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CHIME: Hospital CIO’s Confidence Wanes in Hopes of Qualifying for Early EHR Stimulus Funding

December 9, 2010

The percentage of CIOs who expect their health care organizations to qualify early for stimulus funding for implementing electronic health records (EHRs) dropped by half, according to a recent survey by the College of Health Information Management Executives (CHIME).

Implementation of computerized provider order entry (CPOE) is looming as one of the more difficult objectives to achieve; with more than half of CIOs identifying CPOE as a challenge saying their biggest concern is getting clinical staff to use the systems.

CIOs from community hospitals now appear to be far less confident than they were in responding to a similar CHIME survey in August. In the recent survey, only 5 percent of CHIME member respondents at community hospitals expect to qualify for funding in the first six months of the stimulus funding program, compared with 23 percent three months ago.

Some 42 percent of community hospital CIOs also reported that they expect to accelerate plans to implement EHRs, nearly double the 24 percent who responded similarly in the previous survey. Additionally, 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.

“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, FCHIME, 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.”

Results of the mid-November survey of some 191 CHIME members illustrate a variety of changes from the initial August 2010 survey, in which members indicated cautious optimism about their chances for achieving stimulus funding under the HITECH portion of the American Recovery and Reinvestment Act (ARRA).

According to CHIME’s most recent survey, 15 percent of respondents said that they expect to qualify for stimulus funding in the first six months of fiscal year 2011, which began on October 1, 2010. By contrast, 28 percent reported in August that they expected to qualify for funding by April 1, 2011. In both surveys, only about 10 percent of responding CIOs said they believe their organizations will not qualify for stimulus funds until fiscal years 2013 or 2014.

The majority of CIOs– 82 percent – report that they still continue to have concerns related to meeting meaningful use objectives and qualifying for stimulus funding. However, the nature of those concerns has shifted dramatically from three months ago.

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 25 percent 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, FCHIME, CHCIO, senior vice president and CIO at 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.”

Replacing certification as the largest concern related to meeting meaningful use objectives is implementation of computerized provider order entry (CPOE), mentioned by 29 percent of respondents. Another 22 percent report capturing or submitting quality measures as a top concern, followed by vendor readiness, 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, more than half (52 percent) of CIOs said their biggest concern is 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. It is imperative that physician workflows are improved by the introduction of not only CPOE, but clinical documentation, and all other aspects of EHRs.”

A full report of the survey may be accessed here: http://www.cio-chime.org/chime/press/surveys/pdf/CHIME_MU2_Survey_Report.pdf

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