Joseph Heller’s darkly hilarious wartime novel, “Catch-22,” skewered military bureaucracy through the eyes of a bombardier who couldn’t make his mission quota and go home because the quota kept getting higher.
Catch-22 is now part of the lexicon. It’s defined as a “condition or regulation which prevents the resolution of a problem.”
That describes the situation for many hospitals regarding Electronic Medical Records. To get a piece of the $20 plus billion dollar government incentive pie for adopting EMRs, the hospitals must meet an array of measurements proving that they are using this IT in a meaningful way.
Two key measures deal with emergency room throughput–
1) the median time of ED arrival and departure for admitted patients, and
2) the admission decision time from ED arrival to departure for admitted patients.
Hospitals must report these measures to CMS or to their state authorities and that information must be captured electronically.
According to a Thomson-Reuters promotional piece, many hospitals are not capturing the data elements in their HIS systems or it’s not being collected in a way that’s consistent with “e-Measure” vocabularies.
Ironically, the federal incentive program is the reason those hospitals can’t report the data. And, more importantly, it is also the reason they won’t be reporting constant improvements in those ED metrics.
The lure of government seed money diverted hospital dollars from other HIT which actually could have made a positive impact on the ED information it was reporting – namely Real-Time Capacity Management. This technology focuses on operational efficiency across the provider enterprise, including patient flow and data analytics. The automated operational platform frees up space for new patients more quickly and reports all patient movement data in real-time.
The real Catch-22 here is that the federal government passed two bills which contradict one another. The EMR incentives were in the American Recovery and Reinvestment Act of 2009 (ARRA), otherwise known as the stimulus bill. Then came the Affordable Care Act of 2010, or “Obamacare,” which jawboned providers into agreeing to cut $150 to $200 billion out of their collective budgets over the current decade.
So, by accepting the terms of the first bill, hospitals essentially relinquished the means to accomplish terms of the latter.
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