You have just left a meeting with your key vendor(s) and received assurance that they will get you to Meaningful Use. With your estimated $6M in ARRA incentives now well in hand, you should be feeling pretty good or should you? The question is who is really responsible for attaining Meaningful Use? The answer is, the responsibility is squarely on your shoulders.

The challenge with Meaningful Use attainment and sustainment is that the rollout out of software system upgrades and construction of the technical infrastructure is the relatively easy component of the overall project. You should ensure that your vendor is holding this hot potato by providing CCHIT ARRA certified products. You should also expect your vendor(s) to provide training and rollout assistance. Additionally, your vendor should provided plenty of implementation accelerators like large quantities of sample orders sets and care plan templates. So with these expectations, when your vendor says they can get you to Meaningful Use, there is really no mistruth spoken – they should be able to do that.

So now your vendor is on the hook to provide CCHIT ARRA certified products, where does your organization go from here? That is the challenge and the idiom, you can lead a horse to water, but you can’t make it drink, now applies.

Your vendor can not prevent you from the following all too familiar scenario – you successfully complete the most elegant architecture and the smoothest upgrade(s) ever done at your organization. The system is rolled out with much aplomb and the result – the adoption rate is abysmal. Despite the elegance of the technology and providing a technical platform to attain Meaningful Use the system is a failure due to lack of adoption. The painful reality is that the responsibility for system adoption weighs squarely on your shoulders – it is your hot potato, not the vendor’s. Too many sites spend tremendous energy on building the perfect software upgrade/installation/deployment project plan from a technical perspective. As the plan is reviewed the workflow impacts, applicability and risk mitigation is “short sheeted”. Your organization must understand the impact of “going electronic”. Some examples are:

• CPOM, in many cases, can initially cause ordering times to go from 2 minutes to 9+ minutes
• Vendor supplied generalized documentation templates usually do not work in specialty units like the NICU or Burn Unit and have to be modified
• IT systems, under Meaningful Use, become absolutely mission critical and require detailed planning for disaster recovery/business continuity, 24x7x365 help desk support, etc.
• Risk mitigation strategies and plans must be in place in for both technical and business challenges

These are the gnarly, tough challenges and can be as difficult as untying the Gordian Knot. While your vendor can help – your organization ultimately owns these challenges/issues and the solutions/resolutions.

Hopefully this brief review helps clarify the problem, but what about the solution. Remember that there is really no way to ensure success, but there are ways to ensure failure (these are the ones to avoid). There are a few key components that can be implemented that will significantly enhance the probability of success. They are:

• Establish a governance structure that is inclusive of representatives spanning the organization (clinical, IT, finance, and executive leadership)
• Ownership of the project must NOT reside in the IT department
• Ensure there is a dedicated overall program manager that is not “vendor supplied”
• Define the IT department as a service organization supporting the business and not vice versa
• Clearly understand the workflow impacts of Meaningful Use requirements
• Strategize and document how to move from the Year 1 90-day trial period with attestation to Year 2 where 100% of the requirements must be met 100% of the time with electronic proof
• Develop adoption and risk mitigation strategies including an “alternate plan B”
• Budget appropriately for supporting the 24x7x365, mission critical environment remembering once you are paperless your fallback strategies are limited

Remember this list cannot ensure success, but will provide a series of best practices that can help avoid failure.

So back to the original questions that started this:

• Is the funding in hand?
  • Most likely for Year 1, but going forward no real guarantees.
• How should you feel?
  • With appropriate planning confident, but a tad nervous.
• Who is the last to hold the hot potato?
  • Definitely the organization and not the vendor.

As you move forward with ARRA remember the hot potato will ultimately end up in your lap, plan for that and it will not be too painful.

For more information on how Santa Rosa’s “tell you what you need to hear”, experience-based approach, can help you manage the hot potato, please contact us at http://www.santarosaconsulting.com.