A Medical Device Daily Staff Report

A little more than a year after the American Recovery and Reinvestment Act allocated billions of dollars to help hospitals and doctors purchase equipment to computerize patient medical records, even the most sophisticated hospitals in the country are struggling to qualify for the payments. Eight in 10 hospital chief information officers (CIOs) surveyed by PricewaterhouseCoopers (New York) said they are concerned or very concerned they will not be able to demonstrate “meaningful use“ of electronic health records (EHRs) within the federally established deadline of 2015, according to a report entitled “Ready or not: On the road to the meaningful use of EHRs and health IT,“ published by PricewaterhouseCoopers' Health Research Institute (HRI).

Some findings of the survey of 120 hospital CIOs who are members of the College of Healthcare Information Management Executives (CHIME) found:

• Only half of the hospitals 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. These requirements include 1) advancing care processes through decision support; 2) providing and populating patients' personal health records; and 3) 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.

“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.“

According to the report, many hospitals are behind the curve on the path to meaningful use.

The biggest barriers include:

• Lack of clarity and a final ruling hinder meaningful use implementation. Guidelines for system certification were issued by the U.S. Department of Health and Human Services on June 7, but final guidelines for meaningful use criteria are not expected until fall of 2010, leaving many CIOs and their vendors at an impasse. CIOs surveyed are most concerned about reporting requirements. Ninety-four percent of CIOs said they are concerned they can't meet government requirements about how to report meaningful use, and 92% are concerned about remaining lack of clarity in meaningful use criteria.

• Shortage of skilled staff. There is a shortage of professionals in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.

• Vendor readiness and fallout from consolidation are unclear. More than one-third of CIOs surveyed said they are concerned or very concerned about vendor readiness overall. In particular, 44% of CIOs said they are concerned that the external vendors they rely on in health information exchanges (HIEs) are not prepared for meaningful use implementation. Recent merger and acquisition activity among EHR and IT vendors reflects serious efforts by technology suppliers to better position themselves for rapid deployment of systems and integration support.

• Existing infrastructure capabilities are being questioned. Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow all day and night, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records.

According to PricewaterhouseCoopers, one of the keys to successful meaningful use of EHRs is getting buy-in early on from physicians and increasing the involvement of physicians and other clinicians in quality initiatives.

“Nowhere would the meaningful use of EHRs be more valuable than in a hospital emergency department, where it could mean life or death for a patient,“ said Garrett. “Emergency department physicians aren't eligible for stimulus incentives but their meaningful use of EHRs is crucial to the hospital and its patients. Hospitals that do not see the path to meaningful use of EHRs as part of a bigger transformational opportunity to improve healthcare quality could be on a long path toward meaningless use.“

For this survey, PricewaterhouseCoopers' HRI surveyed 120 CIOs and health IT executives, who are members of CHIME during 2Q10. In addition, HRI conducted in-depth interviews with 14 CIOs and health leaders from health systems, health information exchanges, health insurers and regional extension centers.