Meanwhile, Don May, vice president of policy at the AHA, says what he's hearing from hospital leaders is a far more mixed and often more pessimistic outlook. Where does the AHA see hospital readiness right now?
“To be honest, we don't know,” May says. “One told us they are shooting for 2012, another said they're shooting for 2014; another said ‘our goal is 2012,' but the way they said it, they thought they might be there a little later.”
Yet another hospital executive, May says, was considering a last-minute switch of EHR vendors because the hospital's current vendor won't be ready to work on a new installation for 12 to 18 months. Still others, he says, have given up already on receiving any federal stimulus money. Their hope is to stave off cuts in Medicare reimbursements if they don't meet meaningful-use requirements by 2015.
May says the government needs to closely monitor EHR adoption and the achievement of meaningful use. And it needs to consider a backup plan, like extending the Oct. 1, 2012, start of Stage 2. The second-stage criteria are expected to be more stringent than the first stage.
May says it's OK set the parameters for Stage 2 now. That will give hospitals and EHR vendors a long-range, fixed target. But the government also needs to consider giving hospitals a longer glide path to get there by extending Stage 1 to four years instead of two.
Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profit organizations, says he's hearing “great variation across hospitals” in their readiness assessments. “This is just extremely complex and expensive at a time in which a lot of hospitals are being squeezed,” he says. “It's great to have the money, but the money is not going to cover the costs.”
Though deficit hawks may be circling in Washington, Kahn say he doesn't hear any talk about repealing stimulus funding for health IT.
“I think there is a consensus about this,” he says. “On the other hand, I do hear and see interest in a possible re-examination of the time frame for some of the goals in the hospital community at least. They're facing reality and there are some differences in how fast this can be moved.”
Robert Tennant, senior policy adviser for the Medical Group Management Association, is keeping a close eye on regional extension centers, which were funded by the stimulus law largely to help physicians gear up for meaningful use. The first payment year for physicians under the Medicare EHR incentive program starts Jan. 1, 2011.
“One of the concerns we have regarding these RECs, we've been hearing that some of them entered into agreements with a small number of EHR vendors,” Tennant says. “On the surface, it looks good, you get a discounted rate, but there's no guarantee that that product is going to fit the needs of multiple organizations.”
Barbara Hobbs is manager of EHR, interoperability and standards initiatives at Medical Information Technology, or Meditech, of Westwood, Mass., a developer of hospital EHR systems. Hobbs says her company, as well as other EHR vendors, had been waiting on the government to move on picking certification bodies.
“It has taken them a long time,” Hobbs says. “As soon as we have more clarity and definition, we'll choose one of the vendors, the testing and certification bodies, and go forward with that.”
About a year ago, Meditech embarked on “an aggressive hiring cycle, ramping up its workforce to meet what was expected to be a stimulus-linked surge in business, says Larry Schmidt, the company's senior marketing director.
“We've hired about 300 people, which is about a 10% increase,” Schmidt says. He estimates 200 to 300 of its hospitals, or 12% to 15% of its installed base of 2,300 customers, would be able to meet meaningful-use targets right now.
Joanne Sunquist is the CIO for the 465-bed Hennepin County Medical Center in Minneapolis, which started in 2004 on a five-year plan to install a fully integrated EHR across the county hospital, clinics and affiliated organizations, such as county mental health clinics and a clinic in the county jail.
“We have them all on the same system and we've been live since 2007,” Sunquist says. Hennepin County will seek to qualify under both the Medicare and Medicaid IT incentive programs.
“We've done an initial assessment and we feel very confident,” Sunquist says. “I don't mean to make this sound really ho-hum,” she says, but through a combination of things “we're planning to make it within the first six months of 2011. Our chief financial officer has built the Medicare money already into our budget.”
Medicaid payments are another story.
“We don't know when Minnesota will be ready with the Medicaid money,” Sunquist says. “Our eligible providers, we're going to hit the criteria for the Medicare funding,” she says, but “we are cautious about not estimating anything in our 2011 revenue line from Medicaid.”
Josh Lee is the medical director of information services at 514-bed UCSD Medical Center, San Diego. He gives high marks to the CMS for explaining the meaningful-use rules. A lack of coordination between the CMS and Office of the National Coordinator over the release of the final rules on the certification process, however, “was one moment of what I call a lack of clarity. There was a lot of anxiety” as a result, he says.
UCSD's first inpatient computerized physician order-entry system dates back to 2004, Lee says. Swapping CPOE systems between the hospital's old and new EHR, which should be complete in December, and developing a required immunization registry will cause a short delay for the hospital in qualifying for subsidy payments, Lee says.
“Other than that, I'm fully confident that we're already meeting meaningful use,” he says. “We will be able to attest in the first six months.”
Cristina Thomas is vice president of clinical IT strategy for Catholic Health Initiatives, a Denver-based health system that covers 19 states with 350 ambulatory-care sites and 59 hospitals.
In December, the organization embarked on a $1.5 billion, comprehensive clinical IT program. The goal is to have every CHI hospital and clinic meeting meaningful-use targets by 2015, Thomas says. Three pilot ambulatory groups are scheduled to go live in February and should qualify for incentives in 2011, Thomas says. The hospital phase of the program will be getting under way next month, but won't go live until around April 2012, “so we don't anticipate qualifying on the inpatient side” during the first payment year, she says.
Thomas says CHI isn't changing its IT strategy to meet meaningful-use targets, but neither is it ignoring the opportunity to qualify for incentive payments, hoping to strike a balance between the two as opportunities emerge.
Thomas says CHI sees the federal program as having taken good aim, but is rushing the shot.
“This is the right thing for the nation, the right thing for healthcare organizations and patients. The challenge is the time frame that the government put in place. What we're finding is that even though we have a huge commitment from the leadership, it is very, very challenging finding the skills, in terms of IT resources and clinical resources. It's almost a mini-Y2K syndrome,” referring to vast amounts of attention and resources poured into preventing technological glitches when the calendar turned over to 2000.
“Even though we have the program approval, ramping up to add 200 positions to the organization is really, really a challenge,” she says. “You're forced to pay premium dollars for consultants and contractors to remain on track. It's not undoable, but it's very competitive. That's the down side.”