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Meaningful Use

Award-winning health system leverages government funding to help position itself at the forefront of information technology


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Abstract

Health Information Technology (HIT) has the capacity to vastly improve the quality and efficiency of healthcare in the United States. Realizing its potential, however, is not without significant challenges. Renovating HIT entails considerable start-up costs, operational hurdles, and ramp-up time. It also requires enormous commitment and dedication on the part of hospitals and physicians.

In order to capitalize on HIT’s potential and speed its adoption, the government is committing tremendous financial resources to incentivize and assist care providers through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. HITECH designates approximately $27 billion[1] in incentives to providers for the timely adoption of EHRs, as well as substantial penalties for those unable to meet EHR Meaningful Use (MU) standards.

Our client, an award winning health care system and academic medical center, engaged Deloitte to evaluate its HIT capabilities and strategy. It sought to meet impending MU requirements and qualify for HITECH funding in a manner congruent with both long-term business strategies and broader organizational visions.

The Challenge

To qualify for incentive payments, eligible professionals (EP) and eligible hospitals (EH) must satisfy two requirements related to EHRs set forth in HITECH. First, they must adopt certified EHR technology. Second, they must demonstrate meaningful use of the technology by accomplishing defined objectives and reporting on specified clinical quality measures.

Meeting EHR certification and MU criteria presented a number of challenges for the client, in light of three specific issues: 1) significant time and resource constraints, 2) an existing IT infrastructure comprised of uncertified custom internal applications and legacy vendor components, and 3) pre-existing plans to overhaul the present, fragmented IT infrastructure with a new, cohesive state-of-the-art EHR platform.

Simply to meet MU, considerable time and resources would be needed to achieve the technical EHR renovations required, as well as to establish the training, workflow, governance, and buy-in necessary to effectively leverage new EHR technology towards MU. In addition, as part of its broader business strategy independent of MU, the client was planning a full overhaul of its existing EHR infrastructure with a state-of-the-art EHR platform.

An assessment of scope, time, and resources revealed that attempting to deploy a new EHR system in time to receive stimulus funding for over 1,400 eligible professionals and hospital was logistically unrealistic and could present substantial risks. Leadership would need to determine whether to self-certify existing legacy systems in time to collect Stage 1 MU funding, or to focus resources on implementing a new, more advanced EHR system. This would involve forgoing some incentive payments until Stage 3 as part of a broader strategy to position the health system at the cutting edge of HIT.

How We Helped

Deloitte provided a number of services that helped enable the client to answer a number of important questions and establish its EHR strategy and implement MU.

Business Case Analysis: Deloitte performed a series of business case analyses to determine conditions of a high amount of incentives with minimal risk for the client. The analyses helped the client appreciate the negative financial impact of its providers failing to adopt EHR and MU requirements by the end of 2012 deadline, to the tune of $16 million. Furthermore, as a consequence of its substantial physician network, the health system was eligible for approximately $50 million in EP incentive payments if it could meet MU by the end of 2012.

The analyses helped the health system to make a strategic decision to prioritize resources on deployment of a new EHR platform to its 1,400 EPs by late 2012, rather than certification of existing systems.

Deloitte assisted with process, workflow and system issue analysis and documentation. This included process refinement, development of current and future state definition, as well as problem identification, description, root cause determination and option generation.

Sensitivity Analysis: Among targeted EPs, Deloitte performed a series of analyses to help further prioritize EHR and MU deployment. Deloitte advised on which provider groups to give precedence to, the volume to target, as well as the stage of MU to steer towards. Many factors needed to be considered, including which specialties would have the smallest gap to close in order to meet MU requirements, which specialties would be easiest to generate buy-in from, and which changes would benefit patient outcomes most.  

Subject Matter Experience: Deloitte served as a subject matter advisor for EHR certification and MU, including guiding the client through interpretation of highly complicated MU Objectives and Quality Measures, articulating and implementing leading practices around MU project lifecycle. Deloitte also provided insight on provider engagement strategies and tactics being leveraged at other organizations.

Project Management: For each MU metric (either objective or quality measure), Deloitte assisted with identification and remediation of critical and high priority issues/risks that might arise. Deloitte worked with client management to understand the impact of not sufficiently addressing the issue/risk on the broader EHR program. Finally, Deloitte supported project plan development and management.

Team Facilitation: Deloitte facilitated the execution of leadership’s MU strategy across the complex eligible provider network and eligible hospital. This included facilitating communication and knowledge transfer between client business partners and project teams.

Solution

By providing a comprehensive assessment of IT capabilities, subject matter experience regarding MU leading practices and project life cycle, and financial analysis of HITECH incentives, Deloitte helped enable leadership to establish a balanced HIT and MU strategy. Deloitte’s analyses helped demonstrate both the strategic and financial advantages of prioritizing resources on deployment of the new EHR platform over interim self-certification of hospital legacy systems.

In order to collect incentive payments, the client would need to achieve progressively higher levels of MU, beginning with basic data capture and exchange in

Stage 1 to the demonstration of measurable improvement in patient outcomes by Stage 3. A more robust EHR platform would be advantageous in meeting these requirements and in elevating the client’s operational efficiency and care quality. Positioning the health system for long-term HIT health would outweigh the forgone stimulus funding, increased time and resource costs, and workflow disruptions.

The analyses also helped enable leadership to capitalize on incentive payments in a manner that held minimal risk to long-term organizational and IT health. With Deloitte’s help, the client avoided a potential $16M dollar loss of incentive payment due to poor EP adoption of EHRs, through the tactical trade-off of roughly $8M in EH incentive payments.

The approach lead the client to proceed with its implementation of a state-of-the-art certified EHR platform and still position itself to achieve over $2M in EH incentive payments and over $40M in EP incentive payments by 2015.

Finally, Deloitte provided the support the client needed to implement its strategy. This included overhauling its HIT infrastructure, and establishing the training, workflow processes, and governance structures needed to effectively use the new technology to achieve MU clinical quality measures.

1 HealthIT.gov, Incentive Programs and Payment Schedule

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