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What's a community hospital CIO to do?

July 15, 2009
by Neal Ganguly
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The Stimulus Bill and the billions of dollars it directs have hospitals and physicians scrambling to qualify as ‘meaningful users’ in order to collect significant incentive payments. Many community hospitals are working feverishly to develop EMR strategies that would link physician offices to hospitals in order to promote the exchange of patient information. The ability to exchange data was a requirement of the first draft definition of meaningful use, and there is no reason to think that it will not remain a requirement. So, what’s a community hospital CIO to do?

Let’s take the case of a mid-sized community hospital with an entirely voluntary medical staff of over 450 physicians, roughly half of whom practice primarily at the hospital. Mix in the fact that the environment consists primarily of small practices of 1 – 3 physicians with a very low penetration of EMRs to date. The stimulus bill woke up a number of physicians, who began to knock on the doors of administration looking for help. Of course, the physicians did not agree on any particular EMR, each citing particular features that they would require, or other concerns that emphasized their independence. So what kind of help did they want? What were their goals?

Wants were easy. They wanted subsidies to help purchase EMRs. They wanted advice on which EMR to purchase, but did not want to be restricted to a few choices. They wanted information on how to get their stimulus incentive money. The more thoughtful among them also wanted to know who would help them install, and maintain the technology, and who they would call when they had a problem. Ultimately, they were wanted assurance that they would be able to collect the stimulus dollars and end up in a better position than they were today (or at least not be in a worse position).

Goals were, unfortunately, very aligned with the wants. Few, if any, talked about the goal of using technology to improve their practice workflow – whether that is measured in terms of patient volume, or charge capture. Few, if any, talked about the value of being able to have a more complete picture of the patient available for review at the point of care. No one talked about the efficiencies that would accrue from less duplicative testing. The goal was money – saving money – making money.

Okay, so the physicians were struggling to understand why they should do this beyond incentive money. What about the hospital? The administration believes that an EMR strategy will be valuable to improving the quality of care and increasing the efficiency of that care. But what is that worth in terms of measurable value to the hospital? How can administrators determine how much to invest in an EMR strategy, and how can they measure success? These questions are landing on the desks of most CIOs and represent real strategic questions. Operational questions are also facing the CIO. Should the hospital contract with and build interfaces to a limited number of vendors, or support a mini-HIE environment that would allow a wider range of EMRs to connect? Should the hospital support a hosted model for small practices? Who will the physicians call when they have a problem? The EMR vendor or the hospital helpdesk? Or will the EMR vendor punt to the hospital anyway? What will it cost to support this operation?

There sure are a lot of questions – I'll let you know if I find any answers...

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