WASHINGTON – At the American Hospital Association Conference on Monday, chief information officers at some of the most wired hospitals in the country said they would be hard pressed to qualify for stimulus package healthcare IT incentives by next year.

In a session focused on incentives provided under the American Recovery and Reinvestment Act (ARRA), hospital executives and CIOs called for more flexibility in allowing hospitals to qualify.

David Blumenthal, National Coordinator for Health Information Technology (ONC) said, "We've heard this point of view loud and clear."

Doctors share the sentiment, he added.

Blumenthal told AHA attendees that he could not comment on the rule while it is in the rulemaking process, but indicated he is sympathetic with how hospitals feel about flexibility. "We are listening and anxious to make this work for you," he said.

Complaints about the proposed meaningful use rules rippled through the AHA conference from plenary keynotes to smaller sessions.

Currently there are 23 measures proposed that hospitals must implement before 2011 in order to gain the maximum amount possible under ARRA. The Centers for Medicare and Medicaid Services (CMS) and ONC are jointly drafting a final rule expected out by late spring.

"I realize there is a large number of hospitals who have been ahead of their time, not just big institutions, but small ones," Blumenthal said. "We look forward to working with you as we develop policies going forward. Your partnership is vital to our success."

Blumenthal said "getting standards right" is critical to exchange, and ONC is "extremely mindful" in the regulatory process of not preventing innovation with over restrictive standards.

This will be the first in a series of regulations that will change over time, he added. Standards will change and definitions of meaningful use will change.

Pam McNutt, senior vice-president and CIO Methodist Health System in Dallas, said her organization began a complete healthcare IT overhaul in 2003 and had some advanced functionality.

Under ARRA, Methodist believes it will attain $450,000 for its Medicare physicians in its teaching clinics; $10.4 million for its four acute care hospitals, and a similar amount for Medicaid, McNutt said.

Methodist hopes to be ready by 2011, but "only if there is some relief to the all or nothing approach in the proposed rule," she said. If the final rule does not have flexibility options for qualifying, then Methodist won't be ready until 2013, she added.

"I think we will only get two to three years of stimulus funding," McNutt said. "Stage 2 and Stage 3 are a little out of reach for us."

One of the challenges McNutt has already encountered is "the need for manual calculations for meaningful use measures to document things that aren't done electronically."

Mark Probst, CIO for Intermountain Healthcare in Salt Lake City, a hospital known for its advanced use of healthcare IT to improve quality of care, said he would like to see more flexibility in the qualification requirements for meaningful use. 

Since the proposed rule came out, Intermountain has had to add 19 or 20 new items to its IT strategy for this year. "It's a bit disconcerting," he said.

Intermountain plans on spending $13 million to $15 million to achieve meaningful use for Stage 1 by 2012, according to Probst.