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  The Health Record Review
by Patty Enrado

Hospital CIO confidence level for meeting meaningful use drops

A mid-November survey of 191 members of the College of Health Information Management Executives (CHIMES) reveals that hospital CIOs are less confident they will meet Stage 1 meaningful use criteria and therefore not qualify early for EHR federal stimulus funds.

Only 15 percent of respondents, compared to 28 percent of respondents in CHIME's August survey, believe they expect to qualify in the first six months of fiscal year 2011, which began in October of this year.

The percent of those who don't expect to qualify early - approximately 10 percent - remained the same from the August to the November survey. These CIOs expect to qualify in either 2013 or 2014.

While this snapshot is problematic, what is even more troublesome is the drop in the confidence level of community hospital CIOs. Whereas the August survey saw 23 percent  expecting to qualify for funding in the first six months of the program, the November survey identified only 5 percent expecting early qualification.

Not surprisingly, 42 percent of community hospital CIOs anticipate speeding up their plans to implement EHRs, which is almost double the percent of respondents in the August survey.  Going the opposite direction is the percent of respondents who feel their organizations will be able to qualify for funding - from 48 percent in August to 32 percent.

Eighty-two percent of the November respondents still have concerns about the meaningful use criteria and stimulus funding qualification, but the type of concerns has changed from the summer, according to the survey.

Concerns about EHR system certification has taken a backseat to other issues, likely because the certification process has been put into place quickly by the certification bodies that were given the green light by the feds.

Finally, the survey revealed that computerized provider order entry (CPOE) implementation was identified by 29 percent of respondents as a major concern, followed by 22 percent for capturing or submitting quality measures and 13 percent for vendor readiness.

With respect to CPOE, 62 percent of respondents anticipate some difficulties with CPOE implementation, and 52 percent said getting clinicians to use the system would be problematic.

The value of these regular surveys, spaced within a few months of one another, is to get a snapshot of the very fluid environment of EHR implementation. If the industry wants EHR adoption to happen, we need to keep an eye on how healthcare providers are progressing with their plans and how they are feeling about their ability to meet the milestones.

If there are bumps in the road, new concerns replacing issues that have been addressed either by the federal government or other entities, or other problems, the industry at large needs to know so stakeholders can act quickly to keep momentum going for critical mass of EHR adoption.

With regard to the CPOE concerns, David Muntz, FCHIME, CHCIO, senior vice president and CIO at Baylor Health Care System in Dallas, said that benefits of CPOE must be presented to engage physicians.

This is not a difficult thing to do, but it is an imperative thing to do across the provider market if the CHIME survey numbers are to move in a positive direction, instead of sliding backwards.

Many entities should be taking the temperature of healthcare providers and EHR champions need to step up to address those bumps in the road.

Photo by dherrera_96 courtesy of Creative Commons license.


I just wrote about the same

I just wrote about the same issue albeit from a different perspective in my blog
What can the ONC learn from the 80% of hospitals who are not on board with EHR?

The ONC’s State of the Union Message will be delivered this week over a two-day period. Rather than attend, I have decided to wait until the operatic version of the meeting is available on YouTube. Mind you, I am convinced of the good intentions of their efforts, but to write I am skeptical of their results would be unfair in that my optimism would have to increase substantially for me to reach skeptical.
I am disappointed to report Chicken Little’s “The sky is falling” keynote presentation at the ONC event has been omitted from the agenda in favor of continuing to get others to believe that not only is Meaningful Use is meaningful, but also relevant. I am not being intentionally trite, in fact, just the opposite.
The question unanswered by the ONC is does their stick and garrote approach make it relevant from a business perspective? Its only relevance seems to be that without complying, hospitals’ revenues will decline. Why will those revenues decline? Is it because the hospitals made a poor business decision, lost patients to a competitor, or could not manage their expenses? Of course not. Their revenues will decline for one reason, and one reason alone—the ONC will give them less money for services they perform.
There are almost two-thousand hospitals in the US. What percentage of them will complete EHR in time to reap their full incentive payment? I think we can agree with a high degree of confidence that the number will be less than 20%–I’m guessing it will be closer to ten percent. How many of those will then re-implement a certified version of EHR? And then, what percentage of the remainder will pass the Meaningful Use audit? You can probably fit all of those hospitals CEOs in a Hyundai mini-van.
If these figures are close to accurate, one might thing the issues at the forefront of the ONC’s efforts ought to be working with the other 80-90%. They have tried to add that focus through incentive payments. When that didn’t take the ONC created the Regional Extension Centers (RECs). What percentage of the majority of hospitals is benefiting from using the RECs? Will hospitals and doctors be able to link to the HIEs and into the N-HIN? Me thinks not.
I have begun to think Mark Twain’s story Tom Sawyer may have been prescient when viewed in the light of EHR and Meaningful Use. In particular is the part where Tom gets others to whitewash the fence. Is it possible the ONC’s vision is limited to equipping people with giant paintbrushes who are, sadly short of a giant pot of paint?
Is their existing plan one which is executable? Just because they have a plan, if most of the country’s hospitals have not bought into it, does not that simply make it a plan in name only? Even if they buy into it does not, in and of itself make it viable.
If eighty percent of the hospitals are not on board, what can be learned from their lack of response? Is it due simply to a lack of effort, as some would have us believe, or is there something more to it? I think the lack of response by the majority of hospitals should lead us to conclude that something important about the strategy is lacking, to conclude that something is amiss. If someone asked me—and just to give you comfort, nobody has—my conclusion is that more would be gained by the ONC holding a two-day listening session instead of a two-day speaking session.
Can eighty percent of the hospitals have no message worth hearing?