Changing clinician workflows to collect the data CMS will require for quality reporting, then combining and submitting that data in the exact form stipulated, is the top CIO concern as the industry works through Stage 1 while keeping an eye on Stage 2 development, according to the June healthsystemCIO.com SnapSurvey.
Overall, most CIOs felt fairly confident Stage 2 requirements “should be ok” (73 percent), while a quarter were “very uncomfortable,” with what’s being proposed. Most (58 percent) didn’t necessarily think CMS would be the voice of reason, whittling down any excessive measures put forth by ONC and its HIT Policy Committee. Asked if the Stage 2 NPRM would be feasible, they responded, “It could go either way.”
On a positive note, the vast majority (79 percent) felt Meaningful Use had not forced vendors to abandon any projects their customers — CIOs — felt to be critical.
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. 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)
Like a Hawk …
- Like a hawk – I try to listen in to the Webinars of the HIT Policy Committee and the MU WG whenever possible (either live or recorded).
I’m Keeping An Eye On It …
- Most of what I have seen is adding what was originally in Stage One but was delayed on final rule. I have not seen much lately.
- It’s like watching Congress. I watch the people that watch them and, by the way, summarize the outcome.
- I try to keep current, but do not dedicate my energies to MU Stage 2.
- They are still changing definitions of Stage 1 even after the attestation period has started. I don’t think I am going to get too worked up on Stage 2 at this point.
- I spent a lot of time tracking preliminary rules of Stage 1 to find the final rule frustratingly different. I am now paying attention to the big things but waiting for the final rule to be published.
- There will be lots of gyrations before the final rule yet.
It Should Be Ok …
- It is a heavy lift but not impossible.
- Ok for now, but it would be easy to make me uncomfortable.
- It’s a bit much, but doable with great effort.
- I have some reservations about some objectives (e.g., reporting of labs) and hope they will be removed in the rule-making process.
- What’s out there still leaves a lot open for interpretation.
Very Uncomfortable (It’s Way Too Much) …
- It’s not that it’s too much – it just remains too undefined, too many concepts and signals and not enough specifics … new terms (longitudinal care plan for example) – all of which will require changes to systems and process. With the lack of definition, the time worries me a lot – as the government has not been quick in providing specifics.
- Making the provider responsible for the patient’s behavior in areas like use of an online portal seems unreasonable. Extending the Stage Two startup a year is only helpful if they don’t cram a bunch of new requirements into the mix.
- We’re all headed for a big shock. Soon it will be clear that healthcare cost keep rising. Soon we’ll figure out that we have mostly dirty data from early Stage 1 providers. Then Stage 1 folks will look at MU 2 and we’ll asking, ‘When will America see the benefit of either stage?’
- Given the current state of EMR software and the reluctance of physician adoption, I feel it might be too large a jump.
Very Confident …
- My concern is that I hope there will be sufficient clarity in the final rule so we won’t have to wait for a series of CMS FAQs and clarifications to interpret the objectives properly.
Could Go Either Way …
- I do not think CMS fully understands what is really happening “out there” – it would be better to wait and understand how EPs and hospitals are able to comply with Stage 1. In my view, Stage 1 compliance rates will be less than hoped for … so a high bar for Stage 2 will only compound the problem.
- CMS must turn “ideas” or “recommendations” into actual law … this seems to bring a bit more reality into the equation. Tony Trenkle definitely listened to the pros and cons of MU Stage 2 … so I am hopeful.
It’s Likely They Will Be Too Onerous …
- It is likely to be onerous regardless of the thresholds they set, as CMS has shown it can make things unnecessarily complex without even trying.
- ONC is reacting to get something done. Let’s face it. This is an IT project on a massive scale. Remember our choices, “Do it right, Do it Fast, or Do it Cheap.” Which two do you think ONC must choose? Which two do you think providers want? And America wants?
- Savings will be more important than giving out incentives. CMS is in a penalizing mood. Once ICD-10 hits, all requirements will seem onerous.
Clinical Data Management For Quality Reporting
- Not an issue for us, but Problem Lists will be a challenge for many, just for Stage 1.
- Providers have dirty data. We all know it and to fix this will take time and money. Let’s see now, do we have plenty of those?
- I’m not comfortable that we capture everything in the EMR and will be able to electronically submit quality data. I do not feel the agencies will be ready to receive the data electronically, let alone use the data.
- Lots of overlap between MU, PCMH, Core Measures and ACO measures. It will be difficult to line this up.
Garnering Sufficient Vendor Support …
- honestly, it’s a toss-up between vendor support, CPOE, and clinical data management for quality reporting.
Ambulatory EMR Rollout (Owned or Independent Docs)
- Some of our focus at the hospital is shifting to our ambulatory EMR rollout which could become a distraction for the hospital implementation.
- No one issue is of concern; however, when you consider all the moving parts as a whole, and remember that any one point of failure is enough to prevent successful compliance, any CIO worth his or her salt will have some level of angst.
- We require a lot of upgrades to hit Meaningful Use. We’re on a good track for that.
- All of the above
- Getting everything else done and the coordination of efforts between things like MU, IDC-10, ACO (Medical home et al), Beacon grants, HIE, etc.
- Not abandon; however, vendors’ overall performance has slipped – they are trying to do too much, too fast. As a result, many balls they try to juggle get dropped.
- Not critical, but much desired.
- We have actually relaxed our pursuit of MU Stage 1 to address other priorities and to see if one of our vendor’s other clients can actually successfully qualify with their certified version.
- Deliverables have been delayed but not abandoned, but this is occurring more frequently.
- Not the vendors, but we as providers. We now have the Feds taking about 20% of our budgets on the priorities they have set. The vendors go where we go, of course it impacts them.
- Not that I know of at this time. I do fear that MU will cloud the ICD-10 issue and make both harder to achieve.
- Not yet, but resources are getting scarce.
- Connecting wireless smart IV Pumps to the system is one example.
- In that we are our own vendor – I KNOW we have put off other very important I.S. efforts due to MU.
- General product enhancements, including those viewed as essential by clients, are necessarily on the back burner as the vendors deal with MU upgrades.