At an early-morning press breakfast on Sunday preceding the opening of the annual CHIME CIO Forum, this year being held in Atlanta, leaders of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) shared with members of the media their concerns regarding the proposed meaningful use requirements under the federal ARRA-HITECH legislation passed last February by the U.S. Congress.
Publicly releasing a survey that found that significant percentages of CHIME members doubted their capabilities to meet a range of meaningful use requirements, the CHIME briefed members of the trade press on the comments they had made public on Feb. 26 regarding meaningful use; aspects of their collaboration with the Washington, D.C.-based American Hospital Association (AHA) to put forward a unified industry response to the federal requirements; and their perceptions of where the industry is at the moment in terms of demonstrating meaningful use.
While stressing their agreement about the broad importance of objectives represented by the meaningful use requirements, the leaders expressed what they called serious concerns over the timeframe of the federal ARRA-HITECH funding schedule; their concerns over the ability of CIOs to help their organizations move forward successfully across the broad range of meaningful use-related challenges; and what they called an “all-or-nothing” approach to defining and achieving meaningful use on the part of federal healthcare policy-makers.
“The meaningful use requirements are a very proscriptive means to what many of us are already trying to get at,” said Pamela G. McNutt, senior vice president and CIO of the Dallas-based Methodist Health System. “Some of us may have been working on one aspect, others on others. With regard to the reporting requirements, it’s not that we don’t believe that they’re important; we’d all agree that they’re very important things to accomplish in the near future. But when you dig into the regulation and see the method by which you must report,” the requirements essentially straitjacket the path forward for CIOs in terms of both the timing and the order of the steps involved in such key areas as quality data reporting, she said.
David Muntz, senior vice president and CIO of the Dallas-based Baylor Health Care System, who moderated the event, added that he shared the concerns expressed by his colleagues among this group of leaders. The group briefing members of the press at this event were all members of the same group of CHIME leaders that had developed the public comments regarding the preparedness of most hospital-based organizations to meet the meaningful use requirements under ARRA-HITECH, as currently set forth in the proposed final rule issued on December 30.
His comments were seconded by those of Charles E. (Chuck) Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind., who predicted that “There will be a rush to install applications badly,” in order to obtain the federal funding. As a result, he said, “We will actually have a negative impact on the quality of care. There is a significant element in successfully implementing these systems involving process change and clinical design,” Christian added, noting that he and his colleagues at Good Samaritan had spent nearly a decade involved in creating the process change and clinical design needed to appropriately implement computerized physician order entry (CPOE). With hospital organizations rushing to implement CPOE and other required elements under meaningful use with funding as the goal, poor implementations are inevitable, he said.
The comments of McNutt, Muntz, Christian, and other CIOs participating in the media breakfast seemed to be reflected in the findings of a CHIME survey they released to the press at this event. In that survey of 238 CHIME members, 28.2 percent of respondents listed electronic health record (EHR) upgrades or implementation as their biggest hurdle, with 41 percent of respondents listing it as one of their top three concerns.
And while 28 percent of respondents listed EHR implementation or upgrade as their biggest hurdle, 15 percent said capturing and submitting quality measures was their starkest challenge, and 10.3 percent cited providing data access to patients and families as their number-one concern. Significantly, 46.2 percent of respondents cited capturing and submitting quality measures as one of their top three concerns, making it a breakout concern among those cited. Other concerns expressed in the survey included providing medication reconciliation, meeting privacy and security standards, maintaining an up-to-date problem list, and producing summary records.
Russell P. Branzell, vice president and CIO of Poudre Valley Health System, Fort Collins, Colo., another member of the CHIME leadership group that produced the association’s public comments on meaningful use, told the assembled press that “The vast majority of organizations are still at the bottom of the HIMSS Analytics schematic” (the well-known schematic that has been widely used to evaluate hospitals’ progress on clinical IT development). “They still have to select, buy, and implement these basic [EHR and CPOE] systems. We're hearing right now that a lot of people aren’t expecting even to implement those systems until 2013—and that’s not even achieving meaningful use, it’s just achieving go-live. The organizations represented in this room, we’re doing well,” Branzell said. “But those starting from near-scratch, I don’t think they’re going to be able to do it”—achieve meaningful use. “This is a marathon,” he added, and most people haven’t even bought their running shoes yet.”