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Crowded Plates: For CIOs, Policy Mandates are Piling Up

August 28, 2013
by Gabriel Perna
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Just how many policy issues are healthcare IT leaders facing?

If you put the industry’s best-known thought leaders in the same room, they might not agree on much.

They might differ on whether or not the attestation timeline should be extended or even be delayed for Stage 2 meaningful use of electronic health records (EHRs) under the Health Information Technology for Economic and Clinical Health (HITECH) Act. They might differ on whether the transition to the ICD-10 code-set can be done by October 2014. They might even differ on the color of the wall.

But there is one thing that everyone would agree on, and it doesn’t matter if it’s the CIO of a big-time health system in an urban area, an outside consultant, or someone who works in a smaller, rural setting. They would all agree that CIOs are dealing with a serious number of policy issues coming down the pipeline, all of which have overloaded their already crowded plates.

Healthcare Informatics Associate Editor Gabriel Perna recently spoke with seven industry insiders and leaders, many of whom testified on meaningful use in front of the Senate Finance Committee in Washington. These leaders—a cross-section of CIOs and policy experts—talked about everything from the impact of a possible Stage 2 altered timeline to compliance with security provisions of the Health Insurance Portability and Accountability Act (HIPAA) and payment model reform under the Affordable Care Act (ACA).    

Implementing the IT that complies with and supports these broad policy mandates, while dealing with day-to-day responsibilities, is the reality at provider locations across America. During the course of these interviews, thought leaders unfurled the challenges that surround each measure and looked to answer that pervasive question: which one should come first? 


In the past few months, there have been ongoing, industry-wide discussions about Stage 2 of meaningful use. The initial wave of noise began in May when the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) sent out a proposal for a one-year extension of Stage 2. CHIME CEO, Russell Branzell, offers that this policy change is not an unreasonable request to make of the Office of the National Coordinator for the Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS).

“Our argument to the ONC and CMS…is we’re not asking for huge leniency or a break. We’re saying make the timing reasonable, give some time to the people who are actually using this to settle in and get some benefits from it. We want the program to be successful. We think the investment in HIT is dead on target. What’s occurred, though, is over time, we’ve gotten a little off track in putting this in and what we’re doing with it. It gives them [the government] and us a reasonable chance at success,” Branzell says.

This is especially the case with regard to Stage 2, Branzell says. While Stage 1 set the groundwork, the clinical quality measurements (CQMs) in Stage 2 will require significant resources, both from an IT and clinical standpoint, to be managed on a continual basis. In addition, he says, there is the issue of vendor readiness.

Both Branzell and George T. Hickman, executive vice president and CIO of Albany (N.Y.) Medical Center and CHIME’s board chair, say there are various reasons why vendors might not be ready for Stage 2 requirements. This includes, they say, technologies around transitions of care and patient portal integration.

“I don’t want to implement two portals, so I’m trying to integrate my portal implementation to two separate electronic health records. While I know some portal providers out there can do that, what’s been going on is that EHR vendors are bringing their preferred partner to the table and it may or may or may not be agnostic to your circumstance,” says Hickman, who cites as an example the Chicago-based Allscripts and its portal partner, Jardogs (which Allscripts acquired).

“For example, I need to integrate Jardogs with the Siemens EHR, and they haven’t done that before. And they haven’t done it with a bunch of others. And the same thing can be said about other like partnerships,” he says.

In rural Kentucky, Randy McCleese, vice president of Information Services and CIO at St. Claire Regional Medical Center, concurs with the sentiments of Branzell and Hickman. Like them, he says the timeline might be pushing vendors too fast and the government should give providers more time to attest.

“From what I’ve heard, and I don’t think this is specific to rural, there are quite a few organizations that are not ready to attest to Stage 2. Some of it is, they have so many things on their plates. I was talking to a CIO last week and they have moved other things into higher priority than Stage 2, because they don’t feel the payback is there,” McCleese says.

Discussions on Stage 2 are at a fever pitch, says CHIME’s director of public policy, Jeff Smith. “The awareness of the meaningful use policy is the highest I have ever seen on Capitol Hill,” he says. Anita Samarth, president of Clinovations, a Washington, D.C.-based consulting firm, is betting on some kind of delay or extension. However, most experts are unsure whether or not all the talks will amount to anything.