CHIME: CIOs' Hopes Sag for EHR Early Funding

Healthcare CIOs remain optimistic about getting federal EHR stimulus funding, but a growing number acknowledge that federal reimbursement will come later than they'd originally predicted, a quarterly survey by the College of Health Information Management Executives shows.

One-third of the 200 CHIME members who responded to the March survey said they expect to qualify for stimulus funding under the HITECH portion of the American Recovery and Reinvestment Act within the first year of the program, which began on Sept. 30, 2010.

The survey, however, shows fewer CHIME members believe they will qualify for funding within the first six months of the federal program. Only 7.5% of respondents said they expected to qualify for funding by April 1, 2011, compared with 15% of respondents to the same question in November 2010, and 28% of CIOs who responded to the first CHIME survey in August 2010.

Pamela McNutt, senior vice president/CIO of Methodist Health System and chair of CHIME's Policy Steering Committee, told reporters in a conference call on Wednesday afternoon that the road to meaningful use is proving more arduous than many had thought, as CIOs run into a number of nettlesome problems from IT staff shortages to quality measure snafus.

"It's like anything else, the devil is in the details," says McNutt, pointing to a shift in "top concerns" among CIOs. "In December and last year people were concerned about certification and CPOE (computerized physician order entry). What we have seen now is that 26% of the participants in the survey are now concerned about capturing and submitting quality measures. The quality measures are becoming the sticky wicket for everyone."

For example, McNutt says hospitals are being challenged by new quality measures that must be created directly from EHR instead of through the current practice of having them abstracted and entered into the Centers for Medicare & Medicaid Services website.

The survey found that most CIOs said they expect to achieve meaningful use and incentive funding for Stage 1, and more than 90% believe their organizations will qualify for stimulus funding in federal fiscal years 2011 to 2013, the first years of the stimulus-funding program. Twenty-five percent of CIOs in the March poll said they expect to qualify for stimulus funding by Sept. 30, 2011, which marks the first full year of the program, and 58% expect to qualify during Stage 1, but possibly not until late in federal fiscal years 2012 or 2013.

McNutt says CIOs are confronting two challenges. "One is diving into the actual regulation and also diving into what they are specifically needing to do in their organizations," she said. "They are finding there are a lot of details they need to attend to. While they may have been doing some of the things that are in the measures already, like collecting vital signs, they may not have been collecting them in the right place for them to be reported properly. As people start to find these details out their confidence in obtaining meaningful use very quickly is beginning to wane."

Compounding the angst, McNutt says, is a Catch-22 snag that requires hospitals in Stage 1 to report some quality measures using automated physicians' notes generated in their EHRs. "Automated physician notes are not required until Proposed Stage 2," McNutt says. "You don't have your physicians reporting some of the data you need in a granular fashion, so how are you going to record some of these items that are being currently captured by abstraction? That is difficult. We don't have our physicians on electronic documentation yet in most cases."

A majority of respondents said their organizations had not registered for the federal program, the first step in declaring readiness for the incentive program and demonstrating meaningful use of EHR. A total of 19.5% of CIOs at standalone hospitals have already registered for the program, while 29.5% of CIOs at multi-hospital systems have registered all their hospitals for the program.

Responses from community hospital CIOs suggest that their organizations will need more time to qualify for stimulus funding. A total of 26% of CIO respondents from community hospitals expect to qualify for stimulus funding during the first year of the program, ending on Sept. 30, with 66% seeking to qualify in late FY2012 or FY2013.

The March poll shows that more CIOs are accelerating plans to implement EHRs, with 40.5% in March versus 35.6% in November 2010. Those who believe their current IT strategy and existing applications would help them meet meaningful use slipped to 39.5% in March, compared with 41.9% in November.

• Nearly 90% of respondents still have concerns related to meeting meaningful use requirements.
• Capturing and submitting data for quality measures has become the most frequently cited concern of CIOs responding to the survey.
• Nearly 75% of responding CIOs say they are concerned about legislative proposals to repeal incentive funding, including the EHR Medicare and Medicaid Incentive Program.
• 55% of CIO respondents say they still have lingering questions about the program, nearly six months after the Oct. 1, 2010, start of the stimulus funding program.