A Hospital Administrator's View of Syndromic Surveillance

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Penn Krause, HMS’ Vice President of Business Development, has previously served as a CEO, COO, and Division Vice President in non-profit and investor-owned healthcare systems. During his tenure as COO of the Pittsburgh Mercy Health System, the system was named one of Hospitals and Health Networks “Most Wired.”

In a recent HealthData Management article, Joseph Goedert writes, “sales of electronic health records (EHR) systems hit $17.9 billion in 2011, a 14.2 percent increase over the previous year, according to an annual study from Kalorama Information, a New York-based research firm.”

As the adoption of EHRs accelerates, more hospitals are working to understand the financial and technical requirements of Syndromic Surveillance Implementation.

Technical Issues

EHR implementation can be a challenge for even the most skilled IT department. Syndromic Surveillance is just one part of the bigger EHR picture. The biggest areas of concern involve:

• Time. Installing or upgrading an EHR system is time-consuming.  To achieve Meaningful Use certification, most hospitals will need to upgrade or install new systems.
• Scope of work.  Meaningful Use implementation is much more complex than most IT projects, which are often geared toward coding.
• Changes for ICD-10 and HIPAA. EHR implementation overlaps with these changes.

Cost and Timing

Additionally, the up front cost of an EHR is a concern. While compliance ensures receipt of Medicare and Medicaid incentives, getting an EHR system up and running is costly—both in terms of time and money.

• The cost of implementation and the degree of coordination with other projects requires a strong leadership commitment. There is agreement that the EHR strategy should be included in the overall strategic plan and vision of the hospital.
• A budget for EHR can be in the tens of millions of dollars—with a ROI of several million.
• Because of the complexity of project implementation, and its effects across a health system, hospital leadership understands that EHR implementation cannot be rushed. Instead it is part of a multi-year plan.

Long Term Planning

Stage 2 Meaningful Use implementation becomes mandatory in 2014, so long term planning is critical to address the challenges involved.

• There will be changes to the core care delivery processes, affecting physicians, hospital personnel, and the IT staff.
• Project management is being utilized to oversee the redesign of multiple processes while monitoring potential disruptions.
• Hospitals are looking back at Stage 1 as they move forward. During Meaningful Use Stage 1, hospitals discovered that EHR vendors’ work capacity was constrained by the high demand generated by the incentive programs. This comes at a time when both hospitals and vendors face significant shortages of trained staff.

Addressing these complex issues now will help hospitals to plan well for Syndromic Surveillance implementation.  This will help to ease the transition to stage 2.