Hospital CIOs worried they won't make it to meaningful use finish line

June 29, 2010 | Bernie Monegain, Editor

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NEW YORK – Eight in 10 hospital CIOs said they are concerned or very concerned they will not be able to demonstrate meaningful use of electronic health records by the government's 2015 deadline, according to a survey released Tuesday by PricewaterhouseCoopers Health Research Institute.

The report "Ready or not: On the road to the meaningful use of EHRs and health IT," is based on a survey of 120 hospital CIOs who are members of the College of Healthcare Information Management Executives (CHIME).

It found:

Only half of the hospital and health system CIOs surveyed say they 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.
CIOs interviewed for the report said they also were concerned about meeting later-stage requirements within the specified time frames. The requirements include advancing care processes through decision support; providing and populating patients' personal health records; and improving health outcomes through data-sharing outside their own organizations, such as with insurers, patients and other providers.

The promise of stimulus funding has accelerated EHR adoption and the collection of massive amounts of electronic health data as hospitals and physicians across the country race to meet eligibility requirements. But the existing infrastructure to support meaningful use of EHRs on a national health information superhighway is insufficient, according to the CIOs interviewed by PricewaterhouseCoopers.

"Healthcare organizations are building high-performance race cars to travel back country roads," said Daniel Garrett, leader of the health information technology practice, PricewaterhouseCoopers. "Furthermore, we found many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage. The bottom line is improved quality of care and patient safety, delivered more efficiently. Government leaders and health organizations need to give consideration to the ultimate goal as they work to finalize and meet guidelines for meaningful use."

Besides surveying 120 hospital CIOs during the second quarter of 2010, PwC conducted in-depth interviews with 14 CIOs and health leaders from health systems, health information exchanges, health insurers and regional extension centers.

Next page: CIOs identify four things that keep them up at night.

Reader Comments (2)Login to Post a Comment

FLPoggio says: It'a a Meaningful RUSE!

June 29, 2010 | 1:28PM GMT

At the risk of being a called a Cassandra, or at best a contrarian, I will attempt to explain why the federal government's HITECH Act and Meaningful Use (MU) incentive program is a wolf in sheep’s clothing and why the better response for a provider would be to run, don’t walk, from this wolf.

First let’s review the basics. When a hospital or physician’s practice purchases and implements an electronic medical record (EMR) or Computerized Physician Order Entry (CPOE) before 2011 and files with the federal Department of Health and Human Services DH&HS) the yet to be developed regulatory documentation to declare their meaningful
use (MU), then starting in 2011 that provider will be potentially eligible for an MU bonus payment. For physician practices that could amount to a total of $44,000 over three years. For hospitals, depending on the number of discharges, somewhere between $2million to $3.8 million total. These incentive amounts are to be paid over three stages, or years, starting in 2011.

On the other hand if a provider does not implement an EMR or CPOE, or purchases and implements a system but cannot show meaningful use, then a penalty will be incurred on Medicare payments in years 2015 thru 2017. This penalty will be in the form of a reduction to the legislated increase in Medicare payments for that year. Note this is not a reduction
in overall Medicare payments, but a reduction on the yearly Medicare inflationary adjustment factor. The first year the penalty is a 33% reduction of the adjustment, the second 66%, the third 100%, or in effect, you will get no adjustment at all.

Before I explain why I believe there is a wolf at your door let me say I am a believer in the benefits of EMRs and CPOEs. There can be significant benefits in both, but not unless they are incorporate a sound work flow re-engineering processes prior to installation. Unfortunately there are very few if any MUs that are workflow focused.

More at: http://www.kelzongroup.com/meaningful_ruse.html

paulroemer says: Meaningful Use is meaningless

June 29, 2010 | 10:28AM GMT

EHR, there’s a new groundswell against meaningful use. How do I know? I’m starting it now.

After lunch, if I’m in the right mood, I may start one against certification.
At times I think the ONC has taken a Captain Queeg approach to its oversight of EHR, counting the strawberries while all heck is breaking loose around them. Meaningful Use, Meaningful Use ROIs, Certification, RECs.

To me, these are prime examples of missing the focus of the problem, like mopping up water from an overflowing sink instead of simply turning off the water.

Would a single hospital, on its own accord, meet the Meaningful Use standards if the standards did not exist? If they did, it would be by accident. I spoke on this issue last week at the DC Health 2.0 meeting and by way of explanation offered the following illustration. Let us assume each hospital threw a dart at a dartboard whose two axes are EHR functionality and user rollout/penetration. The dart is then removed, and then the next hospital’s representative tosses their dart. This is repeated 4,200 times, leaving a dartboard with 4,200 holes.

The ONC representative steps to the line, and tosses a single dart—wherever the dart lands define the Meaningful Use standards for all of the hospitals. Clearly, 99.9% of the 4,200 hospitals will be nowhere near the standard. The same result would have happened were there no Meaningful Use. Hence, the Meaningful Use standards will have no meaning to most of the hospitals other than to have them do something they would have not done on their own, thereby altering their original business strategy in some capacity.

Certification, from my perspective brings with it the same sense of misdirection or feint. It certifies you qualify for money independent of whether having the money is in your interest or is not.

When hospitals implemented their ERP systems, systems like Lawson or SAP, hospitals didn’t need standards other than their own. They did not need systems which had received the ONC’s “Good Housekeeping” seal of approval.

we must consider the very real possibility that there is no ROI for Meaningful Use. I write this in all sincerity. Healthcare executives march in lock-step or group think to achieve the myth of finding an ROI for Meaningful Use. The ROI is healthcare’s quest for the Holy Grail, albeit without the Monty Python sound track. They cannot proceed without one, so they set the target, figure out what data will demonstrate that they have hit it, and disregard the reams of data that does not support the ROI.

What if the government came out with a standard stating all hospitals ought to buy, install, and use a fifty million dollar transplant device that also flosses the patient’s teeth? This initiative is “optional”, but the government will pay the hospital a two hundred thousand dollar rebate. There are several types of transplant flossers—the ones that deliver that fresh mint taste cost extra.

If we were having a business discussion about the ROI for the transplant device, healthcare executives would be foaming at the mouth about how impossible it would be to calculate an ROI, and rightly so. They would argue all hospitals are different, they have different cost structures, the devices are all different.

The standards for Meaningful Use are arbitrary. The standards were developed by people who do not need to meet an ROI. There was no mandate in the development of those standards to create standards which when met would yield an ROI. Any attempt to force an ROI will naturally differ in a number of ways:

* by provider—size, structure, offering, geography
* by their interpretation of Meaningful Use
* by which EHR they implemented
* when they began the implementation
* how well they implemented the EHR

Somebody somewhere may hit a positive ROI on Meaningful Use, just like somebody playing darts may hit a bull’s eye. Any positive ROI will be accomplished more out of chance, and from having fit the data to a predetermined ROI rather than measuring the ROI against its true impact.

Implementing an EHR can be very good for a hospital. However, it should be a business decision for the hospital based on the same set of business rules the hospital would use to justify any other large expenditure. If the hospital achieves an ROI it will not be because of having followed an arbitrary set of standards. Any ROI for an EHR will come from having done it correctly. Hitting the figure any other way means two things; it was a coincidence, or you are in for trouble down the road.