Part 2 of 2. This article examines the requirements of, and the billions of dollars made available through, the U.S. government's stimulus package and how health care IT departments are turning their attention and resources to the stimulus. Uncertainty about components of the American Recovery and Reinvestment Act -- including meaningful use, certification requirements and the repayment time frame -- is creating some stumbling blocks. These obstacles join the key issues outlined in part 1 of this series: How small and medium-sized hospital IT departments are grappling with shrinking budgets.
Washington is expected to spend $158 billion on the health care component of its stimulus package, another $22 billion on the health care IT systems component of the Health Information Technology for Economic and Clinical Health (HITECH) Act, and up to $16 million per hospital over four years as an additional Medicare stimulus. If hospitals do not comply with the HITECH Act's 2015 deadline, they will receive only a percentage of the potential reimbursement. The following year, hospitals will be penalized for noncompliance.
"It's a carrot and a stick -- and the stick is more of a sword aimed at your heart," said Mike Ward, director of information services at Anderson Hospital, a 130-bed, not-for-profit facility in Maryville, Ill.
Thus, it is not surprising that many small and medium-sized hospitals are expediting their moves to electronic medical records (EMRs); electronic health records, or EHRs; HIPAA revisions; telemedicine, health information exchange, or HIE; computerized physician order entry, or CPOE; and bedside medication administration and verification.
The stimulus package and health care IT: Embarking on EMR
"There was a lot of talk around EMR if we go back a few years, but not so many implement[ations]," said Ashley Leonard, president and CEO of consultancy NetworkD Group, a Sparxent company.
EMR implementations are certainly on the rise these days -- Ward even suggested that EMR tops the priority list of every health care IT director. However, doubts about return on investment hold many health care organizations back, Leonard said.. In a recent study cited by the New England Journal of Medicine, only 10% of hospitals and 17% of doctors in the United States had at least a basic EMR solution in place.
Because of the stimulus package, 90% of physicians and 70% of hospitals will use EMR within the next 10 years, according to Congressional Budget Office forecasts. That leaves a lot of health care IT organizations vying for advice, systems and support from the nation's EMR vendors and partners.
Some health care IT groups that had planned to implement EMR systems already have sped up adoption in order to gain the largest stimulus plan incentive. "Our CEO has just bumped our [EMR] project timeline up. We were looking at, in three years, being completely electronic in our medical records in-house. Now we're supposed to do it within two years," said Bernard Greishaber, network administrator at Saint Genevieve County Memorial Hospital in Ste. Genevieve, Mo. "There are other projects that have to go on hold."
Greishaber's situation is not unique. But speeding up implementations to meet the stimulus package deadlines is putting a strain on small hospitals, which lack sizable IT departments or expertise, said Gary Weiner, a senior manager and consultant at Affiliated Computer Services Inc. (ACS), a Dallas-based provider of business process and IT services.
Roger Neal, vice president and chief information officer (CIO) at Duncan Regional Hospital in Oklahoma, agreed. "I worry that the expectations won't be met after we burn $17 billion to make it happen, and the gains that have been predicted will fall short, creating greater stress on the system at large," he said.
The stimulus package and health care IT: Key components
Because the stimulus plan is spurring EMR adoption, health care IT professionals must ensure their list of potential providers meets the plan's criteria. The EMR must be certified by the Certification Commission for Health Information Technology, meaning it delivers interoperability, security and functionality. The system also must meet meaningful use criteria by including an e-prescribing capability that meets current Department of Health & Human Services standards, the ability to report on technology use to HHS, and connectivity to other providers to create the health care network.
Adopting an badly thought-out EMR system in order to meet federal deadlines could be more costly than paying a penalty for missing the date, some professionals said.
"It's all about how you get there," cautioned Gerard Nussbaum, director of technology services for the Health Care Group of consulting firm Kurt Salmon Associates. "Some hospitals think just because there are incentives they have to rush out for them. Rushing may result in failure, which will cost more than the money they'll recover in the incentive."
When considering vendor choices, in addition to the software itself, hospitals should review the vendor's training, support and maintenance, as well as the costs associated with the hardware and the infrastructure necessary to run the software. Finally, while software should be ready to use, it also should be easily customizable, especially since EMRs are used in so many capacities and job functions.
Health care IT organizations often approach vendors without knowing what they want, though. "You should look at the reason you're bringing an outside vendor in. Is it to reduce risk? Is it a timing issue? Consulting firms work on definitions of work and you have to define the scope," said Jeff Laurinaitis, a sales director at RKON Technologies, which provides IT services to Children's Memorial Hospital in Chicago, among other medical clients.
The stimulus package and health care IT: Developing an action plan
Hospitals investigating potential EMR vendors should include an array of advisers, from upper management to doctors, from nurses to administrators. Finding a tool that meets users' needs -- or a customizable system that IT can tweak to meet individual users' preferences -- can spur adoption and acceptance. This is vital in the many instances where EMR is replacing old-fashioned clipboards and manila folders.
Some hospitals think just because there are incentives, they have to rush out for them. Rushing may result in failure, which will cost more than the money they'll recover in the incentive.
Gerard Nussbaum, director of technology services for the Health Care Group at Kurt Salmon Associates
By creating a list of criteria, of must-haves and nice-to-haves, IT executives can cull some contenders from available applications. And because all these professionals will use the EMR, it is critical to get buy-in from all departments, executives said.
"Some of the challenges were getting the physicians, who were used to paper, to take [the EMR] up. At first it took a lot longer when they were getting used to the system. Training is always a challenge," said Chuck Wiley, CIO of Harrison County Hospital in Corydon, Ind. "A lot of them are set up the way the doctors like them to read. A lot of it is, 'How do I want my screen to look?' That flexibility means we [in IT] have more work on our part."
In addition to consulting on-staff personnel, speaking to fellow health care IT executives, as well as existing vendor or solution provider partners is key, to help determine those software developers and products that work well -- or don't.
The stimulus package and health care IT: Maintaining a healthy outlook
Even before the pending infusion of government dollars, EMR technology was proven to enhance patient care, cut costs and errors, and potentially, increase revenue by improving medical professionals' productivity.
Using a well-balanced approach to selecting an EMR system, one that addresses the needs of each hospital community's diverse array of users and professions and meets the requirements of the stimulus package, health care IT executives can ensure that the prognosis is good, and above all, that their patients will thrive.
"We've had vendors come in and talk and talk and talk, and I've said, 'I can't work with you. It might sound goofy but you've never mentioned the patient once,'" said George Curtis, director of information systems at Upson Regional Medical Center in Thomaston, Ga. "If they don't ever mention the patient, they don't belong here. It always keeps our mission and our vision clear."