EHR Adopters: Confident, Or Cocky? 2

Healthcare providers are doing whatever it takes to deploy electronic health record systems and all the related technology they'll need to qualify for a share of the $27 billion in U.S. federal stimulus funds set aside to encourage investment in health IT. Their top priorities this year all relate in some way to the government's financial incentive program, including meeting regulatory requirements, managing digital patient data, improving care, reducing costs, and increasing efficiencies.

It's not surprising that providers are focused on grabbing those subsidies. But it is surprising how confident they are that they'll be able to handle the task ahead.

Nearly six in 10 healthcare organizations still need to buy an EHR system or upgrade an existing one to qualify for the federal funds, according the InformationWeek Analytics' Healthcare IT Priorities Survey of 357 business tech- nology professionals at healthcare providers. And 62% of respondents who have EHRs or are planning them say they'll spend more than 20% of their annual IT budget on EHR projects this year. In other words, there's still a lot of heavy lifting for U.S. hospitals and doctors' practices to deploy systems that comply with federal guidelines.

Qualifying for the funds isn't easy. Healthcare providers must be using certified EHR systems that meet federal requirements, and they have to demonstrate that they're making "meaningful use" of those systems, complying with a laundry list of 20 requirements for medical practices and 19 for hospitals. And they have to do all this for 90 consecutive days before the end of next year.

Despite the complicated process, a surprising 83% of respondents who are evaluating, deploying, or have deployed EHRs are confident they'll meet the federal government's deadlines and qualify for incentive funds. Specifically, 52% of them say they're "very confident" and 31% are "somewhat confident".

A quarter of respondents anticipate no problems with EHR adoption in their organizations. That's a high number considering the potential issues that can come up when deploying an EHR system, such as negative reactions from physicians and staff, disruption to patient care, security and privacy mistakes, and shortages of technical expertise. It could very well be that providers underestimate how challenging meaningful use compliance is.

Lighthouse Institute, a New York nonprofit providing services to the blind and severely vision impaired, ran into a significant problem, and now it isn't sure whether it's even eligible for meaningful use incentives.

Lighthouse has a homegrown EHR system that it has been using for several years--one that's been recognized as the first Web-enabled e-record system based on best practices for treating visually impaired patients.

Even so, because the software is homegrown and not certified by the federal government, the nonprofit doesn't know whether it's eligible for the meaningful use incentives, says CIO Tom Nolan. Lighthouse is trying to decide whether to buy modules that have been certified, to add to its system and possibly make it compliant. However, in addition to not having a certified EHR system, Lighthouse doesn't expect to be able to comply with meaningful use's e-prescribing requirement, because its clinicians don't prescribe many drugs.

The Integration Factor

While Lighthouse sorts out its eligibility questions, it's building interfaces that will let its billing and clinical examination systems work with its EHR system so practitioners can more easily document services for billing. "We want to reduce the paperwork that's involved with that," Nolan says.

Fifty-seven percent of survey respondents say the ability to integrate with a hospital or medical practice's existing infrastructure is the most important criterion when selecting an EHR system, ahead of cost (45%), ease of ongoing maintenance (34%), and even a vendor's guarantee of meaningful use compliance (29%).

Among respondents, an eyebrow-raising 31% of healthcare providers say their EHR systems already comply with the government's meaningful use requirements. What they likely mean is that their systems have been certified as meaningful use compliant.

However, certification ensures only that products have the features and functionality needed to accomplish meaningful use. Additional programming and workflow adjustments often are needed to integrate with other systems and processes in a healthcare organization. Significant staff training is commonly required.

Healthcare providers also must ensure that their EHR systems are collecting the data needed to demonstrate that they're using the systems in a meaningful way--to show that a certain percentage of patients have drugs ordered electronically and have lists of their allergies and medical problems in the system, for instance.

It's not uncommon for healthcare providers to think they're making great progress meeting meaningful use requirements, only to discover they're missing the mark, says Dana Sellers, CEO of Encore Health Resources, a health IT consulting firm.

For example, one integrated health system with several hospitals thought it was exceeding federal meaningful use guidelines because computerized physician order entry was being used to order medication for 40% of its patients, Sellers says. But upon closer examination it found that the 40% was being achieved only on weekdays, and CPOE use dropped to 15% on weekends. Stage 1 of meaningful use requires that at least one drug be ordered using CPOE for 30% of a provider's patients for 90 consecutive days--and weekends count.

"You can't just install the systems; you need to understand the process, capture discrete data, get it back out to aggregate, report on it, and use it," Sellers says. In the end, it's all about improving patient outcomes, she notes.

InformationWeek Analytics' survey respondents were just as optimistic about meeting meaningful use deadlines as healthcare providers polled in two other recent studies.

Twenty-eight percent of 152 healthcare IT executives surveyed in August predicted they'd qualify for Stage 1 incentives in the first six months of fiscal 2011 (which started Oct. 1), and another 62% expected to qualify between April and Sept. 30, 2012, according to the College of Health Information Management Executives.

A survey commissioned by the Office of the National Health IT Coordinator and conducted by the American Hospital Associations found that 81% of hospitals expect to achieve meaningful use and 65% plan to enroll in the government's incentive program during Stage 1.

Beyond Meaningful Use

Complying with meaningful use requirements may be top of mind but it's not the only focus. Clinical decision support, chronic disease management, business intelligence, and giving patients Web access to personal health records will get significant attention in the next 12 months, even though they aren't connected directly to the first round of meaningful use requirements. Having technology in place for any of these areas could help providers comply with later stages of meaningful use, however.

At Cleveland Clinic, the development of BI dashboards is a priority this year. The medical center has developed 20 dashboards over the past several years that are used by executives, nurse managers, and others to analyze financial, operations, clinical, quality-of-care, and other data, says Andrew Procter, administrative director of medical operations at Cleveland Clinic Innovations, the facility's technology commercialization arm.

The medical center has a "queue of requests" from clinicians throughout the organization, Procter says. "It's a big part of what we do. It's a big part of the culture" to use analysis that aligns clinical, financial, operations, and quality-of-care data to shape better decisions.

Mobile computing is another area getting attention. University General Surgeons, in Knoxville, Tenn., is evaluating whether to provide its six surgeons with tablet PCs with a hosted billing application. The tablet and app would make it easier for the physicians to document treatment information needed for billing while at a patient's hospital bedside, rather than writing notes on paper and entering the charges later in the office, says practice administrator Michael Poulsen.

Collaboration Underplayed

Less than 30% of healthcare providers rank improving collaboration among clinicians and with patients as top priorities. In addition, nearly a third aren't planning to participate in a health information exchange (HIE) that would facilitate data sharing among practitioners in a local community, region, or state.

The top reason given for not participating in an HIE is that there's "no business or medical need." Healthcare providers, unconvinced of the benefits of data sharing and comfortable working on paper and in data silos, haven't seen the benefit to paying for an HIE membership. Some providers are reticent to share patient data, fearing that competitors will try to steal patients.

These responses are likely to change in the next two years, since data exchange capabilities are expected to be part of later stages of the federal meaningful use requirements.

Providers are taking a "wait-and-see approach," says John Kravitz, associate VP of IT at Geisinger Health, an integrated health delivery network and health plan in central Pennsylvania. They're "putting out the closest fires first," he says. "Stage 1 is challenging on its own."

Geisinger, along with six partners, will be expanding KeyHIE, a regional HIE established to share data on chronically ill patients. KeyHIE uses GE's Web-based portals for data sharing. Its goal is to reduce hospital readmissions for patients with congestive heart failure and chronic obstructive pulmonary disease from the current average of six a year to one or fewer. The system will automatically notify case managers of patients' doctor and hospital visits.

Singular Focus

This year's focus on achieving meaningful use compliance is no surprise. Even before meaningful use programs were introduced, healthcare providers had hints that the government sooner or later would pressure them to use EHRs, says Les Clonch, CIO of Doctors Hospital at Renaissance, a 503-bed acute-care facility in Edinburg, Texas. The increasing amount of patient data that state and federal health departments have been asking physicians to provide alone has been a clear sign, he says.

The biggest impact of the government's meaningful use program will be to get technology laggards moving. Those who will have the most difficulty meeting the requirements likely will be medical practices that haven't begun making the switch from paper to digital records.

But even for providers that have been adopting technology, qualifying for meaningful use can be a challenge, one that clearly demands a great deal of attention this year.