CIO Roger Neal: Getting ahead on project implementation has its downside

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Despite trying to stay ahead of the game when it comes to ICD-10 and Meaningful Use, Roger Neal, CIO of 145-bed Duncan (Okla.) Regional Hospital, says that both projects have presented their share of problems. While trying to implement an emergency department information system (EDIS), Neal had to deal with ER information being pulled--and then re-established--as a requirement for Meaningful Use, forcing him to "jockey resources" among departments. With regard to ICD-10, meanwhile, last week's announcement that CMS might delay the implementation deadline leaves him in limbo with how to proceed with implementation.

Neal (pictured) spoke with FierceHealthIT at the Healthcare Information and Management Systems Society's annual meeting, which takes place in Las Vegas this week, to talk about how he's dealing with those challenges.


The possibility of an ICD-10 deadline delay doesn't mean you should abandon your plans to prepare for the transition. FierceHealthIT has gathered a panel of health IT experts to discuss how CMS' announcement will affect your ICD-10 strategies and share implementation advice. Be sure to register for the breakfast panel discussion, which takes place at the HIMSS conference in Las Vegas from 7 to 8:30 a.m. on Wednesday, Feb. 22. For more information and to register, visit the ICD-10 Readiness for Hospital IT Leaders: Lessons Learned from the Trenches website


FierceHealthIT: Tell us about your hospital's deployment of EDIS and meeting Stage 1 of Meaningful Use.

Neal: We went to the ED because it's a small group of physicians, a much more consolidated area and a little bit different workflow. As we were going through that it really, really looked good. We were already on an EDI system back in 2009 and thought that this would be a pretty easy transition.

It was all good at the beginning, and then, unfortunately, there was a lag period in there when all of the ER information got pulled out of the requirements. Our hospital then had to turn that spigot off in our ER and turn on the inpatient side. We had to jockey projects and jockey resources because we still wanted to be out of the gate as fast as we could.

We started with that process working on our inpatient computerized physician order entry, which was really the last piece we needed, until we got to August of that first year when the final Stage 1 rules came out and, lo and behold, the ED was put back in. So then we're ahead of the game because we've got both of them going simultaneously, but it really became a resource nightmare to try to balance the workload and try to get everybody in there. The nice thing about it, talking about it a year later, was that we really learned a few things through that whole ED implementation that we've been able to carry over, especially around the CPOE portion for the physicians.

FHIT: With CMS set to announce the final Stage 2 Meaningful Use requirements, what challenges will your facility face--assuming that the rules will follow the recommendations from the Health IT Policy Committee from last summer?

Neal: I think our biggest challenge going forward will be the jump in the number of quality measures we'll have to report. I'm a little bit concerned about the number of quality measures basically doubling.

The other thing that we're really watching is the whole idea of Meaningful Use around consumer-driven care--physician portals and how we can set it up so that as a patient you have access to your medical records. I think from a security standpoint we can do it, and technically it can be done, but the workflow is what's making me a little bit nervous.

FHIT: How does last week's CMS announcement that it might delay the ICD-10 deadline affect your implementation plans?

Neal: For us it's a nightmare. Delaying it will make it a bigger nightmare. The date was set and we already started. We've had teams meeting, analyzing all the systems and where all the codes go. We're way, way down the road, and now it's going to be delayed.

Do you now continue, knowing that when you get to the end nobody will take the codes for another year--meaning that for another year you have to keep up with two sets of codes? I would almost rather just set a date and go with it, come hell or high water. Get everybody live and then work the bugs out. We can usually do that faster than delaying it expecting everybody to catch up, because people will just wait until the next deadline and start the complaining all over again.

It's more work for us now because we were ready when nobody else was. Well great. Maybe we should have just dragged our feet.

Editor's note: This interview has been edited for length and clarity.

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