Health Care IT Leaders Still Optimistic and Now Realistic

by Fred Bazzoli

Earlier this year, a hospital CIO described hospitals' efforts to achieve meaningful use of electronic health records as thinking you're running in a 5K but finding out it's a marathon, and the finish line is moving further away with each step.

It's true that marathon runners experience a rush of adrenaline when they start, and everything looks rosy that first mile. Likewise, hospital CIOs were optimistic a year ago about their organizations' chances of receiving federal stimulus funding under the HITECH portion of the American Recovery and Reinvestment Act.

CIOs now are discovering they are in the midst of a long-term effort that will present a variety of challenges. While their timelines have been readjusted, most are cautiously confident as they move ahead with plans to implement EHRs.

Since August 2010, the College of Healthcare Information Management Executives (CHIME) has been tracking the expectations of its 1,400-plus members -- CIOs and other senior health care IT leaders -- through a series of surveys on meaningful use progress and challenges. Results of the past four CHIME surveys provide insight into how the nation's hospitals are making progress in using EHRs.

Over the course of the four surveys, CIOs have been consistently confident that their organizations will achieve meaningful use objectives that will qualify their organizations for stimulus funding. For example, the latest CHIME survey, conducted in mid-September, found that 93% of respondents predicted that their organizations would be able to qualify for funding under parameters outlined for Stage 1 of the program. This finding is consistent with the results from the last three surveys, where at least 90% of respondents said they expected their organizations to qualify for Stage 1.

Adjusting Expectations

While CIOs remain optimistic about the meaningful use program, their timelines have lengthened. In CHIME's first survey, conducted in August 2010, some 28% of respondents indicated they expected to qualify for stimulus funding in the first six months of federal fiscal year 2011, or by March 30, 2011. However, CHIME's third survey of members, conducted in March 2011, found that only 7.5% of respondents said they would qualify by that date.

In CHIME's most recent survey, 26% of respondents said they had qualified for payments within the first year, and more than two-thirds (68%) expect to achieve Stage 1 objectives over the next two fiscal years.

Over the past year, reasons behind this readjustment of expectations have become clear.

The meaningful use incentive program is complex, and some important details have emerged only recently through a series of answers to frequently asked questions that federal agencies administering the program have provided. The program first requires registration, and attesting to achieving meaningful use requires 90 days of documented experience, at least for Medicare reimbursement. Further, as of Sept. 30, only about half of all states had active Medicaid meaningful use programs, limiting incentive payment disbursements through Medicaid.

Hospital Size Matters

Results of the surveys also revealed variations among hospitals of different sizes. For example, in the latest CHIME survey, 30% of CIOs from hospitals with fewer than 200 beds and 28% of CIOs from hospitals with more than 600 beds reported that their organizations had qualified for funding. However, other hospital sizes didn't fare as well -- just 18% of CIOs from hospitals with 200 to 399 beds and 23% of CIOs from hospitals with 400 to 599 beds reported qualifying for funding.

Those results suggest that the scope of EHR implementation at smaller hospitals is perhaps more manageable, while larger organizations have more resources to put toward an implementation project and are more likely to have begun EHR adoption years in advance of the meaningful use program.

On the other hand, mid-sized organizations may struggle more in the future, coping with both the size of the implementation project and the cost requirements of successful initiatives.

Concerns Changing

CIOs have reported a variety of concerns about achieving meaningful use, and those worries have changed over time as issues arise and then are resolved. For example, a key concern cited in the first survey, conducted in August 2010, was certification of EHR products. Those worries subsided after the temporary certification program ramped up in early October 2010.

For the second survey, implementation of computerized provider order entry was most frequently mentioned as a concern by CIOs. For the last two surveys, capturing and submitting data for quality measures has become the chief issue for CIOs.

Finally, while CIOs have their hands full with EHR implementation and other looming issues, they are more aware of political forces that could affect the future of the meaningful use incentive program. In an open-ended question about ongoing concerns in the most recent CHIME survey, several respondents noted their unease about ongoing funding for the program.

"I don't believe the money will be in this program long-term," wrote one respondent, while other CIOs mused about whether the incentive program will survive deficit-reduction efforts of the congressional super committee or a potential change in administrations.

Repetition of these concerns underscores the high importance that hospital organizations are placing on federal funding to help defray the cost of expensive EHR implementation.

Larger, organization-wide concerns about sustaining funding for EHR projects also indicate growing interest in EHRs by hospitals' senior executives and the high level of responsibility that CIOs bear for these projects.

But since the starting gun has been fired, health care IT executives nationwide are settling into a comfortable pace, looking to sustain themselves and their organizations for what looks like a long, grueling but ultimately satisfying challenge. "Perseverance is not a long race; it is many short races one after another," wrote Walter Elliott in The Spiritual Life. That may be particularly true for those in health care IT in the years ahead.

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