Survey: CIOs Support MU Delay, Citing Barriers That Still Exist

Although the majority of CIOs support an extension of Meaningful Use stage 2 and believe the federal incentive program is headed in the right direction, serious concerns remain, according to the May healthsystemCIO.com Snap Survey.

Nearly 70 percent of CIOs said they believe while Meaningful Use has played a key role in advancing the healthcare IT industry, major challenges exist, including tight timelines, a lack of interoperability standards, and a flawed framework — specifically, the fact that stages and requirements are added without first evaluating the success of the first phase. “There are a lot of assumptions that MU Stage 1 has been a success without empirical data,” one respondent noted.

Another CIO stated that having short windows of time between deadlines affects the organization’s ability to “fully optimize clinical workflows,” which can lead to errors in patient care as well as staff burnout. “Timelines place us in a position of perpetual upgrades and implementation,” he added.

For the most part, CIOs feel that pushing back stage 2 is the right move, particularly in light of the many priorities they’re forced to juggle. “If meaningful use was the only initiative on our collective plates, the current timeline would not be an issue,” one respondent said. However, “when you combine this with ICD-10, ACOs, Medical Homes and the normal production support for the systems within the healthcare setting, the pace is too fast and resources are short.”

On the other hand, others feel that a delay could stall momentum. “The industry responds much more effectively with the aggressive timelines,” one CIO noted. “Postponing the deadline creates a sense of complacency that stalls innovation.”

But despite the inherent flaws that may exist, most CIOs believe Meaningful Use has put the industry on the right track, and that it’s imperative to keep moving forward. “The ability to enhance patient care through the use of technology has been a 20-plus year goal, and we are finally seeing it come to life,” a CIO stated. Another simply said, “This is the right thing to do for patient care.”

(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.)

1. Do you support the proposed one-year extension of Meaningful Use stage 2?

Yes

• We don’t know the benefits of Stage 1. Why would we continue to implement a program without understanding the benefits?
• If meaningful use was the only initiative on our collective plates, the current timeline would not be an issue. When you combine this with ICD-10, ACOs, Medical Homes and the normal production support for the systems within the healthcare setting, the pace is too fast and resources are short. We have to bring in expensive consultants to accomplish the work, and this is not helping to lower the cost of healthcare, but rather is impacting it negatively.
• It doesn’t matter to us. As a children’s hospital attesting under the Medicaid program, there is no penalty if we don’t demonstrate meaningful use. And with 3 years in Stage 1 (1 year for adopt/implement/upgrade and 2 years for MU), our final year of incentive dollars will be year 1 of Stage 2. It’s unlikely we’ll bother with stage 3.
• With payment reform kicking in, I think as a priority this becomes a bit less as more and more providers are starting to see significant hits to their bottom lines already.
• Globally, yes, this would benefit the greater good and allow providers to realize the intended benefits of MU.
• Vendors won’t even have the required system updates ready to adequately implement with workflow process changes. The requirements were delayed coming from the feds, so why should we have to make up the difference in our implementation and put patients at risk?
• The system upgrade for this for us will not occur until July and it takes post-upgrade time to implement new processes. This, coupled with ICD-10 and our need to be mindful of how much work we push to the physicians, is hard to juggle in the same timeframe.
• There is so much packed into the next few years. A delay would help us in many areas.
• The more of these stages which are proposed, the wider the gap between institutions capable to maintain goals and those NOT having the resources, nor infrastructure to support them.

Yes, but one year isn’t enough time

No, I don’t support an extension

• Honestly, I’m not sure the money will continue to remain available for incentives.
• The industry responds much more effectively with the aggressive timelines. Postponing the deadline creates a sense of complacency that stalls innovation.
• CMS already has acknowledged this issue and granted an extension in the form of quarterly reporting in 2014. I personally think that Stage 2 offers greater challenges but that Stage 1 is no longer really problematic for most providers (about half of eligible providers have received incentive payments and another quarter have registered).
• I prefer to streamline MU 2 requirements, eliminate key obstacles, and move forward.

2. Would an extension affect your current strategy in terms of meeting stage 2 requirements?

No – we’ll just keep pushing forward

• We continue to push forward with ICD-10 subsequent to the delay announcement, and we would do the same with MU Stage 2.
• I would like the breathing room, but we would keep on our current trajectory.
• No, although we might take an extra few months to ensure we get it adequately tested and the workflow changes ingrained.
• We’re working with our EMR vendor to achieve all of our goals, but it will be hard on resources — both developmental and financial.

Yes – we’ll probably make some changes

• We would be able to adjust our current priorities and get to some more pressing work that simply has to be put on hold in order to make the MU timelines.

I’m not sure

• Our intention would be to continue moving aggressively; however, the extension creates an excuse for those who have not completed preparation, including our vendors.

3. What is your biggest concern with the MU program going forward?

The timelines are too tight

• The requirement to report all CQM’s thru the EMR, plus ICD-10, all due at the same time in 2014 is what is killing us. We also have to put in a new certified surgery system so our abstracting system can use the SCIP measures before the CQM work can start. We also have to upgrade our ED and OB systems to certified versions before we attest for Stage 2. So, yes, an extension helps because of the other work that goes into MU stage readiness. We are barely attesting for the first time this year.
• Timelines place us in a position of perpetual upgrades and implementation. This does not allow us to fully optimize the clinical workflows and results in concerns for risks as well as employee burnout.

Stages and requirements are added without first evaluating the success of the first stage

• There are a lot of assumptions that MU Stage 1 has been a success without empirical data.

Challenges with interoperability

• Vendors are standardizing their interoperability to the lowest level requirements. We need much more functional interoperability similar to that found in the European Union (epSOS). Why can’t the government collaborate around that process, which works?
• HIE development and sustainability is a complete mess.

Lack of a unique patient identifier

• With exchanges still struggling financially, it may really impact our ability to exchange expanded clinical information and do so securely while having the confidence we have the right patient record.

All of the above

• Amen… seems like we have all of the reasons listed, but nobody seems to listen.
• Plus other major federal initiatives such as ICD-10.
• These are all concerns. Tight timelines and lack of interoperability standards are my top two.

Other

• One size fits all: I resonate with the staged objectives leading to consistently improved and predictable patient outcomes. Increased meaningful use requirements become less understandable for hospital-based physicians who don’t see patients but are eligible providers because of the billing site of service definition. ONC/CMS should give more thought to what constitutes meaningful use of HIT for radiologists, pathologists, anesthesiologists and hospitalist EPs.
• Lack of relevance to pediatrics

4. Do you believe pushing back stages 2 and 3 is the right move for the industry as a whole?

Yes

• Yes, if it can be proven that attesting to MU stages drives a higher quality of care at a lower cost.
• It makes sense for hospitals like mine where we are barely attesting for the first time this year. The rate of change is breath-taking, and completely exhausting.
• We are going to hurt someone by keeping up the current pace. Providers are having their worlds turned upside down and many are struggling to learn the new systems. Somebody is going to make a mistake and we will all feel foolish.
• Yes, if the Feds want long-term success.
• I think there is going to be mass chaos without it. The vendor community can’t support the providers who are required to make the changes in the current window
• The slower the process, the more institutions who will be able to achieve MU.

No

• I suggest that we will continue with further delaying tactics. ONC/CMS would be better advised to focus on those requirements that would have the greatest impact and move forward.

5. In general, do you believe the Meaningful Use program has been successful in moving the healthcare system in a positive direction?

Yes, definitely

• The industry has been discussing EHRs since the early 1980s; however, it has never had the sense of urgency to allocate enough funding to make it a reality. We are significantly behind the IT adoption of other industries. This is the right thing to do for patient care.
• It’s probably one of the best things to happen to healthcare in a long time.
• Although the Meaningful Use program has its challenges, I believe the long-term benefits are worth it. The ability to enhance patient care through the use of technology has been a 20-plus year goal, and we are finally seeing it come to life in small incremental steps.

Yes, but it is still flawed

• MU has insufficiently addressed measures that can be readily automated and harmonized across federal programs.
• It’s too early to tell.
• Any time it takes months to provide ‘additional clarity’ to the regulations, it’s a clear sign that not enough thought was put into it.
• MU is good for the industry and for the patients we serve, but many measures seem arbitrary. The pass/fail nature of the measures do not account for the varying strategies taken by different organizations. For example, we implemented BMV/eMAR before CPOE — it would be nice to take that into account. Timeframes are unreasonable because of the time it takes from the point where CMS releases the requirements, the vendor updates the software, and then each site installs and adopts the new software.
• This is a qualified ‘yes’ as all of the CIOs I know were doing this work before the legislation. So I am just not sure if it is helped to move the ball forward for work that was well underway.
• Yes, a success in the sense that the industry has some standards and working toward such.
• Many of the requirements show no benefit to patient care. However, the push for interoperability standards and basically forcing outpatient care to an electronic age is a great thing.
• Interoperability should have been addressed first while layering in the use of the tools so that care can be coordinated. Standards should be forced on vendors. I have a vendor currently that refused to send their data to a patient portal and required us to buy their portal, and they are MU Stage 1 certified. I wonder about all the ambulatory EMR vendors and their ability to survive long term.
• It needs much more insight than that provided by the federal government, who does not know how to practice medicine.

No