Never have IT leaders at hospitals and healthcare systems been tasked with as many policy mandates as they are being asked to manage currently. In the upcoming September issue of Healthcare Informatics,Associate Editor Gabriel Perna talked to several industry leaders on the scope of different policy issues facing healthcare IT leaders in 2013 and beyond.

Leading up to the release of that feature, over the next week or two, he will be publishing additional, extensive interviews of what was said by a few of these experts. Much of this has been left on the “cutting room floor.” Part 3 of this series is with Russ Branzell, CEO of the College of Healthcare Information Management Executives (CHIME) and George  T.“Buddy” Hickman, executive vice president and CIO of Albany (N.Y.) Medical Center and CHIME’s board chair.

Below are excerpts from that interview.

Russ Branzell

What are some of the major policy issues facing CIOs for the rest of 2013?

George T. Hickman: For the rest of 2013, we are dealing with how we prepare and manage to deal with meaningful use Stage 2 and what is coming with meaningful use Stage 3—what will and won’t be ready and predictions about timing. We talk about the ICD-10 issue now sort of being on top of us because we have to deliver that our organizations next October. The regulatory elements of reform in the sense of what’s happening with insurance exchanges and even some of the regulatory elements around how we offer healthcare insurance to employees as employers will start surfacing. That has complications and regulatory and environmental implications tied to it with the emergence of high deductible plans. Those seem to be the things that are current.

Russ Branzell: The one thing that is sub to all of that is this pervasive desire to have clearer standards that are embedded in all of this. I think we’re heading in generally in the correct direction, we may not be moving at the pace we should. An example would be there is zero clarity within any of the meaningful use Stage 1, 2, 3, ICD-10, ACO— any government regulatory process that explicitly defines patient matching requirement. You end up with isolated areas of solution, and for me with my previous employer, having to deal with four different HIEs [health information exchanges] that have four different patient matching methodologies with a patient population that often moved amongst those populations. There is a place for the government to have good regulatory policy that actually assists with propagation and requirement for standards. We’ve launched with meaningful use in some cases without clarity of standard, and if there is one, without a clarity of requirement.

(Coming this week, Crowded Plates: For CIOs, Policy Mandates are Piling Up from the September issue of Healthcare Informatics,featuring Hickman and Branzell’s specific examples on this lack of clarity of standard)

What’s the case for altering the Stage 2 timelines,as CHIME and others are arguing?

Branzell: When you put something in and you go live, you don’t receive the benefits immediately. There is always this concept of optimization period after you put something, and we’re putting in big, complex systems across the country. And then we’re immediately saying, ‘OK you’ve done a successful job of going live, not start putting the next one in, and start getting ready for ICD-10.’ What we’re not doing is giving the providers, the people that actually manage the workflow the opportunity to receive the benefits of that investment.

 By no means is it scientific, but if you could just use a one for one ratio, the average EMR implementation from start to finish is probably between 12-18 months…that’s just to get the technology in. You do a little bit of workflow, a little bit of templating as part of that process, but the real opportunity for gain in that investment is usually post go-live. What we’re doing with the current time constraints is not giving us time to benefit from the investment.

What do you expect to come of this?

Branzell:  You’re going to see a bell-shaped curve form. The really proactive organizations, those who have had EHR implemention as a part of their strategy years before meaningful use was a twinkle in anyone’s eyes, are in great shape. They’ll continue to move, and they’ll have challenges, the quality measures will be harder and a few other things, but generally they are well resourced to get there. The middle, big part of the bell curve—half of them will get there, half will struggle, and a lot won’t get there. The bottom part of that bell curve, they don’t stand a chance.

Without any timing [on the part of the federal government], the possibility of that lower part being a bigger chunk will be much greater. We jokingly called it ‘no hospital left behind.’ There will always be people who will lag and not want to do this. It’s ‘don’t leave anyone behind that wants to be a part of this.’ Let’s give this a reasonable shot of being successful.

We’ve offered several timing differences that we think either one works within the legislative construct. We shared that with the senior team at both the CMS [Centers for Medicare & Medicaid Services] and the ONC [Office of the National Coordination for Health IT], both in an initial blush said they could see how this [their altered timeline] would work, they didn’t say they necessarily wanted it work. Even some of the most recent rhetoric [from the government] at the Finance Committee Hearing was about not slowing down and putting pedals to the metal, does serve some concern on our part. Is that just political fodder?

Hickman: What will happen is you’ll see a lesser success rate of meeting the incentive over the next year. That will happen if they don’t make an adjustment. Then you have to question, is it about performance of the organizations or is it about policy?

If you are an eligible physician or you’re implementing that sort of ambulatory record, you earn that incentive money one doctor at a time. You have to have the EHR in place, the elements of support in place, the exchange, portal, and the transitions of care and then you are attesting doctor at a time. So depending on behavior of physician and that clinic, you can still get incremental money. It may be that you earned a million and a half in incentive money last year, well maybe that number goes down some because you don’t have as many doctors that are able to meet the bar. However, if don’t get all of the elements to meet the bar, you lose it all. The hospitals work that way to start, it’s all or nothing. You have to get the elements in place to get the incentive money. It is an all or nothing game. In terms of the  money on the table and the risks of collecting incentives, it is greatly increased.

Branzell: I’ve heard from several CIOs, who were early adopters of Stage 1 and have advanced electronic environments, and they are saying, ‘Why should we do Stage 2 considering the financial risk of ICD-10?’”