A new survey of healthcare CIOs from the Ann Arbor, Mich.-based College of Health Information Management Executives (CHIME) is documenting a significant decline in the percentage of CIOs who expect their organizations to qualify early for stimulus funding under the requirements of the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.
Indeed, 15 percent of respondents surveyed by CHIME in mid-November now believe that their organizations will qualify for stimulus funding in the first six months of fiscal year 2011, compared to the 28 percent who were confident they would do so when surveyed back in August. The numbers are even starker among self-identified CIOs of community hospitals, with 5 percent now saying they will qualify for meaningful use in the first half of 2011, compared with 23 percent who believed they would quality for MU when polled three months earlier.
Still, in both the survey taken in August and the one in November, only 10 percent of CIOs said they expected their organizations to be unable to qualify for the federal stimulus funds in 2013 or 2014.
What is making for a dramatic falloff in confidence with regard to 2011, among CHIME's CIO members? Leading CIOs are chalking the result up to a growing overall awareness of the intense complexity of some of the details within the meaningful use requirements. Chuck Christian, director of information systems and CIO at the 300-bed Good Samaritan Hospital in Vincennes, Ind., says that as CIOs are plunging into the details of the meaningful use requirements, they are starting to feel more and more daunted by them. “While a few of us have been digging [into the details of meaningful use] for a longer period of time, in general, people are getting more information now, and are having more conversations with others about what's really involved, and are becoming much better informed,” Christian says.
He cites as an example the clarification that the Office of the National Coordinator for Health Information Technology (ONC) recently released regarding the status of emergency department patients. “There was discussion about what patients should be included on the numerator and denominator as far as ED patients. The clarification is, all patients from the ED admitted to inpatient or for observation, counted. So now you can include all ED patients if you want to, or include only those ED patients who would become inpatients or observation patients. That's what creates that decision point around, what's our best opportunity for success? So there is a decision point to go through,” he says.
More ominously, some of the details are proving far more challenging than anyone had imagined, says Pamela McNutt, senior vice president and CIO at Methodist Health System in Dallas, and chair of CHIME's Policy Steering Committee. McNutt says that two clarifications issued by ONC in the form of frequently asked questions, released in September, are only now coming to be fully understood, yet could pose very significant challenges to many CIOs nationwide. Essentially, McNutt explains, if a hospital organization has “Vendor A” as its core EHR vendor, but also uses “Vendor B” for its ED system for example, it is, according to the meaningful use requirements, in a very difficult position with regard to vendor certification. That is because core clinical vendors are only certifying use of their complete systems, not, for example, use of their systems minus use of freestanding, best-of-breed ED systems.
As a result, she says, ONC officials have clarified to the CHIME leadership that, in the current environment, a hospital CIO has one of three options if their organization is not pursuing a single-source clinical IT strategy. They can seek certification for the entire constellation of elements from their core-clinical vendor, and not use the ED component; can seek separate certification for their separate ED system; can pursue self-certification separately for the ED system; or can “rip and replace” and dump their ED system altogether and replace it with their core-clinical vendor's ED system.
“Interestingly, the two FAQs speaking to the specifics in this common situation were actually released in September, but it's taken until now for people to realize that that is actually the reality of what was meant by them,” McNutt says. “All I can say is that I'm so relieved that I decided to pursue a single-source strategy years ago.” McNutt says that CHIME leaders have asked ONC officials for their advice on handling this situation, and that ONC officials have urged CIOs to put pressure on their vendors to pursue certification of their packages with variations such as “minus the ED system,” and so on.
WHILE A FEW OF US HAVE BEEN DIGGING [INTO THE DETAILS OF MEANINGFUL USE] FOR A LONGER PERIOD OF TIME, IN GENERAL, PEOPLE ARE GETTING MORE INFORMATION NOW, AND ARE HAVING MORE CONVERSATIONS WITH OTHERS ABOUT WHAT'S REALLY INVOLVED, AND ARE BECOMING MUCH BETTER INFORMED. -CHUCK CHRISTIAN
McNutt says that she can empathize both with ONC and with CIOs, both because the overall intentions of federal officials are correct-“the intent here was decent-let's move America forward”-and because of their awareness that making the MU requirements too flexible could potentially cause chaos in the industry.
On the other hand, she says, “The complexity of this is, once we peel the onion and begin to understand what it will take [to meet the requirements of meaningful use], we're realizing there are a few more hoops we're going to have to jump through. Still,” she adds, “these new complications with certification could trip some people up, and I think we'll find that they will further reduce the confidence of CIOs over meeting meaningful use in the next year. I think it will cause people to do regrouping for 2012 or 2013; but I think the number who will qualify will be fewer than previously thought; but that will shift it out to 2012 and 2013.”
To read the full report on the survey, please go to: http://www.cio-chime.org/chime/press/surveys/pdf/CHIME_MU2_Survey_Report.pdf
Healthcare Informatics 2011 March;28(3):61-62