Nov. 11, 2011
After conducting “ARRA readiness assessments,” many CIOs are juggling their project priorities to work toward achieving the definition of meaningful use. As a result, some financial and infrastructure projects are put on hold. Once work on CPOE, quality reporting and data sharing are on track, expect IT leaders to refocus some of their attention to topics such as clinical-financial integration, business intelligence, and asset tracking.

The Landscape: After conducting “ARRA readiness assessments,” many CIOs are juggling their project priorities to work toward achieving the definition of meaningful use. As a result, some financial and infrastructure projects are put on hold.

The Future: Once work on CPOE, quality reporting and data sharing are on track, expect IT leaders to refocus some of their attention to topics such as clinical-financial integration, business intelligence, and asset tracking.

When the Office of the National Coordinator for Health IT rolled out its meaningful use matrix last year, most people thought first and foremost about how close their institution already was to achieving those goals.

Hospital executives set out to do gap analyses and accelerate projects such as CPOE implementation and interoperability with community physicians. But what has received less attention is the impact it has had on financial and other non-clinical IT projects, some of which could be put off indefinitely due to the double-whammy of HITECH and the recession.

“When they do this reprioritization, something has to fall to the bottom of the list,” says Sharron Finlay, a regional manager with Beacon Partners Inc. (Weymouth, Mass.). “I would expect that things like biomedical asset tracking would be put off. If they are not contributing to patient safety and the overall goals of meeting meaningful use, they might be delayed,” she adds. “Things that are clinically outcome-focused now have the weight of the institution behind them, where three years ago they might not have.”

Paul Pitcher, director of financial systems for KLAS (Orem, Utah), has heard much the same from both vendors and hospital executives. “My impression is that other projects are being put on hold in order to achieve the definition of meaningful use,” he says. “Patient accounting projects are being done if they are tied to clinical, but otherwise, people are not going to replace financials right now.”

Of course, the level of change to the overall IT plan will depend on a hospital's situation. CIOs who realize they need huge capital outlays for new clinical systems to meet meaningful use guidelines will see a greater impact on how much can be spent on other projects.

David Briden, CIO of the 100-bed Exeter Hospital (N.H.), says his organization has accelerated work already underway on physician e-prescribing, CPOE and interoperability with the EHRs of community physicians. On the non-clinical side, Exeter is in the third and final year of an upgrade to its Lawson (St. Paul, Minn.) payroll and human resources implementation. “Because we already own the clinical software, we weren't looking at a big capital expenditure,” Briden says. “But if you had a big purchase of CPOE competing for dollars with something like a Lawson system upgrade, then absolutely the non-clinical work would take a back seat right now. You just can't afford not to be focused on the meaningful use guidelines,” he adds. “CFOs understand it is not just the bonuses in the first three years, but the penalties that kick in for not meeting it that extend out forever.”

It may be difficult to separate out the impact of the economic downturn from the looming HITECH guidelines, according to Harry Greenspun, M.D., CMO for Dell Perot Systems (Plano, Texas). “Many hospitals have frozen most discretionary spending and frozen hiring,” he says. “They are cutting costs everywhere.”

Both because CIOs wanted some more specificity and also because of the economic shock, there was initially a real pause in spending on either clinical or non-clinical solutions, Greenspun says. “Now that is breaking loose. People feel a little more confident about what the meaningful use will mean to them and they are moving forward.”

Greenspun says he believes that hospitals will soon have to turn their attention to integration. “With the overall health reform focused on public reporting, transparency and value, there is going to be much greater emphasis on integration of clinical and financial systems,” he says. “How do you demonstrate value other than cost per quality? So those that are best able to demonstrate value are going to be leaders in the market and gain market share.”

A juggling act

Some CIOs say they can't afford to put off non-clinical projects, such as enterprise scheduling and charge capture using handheld devices. “We haven't put anything financial on the back burner,” says Mike McTigue, CIO of 645-bed Saint Barnabas Medical Center (Livingston, N.J.). “If something like denials goes through the roof, that kills us,” he says. “As important as clinical systems are, the financial side is also critical and drives our business strategy.”

In Arizona, as the 345-bed Phoenix Children's Hospital ramps up its work on eMAR and bidirectional pharmacy ordering, Vice President and CIO Bob Sarnecki says he has decided that development of financial systems must keep pace. “If CPOE lets us understand physician ordering practices 10 times better, the idea is in the long run to deliver more efficient healthcare, and that means identifying and providing financial incentives for best practices,” he says. “So we have to tie that into our financials.”

Sarnecki's team defined a set of challenges involving charge auditing across the hospital to look at losses. “We thought these important enough to hire four FTEs in the business systems group to tie the clinicals tighter to the back-end financial systems,” he says.

Taking a lower priority in the short term, says Sarnecki, are infrastructure projects. For instance, a new hospital tower under construction has a more sophisticated network than the one in the older tower. “We are going to make due with that older network until 2011 rather than doing both at once,” he says.

Other CIOs tell similar stories of trade-offs. Charles Colander, vice president and CIO of 427-bed Elmhurst Memorial Hospital (Elmhurst, Ill.), is preparing to move to a new 866,000-sq.-ft.-hospital building while also working on meeting meaningful use measures. Moving to the new building was a catalyst for creating a new IT strategy, and that series of IT initiatives fits nicely with HITECH, Colander says. “But there are certain things that are just not getting as much attention, both because of HITECH and because of our IT strategy that we put in place to coincide with our move to the larger facility,” he says. “We have a homecare and hospice system that has been clamoring for a new billing system for a few years now, but we are just not in a position to do those projects now.”

Staffing Strains

Besides limiting some other IT projects, CIOs say, all the work toward meaningful use will put a strain on the health IT work force. Recognizing how serious an issue it is, the Office of the National Coordinator is launching an $80 million community college work force training program.

“We are working with our independent physician community helping them with their billing systems on a consulting basis,” says Elmhurst (Ill.) Hospital CIO Charles Colander. “Everything is under stress because of the financial crunch. Even if you do find the financial resources, where do you find the talent?”

Phoenix Children's Hospital Vice President and CIO Bob Sarnecki has found an interesting solution to that problem. “People are reluctant to locate here unless we purchase their existing home,” he says. “We came up with a solution of using a distributed work force. I have people in places like Tucson, Minnesota, and New Jersey telecommuting, so I don't have to buy their houses.”

Although he hasn't felt the worker shortage yet, Winchester (Mass.) Hospital CIO Gerald Greeley says, with eClinicalworks and Partners HealthCare close by, he's sure it will be an issue. “We have been extremely fortunate to date to be able to hire and retain good staffers, but I am sure the crunch point will come.”

IT projects at 580-bed University Hospital (Augusta, Ga.) have to compete with all of the hospital's other capital projects, says William Colbert, vice president and CIO. Though some projects may need to be postponed, Colbert says many of his earlier investments align quite well with the meaningful use matrix. “We will do basic investment in infrastructure such as replacing servers that are at the end of life,” he says, “but we are putting off buying a radiology information system, and we are not planning to do RFID or ultrasound for locating medical equipment. That is expensive and we just can't cost-justify it.”

Winchester Hospital, a 229-bed facility in Massachusetts, did a reprioritization after HITECH passed, and found that most of the meaningful use guidelines appeared to be in line with what it had already been working on, including a widespread CPOE implementation and connecting to physician office EHRs, says CIO Gerald Greeley. “One thing we do need is a business decision support tool for business analytics,” he says, adding that it would likely be a need that goes unmet for the next few years. “For years we have been concentrating on the clinical over the business side, and that is not going to change. The trend of focusing on clinical applications is only going to get stronger.”

Healthcare Informatics 2010 February;27(2):39-41

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