Beyond Meaningful Use

K.W. Keirstead, Managing Director, Civerex Systems Inc.

800 529 5355

The consensus among healthcare agencies seems to be that a net investment is required by provider organizations to achieve “meaningful use” and that the ROI recovery time is likely to exceed what most organizations are prepared to live with.  This is solidly backed up by the large “EHR Impact” study published in 2009 by the European Commission.

At first glance, a reasonable strategy for agencies might appear to be to do nothing, but:

1)  Payors are starting to indicate that the level of reimbursement will be tied to “meaningful use”.

2)  Reduced budgets appear to be settling in for the long haul.

3)  The number of individuals requesting services is poised to increase dramatically.

Sitting on the fence waiting for things to settle down has its own set of problems.  Agencies that elect to cut back on staffing and overhead costs at the same time as the demand for services goes up risk a crash and burn outcome.

The good news is that for the same investment required to meet “meaningful use” criteria, software solutions are available today from Civerex Systems Inc. that allow agencies to look beyond “meaningful use” and tap into quantifiable benefits listed below that can dramatically shorten the ROI timeline.

  • Increased staff efficiency
  • Improved patient throughput
  • Decreased admin/clinical errors
  • Improved compliance with internal and external rules and regulations

Readers will be quick to point out that in the absence of substantiation, these benefits are nothing more than the usual “saves time and money” representations that all of the software vendors in this market space are quick to parade in front of their prospective customers.  Not good enough.

For many agencies, the time previously spent looking for paper charts will simply be replaced in EHRs by time navigating computer system menus and hunting for forms required to document interventions.  But, what if the computer system were to have no menus, what if the computer system were to have the ability to automatically bring forms to users, and what if completion of one intervention could lead to automated scheduling of the next intervention?

Suppose we take Agency “best practice” protocols that may, at best, be documented on paper flowcharts and we put these “in-line” and give users a simple InTray consisting of a schedule and a To-Do list.

Clearly you need “pattern recognition” software that can “read” paper flowcharts, carve up these charts into “steps” or interventions.  Then you need an Orders Management System capable of posting interventions to User InTrays.

As each step along an “in-line” best practice protocol (e.g. patient care pathway) becomes “current”, the software posts the step to the appropriate user InTray either as a fixed time appointment or as a floating time to-do step.

When the user completes the step that is current, the flowchart logic should reasonably be able to detect this and immediately post the next-in-line step to the appropriate user InTray.

You can see that we have here a solid basis for increased staff efficiency and improved patient throughput (i.e. a simple, easy-to-use interface consisting of one computer screen, with no need for navigation and no need for routine communication across users at the individual transaction level).

You now have your shopping list for a new software system – instead of looking for a rudimentary EHR software system, look instead for workflow management software that has the capability of a) compiling mapped processes (e.g. best practice protocols), and b) posting “orders” based on the logic that is built into these processes.  EHR quietly moves from center stage to the background where it rightfully belongs.

From here, how do we get to the two remaining benefits highlighted earlier?

Workflow management systems automatically take care of what is the next step, who should perform it, when, where, and how it should be performed, leaving very little opportunity for things to fall between the cracks.

But the reality of providing healthcare services is that no workflow can account for all of the extraordinary situations that can arise.  Therefore it becomes necessary to allow users to perform tasks out of sequence, skip tasks, and perform tasks that are not part of a best practice protocol.

This raises the question “why base processing on best practices if, at a practical level, there are going to be frequent deviations from these practices?”

Good point.  As usual, the devil is in the details, so you need in any workflow management system the ability to accommodate Process Control Points (PCPs) at key steps along patient care pathways where the software system independently carries out background checking and sets up hurdles that are removed only when all observed deficiencies have been remedied.

This takes care of decreased admin and clinical errors and improved compliance with internal and external rules and regulations.  Yes, you can have your cake and eat it.

Bottom line . . . Doing the right things, the right way, at the right time, using the right resources whilst maintaining documentation standards puts you well on the road to improved outcomes which is what “Meaningful Use” is supposed to be all about.

Both the CIVER-PSYCH® Behavioral Healthcare/Workflow Management Software Suite and the CIVER-MED™ Medical Management Software Suite from Civerex Systems are Orders-based software suites that satisfy all of the above.

For more information, visit or contact K.W. Keirstead, Managing Director, Civerex Systems Inc., at 800-529-5355 or


Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, connect-the-dots law enforcement investigations, healthcare services delivery, job shop manufacturing and b2b/b2c/b2d transactions. (C) 2010-2018 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
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