What is the source of all this distraction? In a nutshell, it's Washington, D.C. Christian's lament is widespread these days. Ask hospital CIOs about their holiday wish list, and you pretty quickly catch on to that theme.
CIOs are overwhelmed by the sheer volume of federal programs coming their way. They're finishing the year with their transition to HIPAA 5010, the new claims transaction standard that requires system upgrades and testing with payers. At the same time, they are mired in meaningful use, installing and deploying EHR systems and modules such as e-prescribing, computerized order entry and patient portals. They're hustling to qualify for federal incentives (and avoid eventual federal penalties).
Beyond that, CIOs are facing an October 2013 deadline for the conversion to ICD-10 (see cover story, page 18). That alone requires a massive overhaul of clinical, financial and administrative systems in order to keep the cash coming. Layer in other federal programs spawned by health reform-such as accountable care organizations and the shift in risk-sharing and payment methodology they represent-and you have the underpinnings of a bad dream. Factor in the push for health information exchange, and the nightmare can turn into waking delirium.
What's significant about CIO frustration with the regulatory environment is that it's coming from leaders who solidly champion clinical IT. They are not resisting government programs because they want to live with paper charts. In fact, many CIOs are clamoring for federal involvement in areas where they perceive a need-such as a national patient identifier and a broadened IT labor pool to help pull off the projects the government is asking them to do.
"My top wish is for the whole concept of the EHR to come into fruition from the national guidance perspective," says Russ Branzell, CIO at Poudre Valley Health System, which runs two hospitals in Fort Collins, Colo. "A lot of work across the country isn't coordinated. We need to get to the point that it's improving care. My fear is that nationally, and on the state level, we are doing so much so fast we may not be doing a great job. With meaningful use, we're trying to push so fast. People are doing IT projects, but they're not oriented to improve care. We're trying to slow down our own effort to make sure we're doing the right thing for the right reasons."
Branzell is no newcomer to the EHR. Poudre has been building out an electronic record for the past eight years. And the federal incentives under meaningful use-while aimed in the right direction-are creating unseen consequences, he says. "Vendors can't keep up with government requirements and CIOs are stretched thin. It is putting the industry into turmoil."
Sidetracked Efforts
For some CIOs, the web of regulations means some efforts likely will be sidetracked. In essence, each government program is pushing against others. That's why an extension on ICD-10 is tops on the wish list of North Shore-Long Island Jewish Health System CIO John Bosco. "Not for the purpose of procrastinating," he says. "We're working on ICD-10 now and have a detailed project plan with established governance, a steering group and nine workgroups. Our fear is running into deployment plans for the EHR and Stage 1 meaningful use. We could disrupt some EHR deployments."
With 15 hospitals and 2,200 physicians, North Shore-LIJ is a complex operation. And completing the ICD-10 transition alone will be a major challenge, Bosco says. "About 130 applications are impacted," he says. "Half are clinical and half are revenue." And when push comes to shove, Bosco says the health system will set aside its EHR enhancements to qualify for meaningful use incentive payments and prioritize instead its transition to ICD-10. "We are a $7 billion health system with millions of claims going out the door. Meaningful use means less than $100 million for us. ICD-10 will be the highest priority, but we still strongly believe in the EHR."
Seconding Bosco's wish to delay ICD-10 is Mike Restuccia, vice president and CIO of Penn Medicine, which encompasses the University of Pennsylvania Health System, a research center and a medical school. Bosco says U-Penn is well on its way to attesting for Stage 1 meaningful use, merely waiting for one piece of homegrown software-its data warehouse and analytics tool-to be certified. "We have all the criteria met for inpatient and ambulatory," he says. "We are 100 percent CPOE and 100 percent physician adoption on the ambulatory side."
Despite the progress, Restuccia wishes for the gift of a 12-month postponement of ICD-10. Delaying ICD-10 would enable Penn Medicine to better tackle Stage 2 of meaningful use, as well as enhance its overall clinical IT footprint. Toward that end, the health system has several major EHR system upgrades planned to support the advanced functionality likely to be called for in later stages of the federal incentive program. "These are not small projects," he says, ticking off a list that includes the ambulatory EHR, the lab system, and the inpatient EHR.
Upgrades Galore
Tackling the upgrades across the health system's three hospitals makes the project even more difficult. "When you think about multiple hospitals, the number of physicians affected, the CPOE system, results, pharmacy and clinical documentation, you'll be affecting a lot of people," Restuccia says. "Getting more value out of those systems is where we would like to focus. But doing ICD-10 at the same time is too much at once. It will need assessment, remediation and an incredible amount of testing. Something will have to give."
