Hospital CIOs confused over e-health records rollout standards

Lack of clarity about government rules slowing efforts, survey says

Eight out of 10 hospital CIOs recently surveyed by PricewaterhouseCoopers LLP (PwC) said they're concerned they will not be able to demonstrate "meaningful use" of electronic health records (EHRs) -- and therefore won't qualify for federal reimbursements for rolling out the technology.

Ninety-four percent of CIOs in the survey released Tuesday said they are concerned they can't meet government requirements about how to report meaningful use of EHRs, and 92% are concerned about a lack of clarity in the criteria used by the government.

Last year, the American Recovery and Reinvestment Act (ARRA) set aside $36 billion to help hospitals and doctors purchase equipment to computerize patient medical records, but even the most sophisticated hospitals in the country are struggling to qualify for the payments, PwC's study indicated. Clinicians and hospitals that deploy the technology and prove that it meets a set of government "meaningful use" standards showing it's being effectively used can receive up to $44,000 per doctor in reimbursement funds beginning next year.

A 275-bed hospital, for example, would be eligible for about $6 million to defray IT costs.

There is a four-year window to receive the reimbursement funds , and by 2015, facilities that have not deployed EHRs will face Medicare and Medicaid reimbursement cuts. Last year, just 10% of health care facilities in the U.S. used EHRs; by 2014, the government wants more than half of all facilities to use them.

The problem is that in order to finish EHR projects and receive full reimbursements, work must begin now. The U.S. Department of Health and Human Services (DHS) has already published a 556-page draft list of specifications and criteria for what constitutes "meaningful use" of EHRs. The final "meaningful use" rules are slated to be published as early as next week, according to sources.

According to PwC's survey, which was conducted during the second quarter of 2010 and included 120 hospital CIOs, 80% of tech executives are "concerned or very concerned" they will not be able to demonstrate meaningful use by 2015. And only half of the hospitals and health system CIOs surveyed will be prepared to meet the first set of meaningful use requirements and apply for incentive bonuses in 2011, the first year they are available.

Bruce Henderson, PwC's national leader of Electronic Health Records and Health Information Exchange Practice, said what surprised him about the survey results was the "overwhelming concern" across the industry. "I think that even among the more prepared institutions that have adopted clinical record systems already there's still a fair amount of concern about being able to ... be in compliance with those regulations within the time period in which the first draft stipulated," he said.

The 120 CIOs, all members of the College of Healthcare Information Management Executives (CHIME), are also worried about meeting later-stage requirements within the specified time frames.

The meaningful use standards are expected to require the use of software to ensure best practices for medical care are followed; patients' personal health records are populated with updated health information; and that health outcomes are improved through data-sharing outside their own organizations, such as with insurers, patients and other providers.

"The first draft went a long way in setting out the principles and the expectations and the intent of the regulations. I think what they need to finish is to add clarity, to add some level of detail around security and privacy - there was a lot of ambiguity there - and then the industry will, to the best of its ability, move in that direction," Henderson said.

The CIOs interviewed by PwC also said the promise of federal reimbursements have sped up EHR adoption, but the existing infrastructure to support their meaningful use over a nationwide health information network is insufficient.

"Health care organizations are building high-performance race cars to travel back country roads," said Daniel Garrett, leader of the health information technology practice for PwC. "Furthermore, we found many health care providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage."

Garrett said government leaders and health organizations need to consider the ultimate goal of better care and patient safety -- delivered more efficiently -- as they work to finalize and meet guidelines for meaningful use.

Hospital CIOs also indicated that they are behind the curve because there has yet to be a final ruling on meaningful use implementation guidelines.

The survey also found that 63% of the CIOs surveyed believe their organizations are either already working with physicians around meaningful use issues or plan to do so within six months. Eighty-eight percent indicated that meaningful use is somewhat or very likely to increase the involvement of non-administrative physicians in quality initiatives.

The CIOs also said there is a shortage of IT staff with the appropriate mix of skills to help integrate the use of IT into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.

In order to address that shortfall, the government has set aside a portion of $2 billion in discretionary spending under Office of the National Coordinator (ONC) to train workers to implement EHRs.

The survey also found that more than a third of CIOs are concerned or very concerned about IT vendor readiness. In particular, 44% of CIOs said they worry that the external vendors they rely on in health information exchanges are not prepared for meaningful use implementation.

Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow within and between hospitals, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records. While some regional health information networks have been successful, the majority have failed to work over the long term, Henderson said.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is .

Read more about health care in Computerworld's Health Care Topic Center.

Copyright © 2010 IDG Communications, Inc.

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