Guerra On Healthcare: Stimulus Funds For All EMR SystemsGuerra On Healthcare: Stimulus Funds For All EMR Systems

One of the Holy Grails in healthcare IT is what's called closed-loop medication administration. Few of these systems have been fully implemented. With them, a doctor uses a computerized physician order entry system to send an order directly to the pharmacy where it's electronically received and checked against different rules engines.

Though the details vary depending on the implementation, at this point a pharmacist eyeballs the order for an additional verification, after which "smart" medication dispensing cabinets, or even robots, bring the right dose of the right drugs to the right unit. After it's received in the unit at some sort of centralized station, a nurse removes the medication from the delivery vehicle and brings it to the patient's bedside. Before administering the drug, the nurse scans bar codes both on the drug vile and patient wrist, confirming right medication, right dose, and right patient.

Closed-loop medication administration is so difficult to achieve because it touches all the main constituencies in clinical workflow--the physician, nurse, and pharmacist. Leaving out any step in the process puts patient safety at risk. Going all the way is very important.

Throughout most of the HITECH process, the government has been intent on going all the way, even sometimes to a fault. It's set the bar defining the "meaningful use" of electronic medical record systems quite high, and the timelines for compliance are extremely tight. The national coordinator for health IT, Dr. David Blumenthal, has said the legislation offers a once-in-a-lifetime opportunity to advance the implementation of health IT that cannot be missed or fumbled due to a lack of audacity.

I've been a strong critic of such an approach, as I'm very concerned about healthcare providers trying to do more than they can reasonably handle just to earn a few stimulus bucks. But there's one area where the government has pulled back to the detriment of the whole program: Hospital-based doctors aren't eligible for stimulus funds.

Hospital-based providers are defined as those who practice 90% of their time in a hospital setting, which would include many pathologists, radiologists, hospitalists, and emergency department physicians. That's 30% of doctors according to some estimates. A fairer distinction might exclude hospital-employed physicians from the program, as those doctors probably wouldn't have separate offices that could benefit from running an EMR.

Why physicians who aren't hospital employees and do maintain an office-based practice are being excluded from the incentive program is far from clear or sensible. Why is the government leaving such a large chuck of the physician population without a carrot to implement EMRs?

A preliminary guess is that the government is paring down the HITECH program, as estimates for its cost dropped by at least $7 billion from early 2009 to the release of the Interim Final Rule on Dec. 31. But when in the last few years have the feds cared how many billions--certainly millions--they throw around? Why start now with something so important?

Last week, almost a $1 billion in HITECH largess was announced including over $10 million for health information exchanges in Guam, Puerto Rico, and the Virgin Islands. Since the government is being so generous with taxpayer money, I hope they give physicians who spend most of their time in hospitals a second look.

There's no doubt that closing the loop on medication administration saves lives, and there's equally no doubt that closing the gap on HITECH physician eligibility will do the same.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].