AMIA2014 Workflow Paper (Sunday): Impacts of EHR Certification and Meaningful Use Implementation on an Integrated Delivery Network

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3:30PM Sunday

“Three years ago Intermountain Healthcare made the decision to participate in the Medicare and Medicaid Electronic Heath Record (EHR) Incentive Program which required that hospitals and providers use a certified EHR in a meaningful way. At that time, the barriers to enhance our home grown system, and change clinician workflows were numerous and large. This paper describes the time and effort required to enhance our legacy systems in order to pass certification, including filling 47 gaps in (EHR) functionality. We also describe the processes and resources that resulted in successful changes to many clinical workflows required by clinicians to meet meaningful use requirements. In 2011 we set meaningful use targets of 75% of employed physicians and 75% of our hospitals to meet Stage 1 of meaningful use by 2013. By the end of 2013, 87% of 696 employed eligible professionals and 100% of 22 Intermountain hospitals had successfully attested for Stage 1. This paper describes documented and perceived costs to Intermountain including time, effort, resources, postponement of other projects, as well as documented and perceived benefits of attainment of meaningful use.

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Our study had several limitations. We did not track the impact/cost of the workflow changes to clinicians (such as time nor effort spent). Nor did we formally survey all the clinicians about workflow changes and satisfaction. The decision to certify our EHR and meet meaningful use for Stage 1 use was a success from a strictly financial perspective. However, the true cost and benefit to the organization is not yet completely understood. We can see that the use of the EHR functions that are prescribed by meaningful use has grown. However, this is balanced with preliminary subjective feedback from clinicians that feel that patients may be more engaged, while these same clinicians are feeling less productive and less satisfied. Further analysis on the impact of the EHR incentive program is needed to shed light on this dilemma. Meanwhile, the Stage 2 requirements and workflows are looming.”

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