Archive for September 2009
Over the past few months, I’ve been talking with Hospital CIO’s about the HITECH Act or “Health Information Technology for Economic and Clinical Health”. I wanted to hear it from the horse’s mouth rather than from all the politicians, firms, agencies and people who have been hyping it to no end. In my discussions, a clear pattern has begun to take shape. Hospital CIO’s fall into 3 different camps when it comes to their HITECH efforts and concerns.
Camp A (Not Concerned)
The Hospital CIO’s in this camp have read a few articles on HITECH but have not had any meetings or discussions internally on the topic. They feel that things need to shake out before they take any serious action. With the share number of projects already on their plate, HITECH is not something they plan to loose any sleep over. They know of the $44k incentive for their physicians, and how they will need to demonstrate “meaningful use” by 2011, but they are not worried about it. They understand they need to become better informed and educated on HITECH, and they intend to do so, but in their opinion things are still very gray and their willing to wait until everything crystalizes.
The reason for their confidence is that they feel good about their existing IT infrastructure and their current HIS systems, both on the inpatient and ambulatory side. They have no plans of switching HIS vendors and are confident they will be able to close any gaps identified once a thorough analysis is performed. If an ambulatory solution will be needed, they will select one of the major vendors, after some proper due diligence, and then either manage the project in-house or outsource it. In fact, they may even opt to have the system “hosted”.
Hospital CIO’s in this camp are also confident that they have enough or can hire enough full-time IT staff to commit to these projects and they certainly don’t need a third-party firm to come in to provide them with a HITECH assessment. Funding will not be problem, as working capital has been promised, and will be provided by the Hospital Board, to address HITECH initiatives that are required.
Camp B (Somewhat Concerned)
These Hospital CIO’s are a bit more cautious in their treatment of HITECH. It has been a topic discussion internally and they have proactively added it as an important project in their portfolio. Work is underway to determine what they need to do with their existing HIS inpatient system (replace, upgrade or maintain). If the choice is to replace, then they are moving quickly into the vendor selection process, otherwise they simply will not have enough time to get the system implemented. Alternatively, they are studying their options to upgrade to their vendors latest version, or to try and make due with the existing version of the system.
In addition, they have a fair amount of work to do in the areas of IT infrastructure, integration, security and encryption of patient information. The existing environment may be fine for what they are doing today but it will not meet the future requirements of HITECH. These Hospital CIO’s will likely solicit a third-party firm to come in to perform a HITECH assessment and to also validate and find gaps in their thinking and plans.
The Hospital CIO may already have a central ambulatory solution in place for their physicians, but this is likely not the case, so they are also evaluating vendor offerings with the goal of making a selection soon. They must have both implementation and an integration plans to connect the ambulatory application EMR, with the hospitals internal EMR, to meet the interoperability requirements of HITECH. Some hospitals may be fortunate to be using a vendor who offers integrated solutions for both inpatient and ambulatory. However, most hospitals will need to integrate different vendor solutions together to accomplish this. The cost of the ambulatory solution will be a factor so they are reviewing a broader list of vendor offerings and negotiating options that best meet their needs and budget.
The Hospital Board is certainly well aware of the 44k in physician incentives, as well as the penalties, for not achieving compliance. Some funding is available today but additional capital will need to be raised and secured. The Board wants to know the total costs of all these initiatives, but the Hospital CIO and their team are still working through the discovery and negotiation phases, and need more time to size everything up. The Hospital CIO will soon provide them with best and worst case scenarios.
Based on the magnitude of projects and work identified, these Hospital CIO’s are going to run into resource constraints. Their direct reports, management team and IT staff all have “some” capacity but they already juggling a number of important projects. The Hospital CIO is not going to be able to hire additional staff, because of these difficult economics times, and they know they are going to need to bring in outside consulting and staff augmentation resources to achieve the goal. The challenge will be finding these quality resources once the national demand grows on an exponential basis.
Camp C (Very Concerned)
Hospital CIO’s in this third camp have reason for concern. They know they will have to replace their inpatient system or upgrade it to the latest vendor version. Their current system capabilities are insufficient, and/or the share amount of time and money it would take to make it HITECH compliant is just not practical. They also do not have a common ambulatory system for their physicians, so they know they will need to make a decision on this front as well. Add to this, the significant amount of work and investment dollars required to enhance their IT infrastructure to support these new systems, and the costs and timeframe really start to add up.
Most of these Hospital CIO’s have also had to downsize their staff this past year due to the economic times and simply do not have the internal resources to take on and execute these important initiatives. They know they will need outside help to both manage and staff augment these projects, and they are concerned about finding the right resources when they need them.
Funding for this Hospital CIO is a real problem. The capital that will be required to get the hospital from where it is today to where it needs to be is significant. The Hospital Board is concerned about the mounting costs and their ability to raise enough capital in this tight market. In fact, some are concluding that the costs just may be to great, and that they may need to sacrifice the HITECH incentives and deal with the penalties, to keep the hospital’s financial health in order. Sometimes strategy is what you don’t do.
Meanwhile, the Hospital CIO is trying hard to find the most efficient and cost effective way they can accomplish the task at hand. They are deep discussions with their inpatient system vendor to identify creative ways to upgrade, while containing costs and spread them over time. And on the ambulatory side, they are considering inexpensive ambulatory solutions, that offer just enough to meet compliance requirements. Alternatively, some of these Hospital CIO’s are looking at license free open source EMR offerings that might fill the bill such as OpenEMR and ClearHealth. They are talking and working with different infrastructure solution and technology vendors to identify ways to cost effectively improve their environment.
Finally, from a resource perspective, these Hospital CIO’a only have a small management team and staff that manage the day to day operations of the hospital. Without question they will need vendor and outside consulting firm assistance to help them on these many projects and initiatives. This will become yet another challenge for them as they diligently try to navigate through these difficult circumstances.