The recently published PriceWaterhouseCoopers Health Research Institute report, Ready or Not: On the Road to the meaningful use of EHRs and health IT, has circulated through the blogmasters desk, and in our continuing effort to keep you informed, we’ve produced the following abstract…

After surveying 120 CIO’s and another handful of healthcare executives, the PwC report adds heft to the impact of the ARRA’s Meaningful Use (MU).

The report makes many keen assertions including:

• “Health systems will need to transform the way they deliver care, so they can sustain performance and grow revenue in the future.”
• Successfully achieving meaningful use “hinges on closer integration with key constituents” (physicians, health insurers, patients).
• Health systems that already have connected with physicians, patients, and health insurers around MU are “more likely to be applying for government incentives” than those that haven’t. But only half of respondents expected to apply for incentives in 2011. (By 2014, 90% expect to be applying).
• Health systems that have included patients in the planning are “more confident about meeting MU standards.”
• “Implementing MU can enhance hospital-physician alignment.”
• Most health systems are failing to connect with health insurers around MU.
• 80% of CIO’s are more than concerned about meeting MU requirements by deadlines. (An American Hospital Association survey reports that 55% of hospitals expect to incur penalties.)
• “The benefits of achieving MU outweigh the challenges.” Those benefits include improve healthcare quality, disease management, coordination of care, improved alignment with physicians, increased productivity, market advantage, and improved alignment with payers.

But PwC identified four barriers to attaining MU: Lack of MU standards clarity, shortage of skilled IT staff, vendor readiness, limited capacity of existing infrastructure . . .

and proffered five benchmarks to achieve compliance: Establish governance, balance compliance against competing priorities, forge new public-private ventures, make the patient the purpose, collaborate with physicians and health insurers.

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: 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?