SO the Internet is FULL of articles about ARRA and the healthcare IT portions it contains.  Whether it is incentives for the docs to become more electronic or the vendors to learn what it will take to be CCHIT certified, everyone has an opinion on how it is going to all play out and how you can get a piece of the action.

I do have to say that whatever your politics or whichever side of the IT fence you live on (vendor or provider), you have welcome the increase in chatter about electronic health records, standards, information sharing, and open source.  Lets face it; one of the best models out there (no matter what you think about the government's ability to get things done) is the VA and Open Vista.  They have been using and improving on Open Vista for years.  And guess what?  It is FREE.  That’s right – anyone can download and install a copy.

Now, for your average physician’s office, you certainly will need some help building a machine to run it and then getting it all set up – but still, aren’t you going to have to do that ANYWAY with just about any in-house solution you choose?

We had a meeting here right after all the lingo hit the streets from ARRA surrounding physician adoption of EHR’s and actually discussed putting a copy of Open Vista on our web site, maybe with some configuration tips, and let folks download it for free.  Not really our business, but being a Linux shop and very much “pro-open source”, we thought we would help spread the word.   MedSphere beat us to the punch – and good for them – as this is more their domain.

I know a lot of folks are out there weighing their options and trying to figure out what they really need to do to take advantage of the incentives while at the same time not handcuff themselves to the government's purse strings and rules and regs.  And there are TONS of vendors throwing their hat in the EHR ring, making it harder by the day to actually determine what your true options are.

To top it all off, there are all these organizations, experts, etc. trying to actually define “meaningful use”.   I am by NO means an expert, but I do have some thoughts that could be construed as words of wisdom:

• “Meaningful Use” needs to be in the context of YOUR BUSINESS.  How can an EHR help you meet the goals of your practice or business, positively impact YOUR workflow which means potentially improving productivity and decreasing costs, and help you maintain high clinical standards?            DON’T get caught up in the hype, the game, the ARRA, the buzzwords. etc.   and let other people or so-called experts tell you what “Meaningful Use” is to you.

• LOOK at your practice’s business – you know it best.  What processes and workflows are the same as other physicians or clinics? What are different, and why are they different? Because of your specialty? Your target market? Your geographical location?

• Make sure you understand the information your practice is collecting in your current processes. WHERE is it coming from? WHY is it being collected? WHAT are you doing with it? HOW is it impacting or used in current processes?  WHAT format is it in – paper? Fax? Electronic? Remember it could be supporting processes or causing roadblocks. And don’t leave anything out.  Include the most mundane information sets including those not directly patient related – phones messages, on call messages, on call schedules.

• Prioritize the information flowing through your practice.  What is most important to keeping your practice on track – financially, clinically, strategically.

Sounds tedious, but I believe what you will start to develop is a list of data elements that should be the foundation for YOUR electronic health record that you will be able to USE MEANINGFULLY.

You can begin to see pieces of it already in place in your current practice and processes.  You will see patterns in your data collection and distribution process, and start to identify areas that could be streamlined or automated or easily converted to an electronic form.    After all, the first steps to an EHR is to actually have electronic data to put into it.

If you slowly incorporate this into your processes even before you settle on a vendor or a tool, you will start to see what qualities that your ultimate choice for an EHR needs to have.

And a final word:
KEEP IT SIMPLE.

The exchange of information is in its infancy.  Standards are non-existent.  Stick to what you know – WORD, EXCEL, TEXT FILES, SCANNED FAXES.  This does not have to be complex.

Keep track of what you are doing and where you are putting it; write some policies – they can be as simple as “All Faxed Requests for Records will be scanned, with the scanned document named in the following format:

“RecordRequestMRN1234567_docname_date.jpg”.
Create a folder on a shared drive to hold this info.  Then start collecting it.

And guess what? You are one step closer to an electronic health record that will actually support your business, reduce your costs, and become a tool you can use (yes, meaningfully) rather one that you are mandated to install.