Survey Says: CIOs Not Bullish on HITECH

In what makes for a disturbing combination, CIOs are both doubtful that the federal government (HHS/CMS/ONC) will have the HITECH program fully operational by the time incentives are to be paid out, and pessimistic about their chances of qualifying for those payments, according to the healthsystemCIO.com April SnapSurvey.

A full three quarters of CIOs doubt that all critical elements of the program — including a functioning EMR certification program, finalized definitions of Meaningful Use (at least Stage 1) and a method of reporting to CMS — would be established with enough lead time for vendors and other critical market participants to aid providers.  And while 75 percent doubted the program would be ready to pay out stimulus dollars, over 60 percent said receiving those monies at the first opportunity was critical to the health of their organizations.

Ironically, while the majority of CIOs said their health systems need an early payout, only 14 percent think they would qualify for the money if the Meaningful Use all-or-nothing program outlined in the NPRM becomes the “law of the land.” Specifically, most CIOs cited medication reconciliation, problem lists and producing the necessary HITECH-related quality reports as their primary gaps.

When it comes to grading ONC on its outreach to CIOs in the trenches, almost 80 percent said National Coordinator David Blumenthal’s office had not done enough to bring real-world perspectives to the table.

But when it came to that offices distribution of non-Meaningful Use HITECH monies for things like education programs and regional extension centers, the majority of CIOs thought the majority of that cash had been well directed, though the REC program was singled out as being of dubious value.

SnapSurveys are answered by the healthsystemCIO.com Advisory Panel, comprised of more than 65 industry-leading CIOs.

(To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)

Mission Impossible …

• “How can they? You need to run the certified version for 90 days before you can begin reporting. So if a provider wanted to start reporting in October, the vendor would have to obtain temp certification before July 1 (and provider install by July 1). The final regs are not due until June – time is not there.”

So much to do, so little time …

• “If the challenges were not enough in the first place there are many details and much nuance still to be worked out. Even with a “final” rule there will be much left to define/refine.”
• “I think they will not have all the elements fully defined and will have to extend deadlines as the lift for most organizations is considerable
  It’s already just about too late – unless you expect that providers and vendors will need no time to respond.”

Yes, but…

• “I suspect that CMS will be pressured to streamline year #1 in order to start this flow of stimulus money. Otherwise the administration will be under severe criticism for their disorganization and bureaucratic leadership.”
• “Yes, but they will change deadlines and possibly criteria to meet their timetable.”
• “Yes if providers and vendors are willing to hedge a bit and continue forward movement on speculative “essential elements” rather than waiting on all items to be published in final form.”

We need it now …

• “Only because we fear the math behind this. If the majority of EPs and Hospitals do happen to qualify, the funding will be depleted very quickly. Think ‘Cash for Clunkers. ‘”
• “We are headed toward very tight financial times in the provider community. ”

We’ll take it as it comes …

• “Since we already made our major EMR investments, receipt of stimulus funding is not a showstopper.”
• “Not critical as we are looking at this as bonus dollars and not part of our bottom line.”
• “In many ways, the stimulus opportunity only reset some priorities — it didn’t significantly alter our long-term objectives. From a strategic perspective, it pushed us to consider major platform revisions sooner than we otherwise would have done (maybe if ever). We view the stimulus opportunity as a real nice to have (and we certainly expect to harvest as much as we can) but the money, per se, is not a central driver for us.”
• “Our organization will be investing in EHR technologies because it wants to provide quality patient care and to remain competitive. The Stimulus monies are secondary to that.”
• “Critical no, but if all this is to be believed CMS must delivery money. Many physicians are skeptics because CMS has promised only later to reverse policies on payments. What would happen if more folks become skeptics around HITECH? CMS must walk the talk.”
• “We are targeting 2012 for first year HITECH compliance for our hospitals and MD practices.”

Medication reconciliation, problem lists and quality measures reporting …

• “We will qualify within the first year, but not likely on the first day of the first year. Medication Reconciliation, complete electronic HIM record and HIPAA audit compliance are open issues.”
• “My confidence is rising with the exception of meds reconciliation. It is much harder than many of requirements.”
• “Meds reconciliation, hospital problem lists.”
• “Need to reach 10% IP CPOE. Problem lists in SNOMED and the Quality Measures are areas of concern.”
• “We are trailing with our Outpatient EMR, Patient Portal, and new quality measurements.”
• “We’ll be close to 90%. Gaps may be a few clinical units, and the ability to actually crunch the data to produce the metrics will be a challenge.”
• “Assessments of data needed; development of processes and systems to create and validate the report; maintenance.”

Needs to reach out more to the little guys …

• “ONC has emphasized academic medical centers and large organizations. Community hospitals are underrepresented.”
• “Dr Blumenthal has met with many of us but his Boston academic background seems to dominate the pronouncements.”
• “They have mostly engaged with the CIOs of some extremely large and well-respected health systems, to its credit. However, these noteworthy organizations are most capable (i.e., have large IT departments) to achieve the goals. Most hospitals do not have those types of resources.”

Need more outreach to better connect with real-world challenges …

• “It seems to me that ONC, including the advisory committee members, has a vision that transcends real world reality. I’m not sure that is a bad thing – it certainly has many providers’ attention – but if the objective is to get money in the hands of providers in return for the implementation, adoption, and meaningful use of EHRs, the bar may be set too high. We will see after CMS publishes the final rules whether the rank and file have been listened to or not.”
• “I know they are meeting with and talking to CHIME and HIMSS but really not talking to the folks working day to day on the deployment of technology. They also aren’t talking to physicians.”
• “They are dreaming of the way they want things to be, not the way they are. It is going to be incredibly difficult to deliver to their expectations.”

RECs don’t inspire confidence …

• “The funds going to regional extension centers seem a waste. It’s not enough money on a per-physician or per-practice basis to make much difference and appears to just be lining consultant’s pockets.”
• “Regional Extension Centers are intended to address the most critical provider needs yet many grantees appear not to have extensive background implementing EHRs.”
• “I have reservations on the value of RECs. On the other hand, monies used to support ONC, in general, and standards-setting are well used.”