By: Bill W. Childs

I had the honor of meeting with David Blumenthal at HIMSS last week along with selected CIO’s, physicians, and vendor representatives. Our discussions centered on the costs and benefits of the ARRA and Meaningful Use criteria.

My Concerns:

1. Time lines for ARRA, Meaningful Use, HIPAA 5010, and ICD-10 are too tight. Some providers (with anywhere from one to ten facilities)who have been working on these efforts for years, can easily reach meaningful use criteria. However, there are many large and small providers who will not be able to meet the time lines as established.  “Too many guidelines; too little time”.
2. The cost of these efforts is beyond the ability for 80% of providers. It will take a great deal to implement and prove the needed requirements to reach meaningful use and history shows that it will cost much more than most people expect.
3. There is not enough industry experienced talent to get these projects implemented. As an industry observer for more than 30 years, I can already see providers hiring bodies that are not talented enough to get the job done. Implementing these systems is a very difficult task, and many of the most talented are already on the assignment.

My Peers' Concerns (in addition to those listed above):

1. The board and “C” suite lack of understanding the full impact of the effort (time, cost, talent, change, security, and interactions with entities not under their control).
2. The cost of sustaining these Herculean efforts.
3. The cost and effort to report to all of the new agencies and on all of the new data requirements.

My session with Blumenthal was enlightening. Not only were some of my concerns confirmed, but I was also made aware of other aspects to be apprehensive about.  Here is one silver lining though: The effort and direction is a good thing. HIT, if built properly, implemented properly, and maintained the right way with updates as necessary, is the only technology introduced to healthcare delivery systems that has the potential to reduce costs and eliminate errors, thus improving quality.

What are your major concerns? What efforts and ideas would you like to applaud? 

By: Mary Ann Ciccone

As part of ARRA, Medicare and Medicaid will provide reimbursement incentives to physicians and hospitals who become “meaningful users” of EMR. This effort will begin in 2011 and end by 2015 at which time all providers will be expected to utilize EMR. Changes will be implemented in stages and include data sharing, compliance with HIPPA and state laws, evidence based order sets, the engagement of patients and families, and care coordination. The final draft recommendations that will define meaningful use were published by the ONC for Health IT in December 2009. Eligible facilities and providers can incorporate these guidelines into projects currently in progress to meet the requirements.  

The result of following the meaningful use guidelines for all stages will be improved and more efficient patient care through the use of disease prevention and reduction of medication errors, greater communication between providers, efficiency in meeting reporting mandates and claims submissions, and lower healthcare costs.

 The recommendations for Stage 1 are listed below.

Source: HHS website for meaningful use.

Just in case you haven’t been able to find it one of the other dozens of sites publishing the link here is the HITECH: Initial Set of Standards, Implementation Specifications, and Certification Criteria for EHR Technology and here’s how you get paid (warning 556 pages).

Mr. HISTalk summarized the finer or most relevant points here. And over at HealthcareITNews.com “Stakeholders have mixed reviews on proposed requirements” while Government HealthIT profiles groups that aren’t happy with the definition.  

We all knew it’d be a mixed bag right? What do you think of the proposal? Have you (are you) going to read it or will you just look for an effective summary? Let us know what your thoughts and questions are in the comment section.

They’ve got their list and they’re checking it twice…meaningful use is still on everyone’s mind. CHIME just completed a survey of 176 of their member CIOs on their “ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines.” Most of the CIOs admitted that they are concerned. In the words of David Muntz, Senior VP and CIO at Baylor Health Care System in Dallas: “Early attempts at standardization were not rousing successes. It’s hard to believe that we will be able to adapt to new standards in time to qualify for the rewards from the stimulus. I’m hopeful we’ll be there before the penalties are levied.” (from CHIME summary).

Over at HealthcareITnews.com the CIOs from Sharp HealthCare, Brigham & Women’s, and Shriners Hospitals for Children discuss what meaningful use means to them and their hospitals: CIOs Discuss Meaningful Use.

 Those three sound like they are ready and waiting for their incentives.

How prepared are you?

By: Susan Sitarchuk, Healthcare Executive

While the majority of Health Facilities CIOs and Executives are scrambling to get information on accredited EMR systems and to get a handle on what is truly defined as “Meaningful Use” there exists another population of Healthcare Executives who are actually seeing the money. Who are these lucky people? These folks are the people who struggled endlessly prior to February 2009 and ARRA to get government sponsored funds: the Grant Department of Health Facilities and Teaching Hospitals.

In the old days, prior to February 2009, the grant writers would have to jump through large hoops to secure funding for the clinical studies and research that is so vital to healthcare. They were in charge of putting together volumes of documentation that were sent to the governing bodies that dole out federal grant monies. This process could take months to acquire all of the correct documentation to secure the most funding and while compiling all of the information needed, the health facilities may not have received any of the intended monies at the end of this road because the funding had run dry.

Well times have changed. These folks are now able to more easily write a grant request and go after the money made available by ARRA. Here is the nice part; they are actually getting the funding very quickly. There is a sum of grant money that was made available by the US government under the ARRA and each month the government website is updated with new grants. Through ARRA states have allotted grant money for particular research and studies.

The University of Pennsylvania (UPenn) has received more than $30 million in research funding from ARRA, awards that fund more than 100 studies in gene therapy, robotics, public education, neurological disorders, tobacco’s effect on health, and more. One such award is a $500,000 NSF grant to continue research into haptography, the science of capturing and recreating the feel of real surfaces. Not only does the field appeal to young scientists and encourages engineering careers, but the applications are widespread and include robotics assisted surgery, medical training and simulation, interactive museum exhibits, online shopping, and stroke rehabilitation. Other grants that UPenn has been awarded enable the purchase of high end instrumentation equipment to be used for biomedical research. Also, grants were awarded to supplemental research into the genome and for upgrades to core facilities to support biomedical and/or behavioral research.

This is just the tip of the iceberg; more funds are being released on a daily basis. Due to ARRA, 2010 should continue to deliver positive growth in the research arena. Healthcare facilities need to get organized and go after these funds. HIT departments must, regularly, pursue federally funded grant money as well as the monies that they will be eligible for when they have an accredited EMR system and can prove “meaningful use” of that product. With more money available for research grants and improvements in IT, the economy and our health have a better future.

By: John Smaling, Executive Vice President

As the final definition of various ARRA related requirements take shape, financial incentives and impending penalties will most assuredly lead to an upswing in ambulatory software implementations. A number of those initiatives, sponsored by acute care organizations, will be large-scale implementations that involve large numbers of practices, and lots of physicians, spanning multiple specialties. With heavy participation by the acute care IT organization, these types of initiatives will introduce a number of complexities that I believe will challenge both vendors and customers, while exposing the differences in approach adopted by the ambulatory software vendors, and those typically employed during acute care implementations.

Historically, ambulatory software vendors have dealt with physician practices ranging from single practitioners, to large, multi-specialty group practices. In the course of deploying their solutions to this customer base, vendors have developed planning, implementation and support strategies that have worked for this profile of clients. I believe that this dynamic will oftentimes differ from the typical hospital customer in many ways, among them:

1. Acute care customers will have different goals and objectives than the typical physician practice in the areas of standardization, data normalization, reporting, and outcomes. For example, a common goal of the acute care organization is to achieve a comprehensive medical record that encompasses both practice and hospital based episodes and the level of integration required to accomplish this will likely be atypical for many ambulatory vendors.

2. Acute care enterprises will generally have larger and more experienced IT teams who have stronger views on infrastructure, security, project management, process and systems management than that found in physician practices.

3. There will be differing views from the acute care customer with respect to the level of individuality required from practice to practice. Many acute care organizations will feel that one physician practice operates essentially like every other practice, and their vision of standard workflows, process, and customization may be far different than the desires and perceptions of their constituent practice groups. The ambulatory vendor needs to understand this potential conflict in views and understand how to arbitrate these differences to meet their customer’s goals and objectives.

4. Acute care software vendors generally hold similar views with respect to the transition from install mode to support mode, and the manner in which they structure their support arrangements with customers. Ambulatory vendors, given their physician practice orientation, oftentimes adopt vastly different approaches than acute care vendors.

5. Decision-making and dealing with complex organizational dynamics, even in a relatively large physician practice is far different than can be found in an acute care organization. The importance of well defined governance, change control, and related process is not something that ambulatory software vendors have had to address to the extent that they will encounter in the future as they engage more acute care organizations.

While this listing is by no means comprehensive, it amplifies some of the key areas that will require adjustment by both parties. Taking the time to dialogue during the sales cycle to understand the many key elements of such initiatives is warranted. Understanding differences such as those mentioned above early in the relationship will help to either promote mutual respect and workable solutions, or to avoid an unproductive relationship and ill fated technology investment.

By: Eric Egnet, CIO

Camp Concerned or the “CCs”

Camp Concerned is an overnight, all summer long camp…these campers need to completely adjust their living situations because what they have in place just isn’t working.

Hospital CIOs in the third camp have reason for concern. They know they will have to replace their inpatient system or upgrade to the latest vendor version. Their current system capabilities are insufficient, and/or the amount of time and money it would take to make it HITECH compliant is just not practical. They also don’t have a common ambulatory system for their physicians, so there is a knowledge that they will need to make a decision about that. Add to this, the significant amount of work and investment dollars required to enhance their IT infrastructure to support these new systems: the costs and timeframes are really starting to add up.

Most of the CCs have also had to downsize their staff this past year due to the current economy and there aren’t the internal resources to take on and execute these important initiatives. Outside help is needed to both manage and staff augment these projects and they are concerned about finding the right resources when they need them.

Funding for this Hospital CIO is a real problem. The capital that will be required to get the hospital from where it is today to where it needs to be is significant. The Hospital Board is concerned about the mounting costs and their ability to raise enough capital in this tight market. In fact, some are concluding that the costs just may be too great, and that they may need to sacrifice the HITECH incentives and deal with the penalties, to keep the hospital’s financial health in order. Sometimes strategy is what you don’t do.

Meanwhile, CCs are trying hard to find the most efficient and cost effective way they can accomplish the task at hand. There are deep discussions with their inpatient system vendor to identify creative ways to upgrade, while containing costs and spread them over time. On the ambulatory side, they are considering inexpensive ambulatory solutions that offer just enough to meet compliance requirements. Alternatively, some of these Hospital CIO’s are looking at license free open source EMR offerings that might fill the bill such as OpenEMR and ClearHealth.

Finally, from a resource perspective, these Hospital CIOs only have a small management team and staff that manage the day to day operations of the hospital. Without question they will need vendor and outside consulting firm assistance to help them on these many projects and initiatives. This will become yet another challenge for them as they diligently try to navigate through these difficult circumstances.

Which of those three camps do YOU belong in? Take the poll in the side bar and let us know what your concerns are in the comments!

By: Eric Egnet, CIO

Camp Kinda Concerned or the “KCs”

KCs are our day campers, they’re routine is changing but they don’t have to make the commitment of staying overnight.

KCs are a bit more cautious in their treatment of HITECH. It has been a discussion topic internally and has been proactively added it as an important project in their portfolio. Work is underway to determine what the CIOs need to do with their existing HIS inpatient system (replace, upgrade or maintain). If the choice is to replace, then they are moving quickly into the vendor selection process, otherwise there may not be enough time to get the system implemented. Alternatively, they are studying their options to upgrade to their vendors latest version, or to try and make do with the existing version of the system.

In addition, campers have a fair amount of work to do in the areas of IT infrastructure, integration, security and encryption of patient information. The existing environment may be fine for what they are doing today, but it will not meet the future requirements of HITECH. This Hospital CIO will likely solicit a third-party firm to come in to perform a HITECH assessment to validate and find gaps in their plans.

These CIOs may already have a central ambulatory solution in place for their physicians, but this is likely not the case, so they are also evaluating vendor offerings with the goal of making a selection soon. They must have both implementation and an integration plans to connect the ambulatory application EMR, with the hospitals internal EMR, to meet the interoperability requirements of HITECH. Some hospitals may be fortunate enough to be using a vendor who offers integrated solutions for both inpatient and ambulatory. However, most hospitals will need to integrate different vendor solutions to accomplish this. The cost of the ambulatory solution will be a factor so they are reviewing a broader list of vendor offerings and negotiating options that best meet their needs and budget.

The Hospital Board is certainly well aware of the 44k in physician incentives, as well as the penalties, for not achieving compliance. Some funding is available today but additional capital will need to be raised and secured. The Board wants to know the total costs of all these initiatives, but the Hospital CIO and their team are still working through the discovery and negotiation phases, and need more time to size everything up. KCs will soon provide them with best and worst case scenarios.

Based on the magnitude of projects and work identified, these Hospital CIOs are going to run into resource constraints. Their direct reports, management team, and IT staff all have some capacity, but they’re already juggling many important projects. CIOs are not going to be able to hire additional staff because of these difficult economic times, and they know they are going to need to bring in outside consulting and staff augmentation resources to achieve the goal. The challenge will be finding these quality resources once the national demand grows exponentially.

Are you waffling between the stress of being concerned and feeling safe at home?

By: Eric Egnet, CIO

Over the past few months, I’ve been talking with Hospital CIOs about HITECH. I wanted to hear it from the horse’s mouth rather than from all the politicians, firms, and agencies who have been hyping it to no end. In my discussions, a clear pattern has begun to take shape. Hospital CIO’s fall into three different camps when it comes to their HITECH efforts and concerns. I’ll detail the three types of campers over the next three days…

Camp Not Concerned or the “NCs”

These guys aren’t going to camp yet, so they aren’t too worried about the implications of changing their routine.

The Hospital CIOs in this camp have read a few articles on HITECH but have not had any meetings or discussions internally on the topic. They feel that things need to shake out before they take any serious action. With the number of projects already on their plate, HITECH is not something NCs plan to lose any sleep over. They are aware of the $44k incentive for their physicians, and how they will need to demonstrate “meaningful use” by 2011, but these campers are not worried about it. In the future the NCs plan on becoming better informed and educated on HITECH, but they are going to wait until there are definitive answers and definitions.

These CIOs feel good and are confident about their existing IT infrastructure and their current HIS systems, both on the inpatient and ambulatory side. There are no plans to switch HIS vendors and they are confident they will be able to close any gaps identified once a thorough analysis is performed. If an ambulatory solution is needed, NCs will select one of the major vendors, after some proper due diligence, and then either manage the project in-house or outsource it. In fact, they may even opt to have the system “hosted.”

Hospital CIOs in this camp are also confident that they have enough or can hire enough full-time IT staff to commit to these projects and they certainly don’t need a third-party firm to come in and provide them with a HITECH assessment. Funding will not be problem, as working capital has been promised, and will be provided by the Hospital Board to address HITECH initiatives that are required.

Are you concerned yet, or are you still feeling safe at home?

By: Robin Shine, Senior Vice President

In September our minds turn away from summer vacations and long warm days to thoughts of back to school, rededication to long work days, and FOOTBALL. Whether you are a fan of high school, college, or the pros weekends will soon be filled with games featuring your favorite teams.

As I listen, read, and absorb all of the information and speculation on the ARRA HITECH legislation, and the debates surrounding the definition of those crazy words “meaningful use,” some questions come to mind in juxtaposition with football!

• What costs more: the new Cowboys stadium or the HITECH portion of ARRA?
• Which are worth more: NFL TV contracts or ARRA incentives?
• Does pre-season football camp remind you in any way of HIMSS?
• Which are more complicated: the rules in the NFL rule book or the CCHIT rules?
• Who is their team’s projected MVP: Tom Brady or David Blumenthal?
• Which produce more revenue for their institutions: BCS football teams or university medical centers?

So, as we all continue to learn more about “meaningful use” send us your comments and questions regarding the definition debate AND the meaning of football or post your own questions on the VCS Blog.