CIO confidence takes ‘meaningful’ dive

The number of CIOs who expect their hospitals to qualify early for stimulus funding connected to meaningful use of electronic health records has dropped by half, according to a survey by the College of Health Information Management Executives.
More than half of the CIOs surveyed identified the implementation of computerized provider order entry as a key challenge. They said their biggest concern was getting clinical staff to use CPOE.
CIOs from community hospitals now appear to be far less confident than they were in responding to a similar CHIME survey in August, officials report. In the recent survey, only 5 percent of respondents at community hospitals expected to qualify for stimulus funding in the first six months of the program; three months ago, 23 percent did.
Meanwhile, the percentage of community hospital CIOs who believe their organizations are well positioned to qualify for funding dropped to 32 percent, down from 48 percent in the previous survey.
At the same time, some 42 percent of community hospital CIOs did say they expect to accelerate plans to implement EHRs – nearly double the 24 percent who responded similarly in the previous survey.
Results of the mid-November survey, which polled 191 CHIME members, illustrate a variety of changes from the August survey, in which members indicated cautious optimism about their chances for achieving stimulus funding under the HITECH Act.
According to the most recent survey, 15 percent of respondents said they expect to qualify for stimulus funding in the first six months of fiscal year 2011, which began October 1.
By contrast, 28 percent had reported in August that they expected to qualify for funding in the same time period.
“One potential reason for the drop in confidence may be due to the fact that CIOs are getting a clear view of the horizon, as many of their questions are being answered by federal agencies,” said Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind. “Many of the clarifications are adding to the complexity of the task at hand.”
In both surveys, only about 10 percent of responding CIOs said they believe their organizations would not qualify for stimulus funds until fiscal years 2013 or 2014. Still, 82 percent said they continue to have concerns related to meeting meaningful use objectives and qualifying for stimulus funding.
As William Spooner, CIO of Sharp HealthCare in San Diego, sees it, “the requirement to possess the functionality to support all 24 requirements rather than 19 (14 core and the five chosen menu set items) has raised the MU bar for many of us.”
“The additional costs entailed in deploying support for all 24 requirements certainly conflicts with the goal of bending the cost curve (downward),” he said.
New concerns
The nature of those concerns has shifted dramatically from three months ago, however.
For example, CIOs now report fewer uncertainties when it comes to certification of EHR systems than they did in August, when certification was rated as the chief concern by a full quarter of respondents.
One possible explanation could be that authorized testing and certification bodies have worked quickly to certify complete EHR systems and modules in recent weeks, said David Muntz, senior vice president and CIO at the Baylor Health Care System in Dallas.
“But for those of us with heterogeneous environments, it is still not clear how to achieve certification without doing some form of self certification,” Muntz said. “The only practical approach would be to allow EHR components that make up a complete EHR to inherit certification from the certification of a complete EHR.”
If certification is no longer as much of a concern, implementation of CPOE has replaced it as a top worry: it was mentioned by 29 percent of respondents. Another 22 percent cited the capturing or submitting of quality measures as a top concern, followed by vendor readiness, which was identified by nearly 13 percent of CIOs.
Overall, 62 percent of respondents said they expect some level of difficulty ahead regarding CPOE implementation.
When asked specifically about implementing CPOE, 52 percent of CIOs said their biggest concern was getting clinicians to enter orders into their CPOE system to meet thresholds stipulated by meaningful use objectives.
“To really engage physicians, one must provide evidence that clearly shows the advantages of CPOE,” Muntz said. “Our experience has shown that once a physician begins using the technology, they will influence others.”
Spooner agreed.
“With the CPOE threshold lowered to the point that it would be hard to trip on it, we would expect greater optimism by the CIOs,” he said. “Adoption should be seen as a clinical transformation driven by physician and executive leadership.”