
And when asked by lay audiences, whether they're patients
or board members or other folks back home that I speak to,
I try to make it clear -- this is really a three-step process.
The first step is making sure that we have a common data set,
that we have, you know, a problem list, a medication list,
vital signs, blood pressure, smoking status,
all that, on every patient, and we should.
The second is using that information
to make sure that we're delivering
consistent, quality care.
And then the third is to make sure
that that quality care and the data can be shared,
because in a modern, mobile society,
and I think everybody knows this for a fact,
the chances that you're going to be
going to the same physician in the same community
for your entire life
are about as close to zero as it gets.
And when you change physicians
in the same community or you move
from Southern California to central Oregon, whatever,
you don't want to have to go through the same process of,
"Oh, here's your clipboard -- fill out all your allergies,
all your medications, all your diagnoses,
all your past operations."
That information really needs to be seamlessly available.
When we get there, then we'll know
that the standardized delivery of high-quality care
is really within our grasp.
I think it really affects the confidence that patients have
in the health care that they're getting
if their providers really
don't have a grasp of their own personal information,
at least the important stuff.
So I think that itself means something to patients.
But the idea that there is kind of a standardized quality
that they should be able to expect,
whether or not they're being cared for
in Long Beach, California,
or Dallas, Texas, or Portland, Oregon,
is something that I think we're going to be forced to confront.
And there's really no way we're going to be able to do that
without a standardized data set of information
that's immediately sharable
among all the health care providers
throughout the country, really,
and with everyone incentivized
to deliver the best quality care.