Find­ings of our an­nual IT sur­vey show how the fed­eral stim­u­lus law is driv­ing project pri­or­i­ties

Modern Healthcare - - Special Feature -

The Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009 is known col­lo­qui­ally as the stim­u­lus law. When it comes to stim­u­lat­ing the at­ten­tion of the health­care in­dus­try, so far the law has lived up to its name. It re­mains to be seen whether the premier health­care in­for­ma­tion tech­nol­ogy ini­tia­tive of the sweep­ing, year-old stim­u­lus law—its multi­bil­lion-dol­lar elec­tronic health-record sub­sidy pro­gram—will work as planned.

Sev­eral key pieces still need to fall into place be­fore Medi­care and Med­i­caid, the pro­grams han­dling the sub­si­dies, will be ready to fun­nel an es­ti­mated $14 bil­lion to $27 bil­lion in net pay­ments into the pur­chase and mean­ing­ful use of EHRs by hos­pi­tals and of­fice­based physi­cians.

For ex­am­ple, there is only a pro­posed def­i­ni­tion of mean­ing­ful use com­mit­ted to writ­ing. It wasn’t re­leased by the CMS un­til late last year, and David Blu­men­thal, head of HHS’ Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy, said at a re­cent fed­eral IT ad­vi­sory panel meet­ing that the CMS rule was “not set in stone.”

Mean­while, the pro­ce­dure has not been adopted yet by the ONC for ac­cred­it­ing or­ga­ni­za­tions ca­pa­ble of test­ing and cer­ti­fy­ing EHRs as hav­ing all the func­tions nec­es­sary to meet mean­ing­ful-use cri­te­ria. Fed­eral pri­vacy guide­lines on how pa­tients can con­trol cer­tain dis­clo­sures of their med­i­cal records are not yet in place. Fur­ther, the ONC just hired Ge­orge­town Uni­ver­sity re­searcher Joy Pritts on Feb. 16 to the new, stim­u­lus law-man­dated po­si­tion of chief pri­vacy of­fi­cer.

Yet, if find­ings from Mod­ern Health­care’s an­nual in­for­ma­tion tech­nol­ogy sur­vey are a fair guide, the stim­u­lus law most cer­tainly has drawn the at­ten­tion of the provider por­tion of the health­care in­dus­try.

Mean­ing­ful-use, in­ter­op­er­abil­ity and qual­i­tyre­port­ing re­quire­ments, stiffer pri­vacy and se­cu­rity re­quire­ments, breach no­ti­fi­ca­tion stan­dards—all IT ar­eas ad­dressed by the stim­u­lus law—dom­i­nated this year’s sur­vey.

For ex­am­ple, meet­ing mean­ing­ful use was men­tioned most of­ten among a list of 19 IT pri­or­i­ties to be ad­dressed in the next 24 months, se­lected by bet­ter than two-thirds of sur­vey re­spon­dents (See chart show­ing the top 10, p. 28).

Sim­i­larly, mean­ing­ful use ranked first among 21 pos­si­ble “hot but­ton” IT pri­or­i­ties, se­lected by 58% of sur­vey par­tic­i­pants (See re­lated story, p. 32).

The sur­vey re­sults also re­vealed a fair amount of skep­ti­cism and trep­i­da­tion about stim­u­lus law pro­grams and re­quire­ments. A siz­able mi­nor­ity, about 31% of re­spon­dents, in­di­cated they ques­tion whether they’ll be able to com­ply with the stim­u­lus law’s mean­ing­ful-use cri­te­ria, par­tic­u­larly dur­ing the first stage of the sub­sidy regime, where the ini­tial cri­te­ria for the Medi­care por­tions of the pro­gram will be the same for both the 2011 and 2012 pay­ment years. (States, in co­or­di­na­tion with the CMS, can set more-strin­gent mean­ing­ful-use cri­te­ria for their EHR sub­sidy pro­grams un­der Med­i­caid.)

That mi­nor­ity of re­spon­dents an­swered that they ei­ther were un­sure, some­what un­likely or highly un­likely to be able to meet the mean­ing­ful-use re­quire­ments in time for the ini­tial pay­ments to be­gin in 2011. The num­ber of skep­tics dropped to about 14% of sur­vey re­spon­dents for the 2013 and 2015 pay­ment years.

Sim­i­larly, while a plu­ral­ity (46%) of re­spon­dents in­di­cated they thought their or­ga­ni­za­tions would ben­e­fit from a stim­u­lus law-funded re­gional IT ex­ten­sion pro­gram, 42% were un­sure and 12% didn’t be­lieve it would be ben­e­fi­cial.

Health­care data pri­vacy and se­cu­rity rules that were stiff­ened and broad­ened by the stim­u­lus law also emerged as a cause of con­cern among some sur­vey par­tic­i­pants, par­tic­u­larly the height­ened re­spon­si­bil­i­ties the new law places on han­dlers of pa­tient in­for­ma­tion in the event of a data breach.

Co-de­pen­dency in IT

John May, chief fi­nan­cial of­fi­cer at 41-bed Wetzel County Hospi­tal, New Martinsville, W.Va., may be typ­i­cal of many sur­vey re­spon­dents this year.

“Our big­gest chal­lenge is go­ing to be to get com­pli­ant with the ARRA,” May says. For now, how­ever, he says, “We’re nowhere near that, and a lot of it is go­ing to de­pend on our ven­dor be­ing in com­pli­ance.”

“We’ll make it over the to­tal term of this thing, but whether or not we’ll make it in year one, we’re not sure,” May says. “We’re not a


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