Healthcare CIOs Concerned about Proposed Meaningful Use Standards

Dec. 4, 2009

ANN ARBOR, MI, December 3, 2009 – A recent survey shows CIOs are concerned about their ability to implement the standards recommended by the HIT Standards Committee in time to meet currently established deadlines. The survey, conducted by the College of Healthcare Information Management Executives (CHIME), drew 176 responses, nearly 13 percent of CHIME’s 1,400 members who make up CIOs or top information executives of provider organizations.

With few exceptions, most respondents reported that their organizations are early in the process of implementing applications that are based on standards under consideration by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services.

This summer, the HIT (Healthcare Information Technology) Standards Committee recommended roughly 20 standards for the electronic exchange of health information. Implementing applications that use those standards are expected to impact health organizations’ chances of qualifying for stimulus payments based on achieving the meaningful use of electronic health records.

Nearly two-thirds of all respondents said they were at least somewhat worried about their ability to implement standards-based applications and how that would affect meaningful use determinations for their organizations. Only 8.3 percent said they were not worried about achieving deadlines. Some 37.3 percent of respondents said they were either very concerned or worried about meeting deadlines for implementing standards; 27.8 percent said they were somewhat worried; 26.6 percent said they were a little worried.

“Early attempts at standardization were not rousing successes,” said David Muntz, Senior Vice President and CIO at Baylor Health Care System in Dallas. “It’s hard to believe that we will be we’ll be there before the penalties are levied.”

Respondents confirmed that their ability to implement standards-based applications will depend on a variety of external factors. There was significant concern that healthcare IT application vendors will not be ready to offer standards-based products that will enable providers to meet the deadline; 21.6 percent of all respondents listed vendor readiness as their top concern.

The need to implement upgraded or new systems in order to comply was mentioned as the top concern by 14.8 percent of all respondents. Also mentioned as the top impediments were insufficient capital, 15.3 percent; lacking staff with needed skill sets, 10.2 percent; and insufficient staff, 8.5 percent.

“Having software that can accommodate the standards is one issue; the resource-intensive work is in implementation of the standards,” said Pam McNutt, Senior Vice President and CIO for

Dallas-based Methodist Health System. “For organizations with clinical documentation already in place, a retooling of the nomenclature will be necessary to map to the standard’s nomenclature.”

“Adequate time to understand the impact of change, to test the changes and to adequately train the users are some of my secondary concerns,” Muntz said. “My primary concern is the time and effort required to implement successful change management.”

When specifically asked about preparedness to use vocabulary standards, organizations are currently using clinical systems that incorporate only some of the vocabulary standards.

SNOMED CT, the standard designated for clinical problems and procedures, is the most widely deployed vocabulary standard, with 51.1 percent of respondents reporting that their systems can support the nomenclature. LOINC, the standard vocabulary for laboratory tests, is supported by systems at the organizations of 40.5 percent of respondents, while 43.9 percent said LOINC is not supported by their IT systems.

Other vocabulary standards have much less penetration. For example, 59 percent of respondents said their systems don’t support RxNorm, the proposed standard for drug and medication allergies, while 51.7 percent of respondents said their systems don’t support UCUM, the proposed standard for units of measure, and 55.8 percent said their systems don’t support UNII, an ingredient allergies standard.

In terms of content standards, providers’ answers suggest they are not as far along in implementing systems that are based on newer standards. For example, 51.2 percent of respondents said the systems of their organizations support HL7 v2.5.1 for clinical messaging, but fewer than 25 percent can support NCPDP and HL7 standards for pharmacy order content.

Survey results showed that standards adoption is a complex area for top IT executives, even at organizations that are implementing advanced clinical systems; that’s particularly true for smaller rganizations that don’t have staff specifically assigned to standards adoption. Respondents often showed a great deal of uncertainty about whether their systems currently support either the content or vocabulary standards. For example, 36 percent of respondents did not know if their systems support UNII; some 30.2 percent did not know if their systems were based on UCUM; and 19.1 percent did not know if their clinical systems support RxNorm.

“In talking to many of my CIO peers, it is clear that while they believe standards are very important, their initial focus related to meeting ‘meaningful use’ has been on implementing functionality, such as CPOE and personal health records,” said Joanne Sunquist, CIO at Hennepin County Medical Center in Minneapolis and Chair of CHIME’s board of directors.

“That, combined with the lack of vendor readiness to support standards, might indicate that the standards component could be better met at a future date.”

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