In July, Hospital CIOs across the country reviewed the final rule on meaningful use of health IT with some relief that the government had given up its all-or-nothing approach.

They felt their concerns had been taken into account, they said, and they especially appreciated the rule's greater flexibility.

"I'm really quite pleased with the changes that were made," said Pamela McNutt, vice president and CIO of Methodist Health System in Dallas. McNutt is also chairwoman of the CHIME Policy Steering Committee. "I think the Office of the National Coordination listened to a lot of what we were saying. Obviously you don't get everything that you ask for."

The 864-page final rule released by Health and Human Services and the ONC took into account more than 2,000 comments the government received during a 60-day comment period on the proposed rule.

Core and menu mix popular

McNutt particularly appreciated the concept of core functionality and menu functionality put forth in the final rule. It showed that the ONC understood the "need for relief from the all-or-nothing approach," she said.

The final rule requires physicians to comply with a set of 15 core objectives during the first year – or Stage 1 – of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and physicians will have to choose five more objectives from a "menu" of 10.

Like McNutt, other CIOs also said they felt they'd been heard.

"With reduced requirements and options from which to choose, most hospitals should be quite capable of reaching MU as long as they have a certified EHR," said William Spooner, senior vice president and CIO of Sharp HealthCare in San Diego.

"In particular, the ability to select from a menu of measures, while complying with a core set of requirements, will help make this program flexible, appealing – and achievable – for a broader set of eligible providers and hospitals," said Mary Anne Leach, vice president and CIO, the Children's Hospital in Aurora, Colo.

But that didn't mean she didn't have worries.

"I'm most concerned about overall organizational attention on these important changes, at a time when our organization has other strategic and growth priorities, and when we are also focusing on 5010 and ICD-10 readiness efforts," Leach said. "There's a lot going on right now, for all of us in the industry."

CPOE requirement scaled back

Indranil Ganguly, vice president and CIO of CentraState Healthcare System in Freehold, N.J. said he was pleased with the greater flexibility in the final rule. "I'm particularly happy to see that the rule has been modified to include the ED as well as the inpatient setting."

The emergency department being brought into the meaningful use criteria was something that pleased McNutt, too. "If you were going CPOE in your emergency department, which is where a lot of people start, that would not qualify you" in the proposed rule, she said.

The CPOE requirement was scaled back quite a bit, McNutt noted.

Spooner said he remained concerned about the overall reporting burden on individual physicians and small groups.

"They have similar requirements to those of large health systems without the staff and infrastructure," he said.
As for Sharp HealthCare, he said, there are many things to accomplish before it can prove meaningful use: upgrading to certified EHR, some workflow changes, site certification of our patient portal, to name a few. "One big item, CPOE, is ready to go today,' Spooner said then. "We will take advantage of the partial year readiness and target mid-2011 to declare readiness."

Denni McColm, CIO of Citizens Memorial in Bolivar, Mo., said her team planned to be ready by Oct. 1 – when providers start to collect their three months worth of data. But, she said, "it looks like they aren't even planning on taking 'registrations' until Jan. 1, 2011 and for the first attestation period to begin April 1. We'll be trying for that period to qualify ASAP."

At Fletcher Allen Health Care in Burlington, Vt., Senior Vice President and CIO Chuck Podesta was in the midst of completing a $57 million implementation of an Epic system that he expected would be done by the end of the year. He said he expected Fletcher Allen to be ready to show meaningful use by January 2011.

"I feel comfortable that we will make it," he said.

Cost top of mind for many

Many CIOs also had been thinking about the cost of getting to meaningful use.

Spooner said he could only provide a rough estimate of what it would cost Sharp HealthCare to get to meaningful use – $1.2 million range for Stage 1, at the most, he said.

"It has cost us a lot to get to the point we are at, including implementing all of the technology and a major upgrade in the past year," said McColm. "We are on the version that our vendor (Meditech) plans to certify with a service release for the new requirements."