What to Do Today to Maximize Your ARRA Funding

What to Do Today to Maximize Your ARRA Funding
Ian Janer and William N. Bernstein, LEED®AP, AIA
June 25th, 2009

Overview of ARRA: Opportunities and Challenges

The American Recovery & Reinvestment Act of 2009 (ARRA) has been instituted under President Obama to encourage economic stimulus. For healthcare providers, the bill seeks to encourage advancement and development by providing incentives for converting from paper records to EMRs (electronic medical records) and for better patient care through improvements in data infrastructure. In order for hospitals and other healthcare providers to maximize their ARRA funding and ultimately cut costs, it is essential that they begin the process of upgrading their systems now to reach the first deadline at the end of 2010.
Another important motivator in adapting these technologies is the nature of the diminishing incentive rates. Every year the incentives will decrease for those facilities still attempting to get up to par with their peers, and any facility that has not adapted EMR by 2015 will begin to see penalties taken out of their Medicare refunds. With the deadline approaching so soon, healthcare providers that haven’t already adopted EMR must act now to see the necessary improvements.

The Realities of Meaningful Use

The government has allotted $77B dollars for medical incentives, and the largest payments will be made to hospitals and practices that are up to the standards of “meaningful use” by the end of 2010. While the term “meaningful use” generally means clear improvements in workflow and patient care thanks to the adoption of EMR, the official definition is still being determined by the CCHIT (Certification Commission for HIT). However, there are a few digital technologies that are expected to be necessary to prove “meaningful use.” Among other systems, hospitals should have PACS (picture archiving and communication systems), CDSS (clinical decision support systems), and, most importantly, CPOE (computerized physician order entry) systems installed throughout their facilities. These electronic methods are essential to the type of patient care improvements that are expected to come out of the ARRA.

Gap Assessment

To be able to make the switch over to digital, medical professionals should go through their workflow and search for gaps: do nurses have to go back and forth between the patients’ rooms and nurses’ stations to enter data? One of the purposes of EMR is to minimize physical workflow constraints, so this would be one area to improve. Another area to investigate is whether the information technologies are available throughout the facility or just in one department: it’s essential that the entire facility be up to standards to receive ARRA funding. What if the IT system goes down? All healthcare providers should have system redundancies (backup computers, servers, workstations, etc.) in case something happens to part of the system – a hospital should never be in a situation where all of radiology is on a single server that could crash without having a backup. The last area to investigate before preparing for the transition is staff readiness: it is important that the doctors, nurses, administrators, and other staff members are behind the transition and prepared to proceed smoothly. The best way to ensure this is through offering monetary incentives and paid training.

Qualified EMR Systems

In order to reach the standards set by CCHIT, which will be announced in about 6 months, facilities should try to start work now, even before the final requirements have been laid out. The main goal should be to reach what is considered by Dr. Richard Howe, vice president of Healthcare Informatics Associates, to be the minimum required to see a large difference in patient care: fully-operational CPOE. Because this is what enables doctors to interact with patients’ files and records digitally, this is one of the most important aspects of a good EMR system. Without CPOE, it’s impossible for any hospital to advance to full digitization and difficult for any hospital to see any significant improvements in patient care.

Evaluating the IT Infrastructure

It’s important that hospitals looking to update to enable CPOE first evaluate their current systems to see if they will be able to support CPOE and other basic digital technologies. In some cases, facilities may need to go through the expensive, time-consuming, but ultimately rewarding process of replacing their old computer systems with modernized ones and starting from scratch. Another option, for hospitals that have EMR systems that are relatively up-to-date but not quite up to par, is to simply refurbish what they already have. This may not be possible or even preferable in many cases, however, because new technologies can mean large changes in workflow and user-interface that could be more easily negotiated with an entirely modern system.

Measuring the Investment

Healthcare providers should make sure not to see this transition as an obligatory inconvenience, but as a way to both improve patient care and cut costs. EMR significantly increases accountability and reduces error, which can save lives and eliminate mistakes that cost money. The investment in a good EMR network is well worth it. To put together a more specific cost-benefit analysis, there are calculators online that hospitals and practices can use to approximate their ARRA stimulus packages, which can be found at the CMS (Centers for Medicare and Medicaid Services) or HIMSS (Healthcare Information and Management Systems Society) websites. Healthcare providers must then estimate how far they are from their goal and how large the investment to reach that goal will be, and they must not forget to include the significant operational cost of training in that estimate.

Action Steps to Take Today

Although the task of switching to digital records may be daunting, there is no time like the present to get started. The first thing that providers seeking to get ARRA checks by the end of 2010 should do is set their “meaningful use” goals: see what systems (PACS, CPOE, CDSS, etc.) can be installed now, and what can follow immediately after. Next, facilities should check on their existing IT infrastructures to see if they can carry the transition and whether they have redundancies or, on the negative side, disparate systems/networks. Hospitals and practices should also immediately eliminate any non-standard procedures, including shortcuts taken by staff to save time. Any procedures that aren’t industry best practices can lead to inconsistencies, which will interfere with the switch to digital. Basically, facilities should be filling in the gaps now to prepare for the transition.

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For further information on ARRA, contact healthcare and hospital architecture firm:

William N. Bernstein, LEED®AP, AIA
Principal
Bernstein & Assoc. Architects - PLLC
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