HIMSS10: CIOs upbeat about meaningful use even as they call for major changes

Call it a modest proposal.

The College of Health Information Management Executives not only wants the timeline for meaningful use of health IT stretched out to 2017, it wants to see CMS offer partial subsidies for providers that meet some of the proposed criteria in 2011, 2013 and 2015. The "HIT marketplace does not have the capacity to support the timeframe imposed by the proposed regulations," CHIME says in lengthy public comments which were submitted to CMS on Friday.

The organization, which joined with the American Hospital Association and others in calling for an extended time frame, based its comments on an extensive membership survey released Sunday, ahead of the annual HIMSS conference in Atlanta. The survey found that hospital CEOs are concerned about staffing shortages, vendor readiness and, most significantly, the uncertain state of health IT certification. "The certification process is the first hurdle," William Spooner, senior VP and CIO of San Diego-based Sharp Healthcare said. "Quit changing the specs." Until the rules for meaningful use are final, according to Spooner, vendors can't possibly build systems that meet all criteria.

The proposed standards for meaningful use only specify requirements of stage one of the program, 2011-12. Qualification for stimulus funding will tighten up in 2013 and 2015, and CIOs that led the survey would like to see both current and future requirements spelled out now. Ideally, they would be able to choose which functions they wanted to adopt for the first phase. "Give us all the criteria now," a vision for the whole program, said Pamela McNutt, senior VP and CIO of Methodist Health System in Dallas and co-chair of CHIME's policy steering committee. "Put all the objectives out there and let organizations and vendors choose what to meet for stage one," McNutt added.

It's unfair for a hospital be penalized for adopting medication reconciliation before computerized physician order entry, according to McNutt. CPOE is a requirement for 2011, while med rec is not.

Despite their strong objections to many parts of the proposal, the majority of CIOs surveyed are confident that they can meet whatever standards CMS throws at them. "We have a can-do spirit," according to David Muntz, senior VP and CIO at Baylor Health Care System, also based in Dallas. However, he said, "This is going to be a heckuva climb for everybody."

Muntz calls the CIO view as "optimism in spite of the evidence," in part because they believe EHRs are the right thing for healthcare; nearly 80 percent of respondents said that EHRs will help their organizations achieve measurable quality improvements.

That's a good attitude to have, because the evidence points to a bumpy road toward meaningful use. Plus, the evidence hasn't exactly given EHRs a glowing endorsement as tools for raising quality. - Neil

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