Many Projects, Little Money

What most CIOs won't want to do is cut out projects that will help them meet future pay-for-performance incentives. Shoolin says at Advocate Healthcare, no projects related to meeting P4P goals have been shelved. "Our current on-hold projects fit mostly into convenience or nice-to-have," he says.

Committing to P4P-related technology, however, also means many hospitals will have to get creative with their spending. While many large hospitals and health systems may already have large-scale P4P applications in place, meeting P4P incentives could be much harder for smaller hospitals and private physician practices that don't already have a full-blown EMR. "Even though there is increasing pressure from a variety of sources to get an EMR in place, many doctors are not hurrying to get them, and as things get squeezed more, it's going to become even less likely that it will improve in the near future and these small practices will invest the $35,000 to $50,000 per doctor to get it," says John Jaffe, MD, executive medical director at Lehigh Valley Physician Hospital Organization in Allentown, PA. The regional healthcare delivery organization was formed in 1993 by Lehigh Valley Hospital and Health Network and the Greater Lehigh Valley Independent Practice Association, Inc.

Jaffe says these smaller group practices and hospitals must look to alternative sources to get the data collection and clinical information they'll need to meet some of the P4P incentives from insurance companies and the federal government. "There are less expensive, less complicated ways of collecting the data that some of the insurance companies are requiring for P4P incentives," he says, pointing out that by using the disease registry, physicians are able to gather basic clinical information about their patients. "That's the poor man's EMR. For example, if you are a primary care doctor and you want to be able to look at your diabetics as a population, you can aggregate data by disease and do some of the same reporting and data collection as you would with an EMR," says Jaffe.

The concept of looking at less expensive alternatives will become more important as budgets become more pinched, he says. "There are companies that sell software that will allow you do to some functions as an ASP model. You pay a subscription, go on the Web site, and hook up with the software through a portal. It's simple, there's no hardware, and it's a less complicated implementation than a full-blown EMR," Jaffe says.

The lucky few … and the rest
Those provider organizations that are able to invest in major projects this year will certainly come out of the downturn in a strong competitive position, says Davis. "It's not like the entire market is going to shut down. There will be those who will start big projects even in a bad economy, because they have to. And, when the economy recovers, it's those hospitals that are going to be in very, very good shape," he says.

Senior leaders at organizations with little or no capital left to spend, however, will be forced to watch how the economy reacts to the economic stimulus plan, says Tempesco. "A lot of people are going to be saying, 'Here's what I know I have, so here's what decision I'm going to make based on what I know. But I'm not going to eliminate anything because I'm not sure what I'm going to have tomorrow.'"