Meaningless Adoption of Electronic Health Records Could Put Meaningful Use Goals at Risk, Says PricewaterhouseCoopers in New Report

Survey: Eight in Ten Hospital CIOs Concerned They Won't Meet Standards in Time

Jun 29, 2010, 04:00 ET from PricewaterhouseCoopers

NEW YORK, June 29 /PRNewswire/ -- A year and a half after the American Recovery and Reinvestment Act allocated billions of dollars to help hospitals and doctors purchase equipment to computerize patient medical records, even the most sophisticated hospitals in the country are struggling to qualify for the payments. Eight in 10 hospital chief information officers (CIOs) surveyed by PricewaterhouseCoopers LLP said they are concerned or very concerned they will not be able to demonstrate "meaningful use" of electronic health records (EHR) within the federally established deadline of 2015, according to a report entitled Ready or not: On the road to the meaningful use of EHRs and health IT, published today by PricewaterhouseCoopers' Health Research Institute (HRI).

PricewaterhouseCoopers' survey of 120 hospital CIOs who are members of the College of Healthcare Information Management Executives (CHIME) found:

  • Only half of the hospitals and health system CIOs surveyed say they will be prepared to meet the first set of meaningful use requirements and apply for incentive bonuses in 2011, the first year they are available.
  • CIOs interviewed for the report said they also were concerned about meeting later-stage requirements within the specified time frames. These requirements include (1) advancing care processes through decision support; (2) providing and populating patients' personal health records; and (3) improving health outcomes through data-sharing outside their own organizations, such as with insurers, patients and other providers.

The promise of stimulus funding has accelerated EHR adoption and the collection of massive amounts of electronic health data as hospitals and physicians across the country race to meet eligibility requirements. But the existing infrastructure to support meaningful use of EHRs on a national health information superhighway is insufficient, according to the CIOs interviewed by PricewaterhouseCoopers.

"Healthcare organizations are building high-performance race cars to travel back country roads," said Daniel Garrett, leader of the health information technology practice, PricewaterhouseCoopers.  "Furthermore, we found many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage. The bottom line is improved quality of care and patient safety, delivered more efficiently. Government leaders and health organizations need to give consideration to the ultimate goal as they work to finalize and meet guidelines for meaningful use."

According to PricewaterhouseCoopers' report, many hospitals are behind the curve on the path to meaningful use. The biggest barriers include:  

  • Lack of clarity and a final ruling hinder meaningful use implementation. Guidelines for system certification were issued by the U.S. Department of Health and Human Services on June 7, but final guidelines for meaningful use criteria are not expected until fall of 2010, leaving many CIOs and their vendors at an impasse. CIOs surveyed by PricewaterhouseCoopers are most concerned about reporting requirements. Ninety-four percent of CIOs said they are concerned they can't meet government requirements about how to report meaningful use, and 92 percent are concerned about remaining lack of clarity in meaningful use criteria.
  • Shortage of skilled staff. There is a shortage of professionals in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.
  • Vendor readiness and fallout from consolidation are unclear. More than one-third of CIOs surveyed by PricewaterhouseCoopers said they are concerned or very concerned about vendor readiness overall. In particular, 44 percent of CIOs said they are concerned that the external vendors they rely on in health information exchanges (HIEs) are not prepared for meaningful use implementation. Recent merger and acquisition activity among EHR and IT vendors reflects serious efforts by technology suppliers to better position themselves for rapid deployment of systems and integration support.
  • Existing infrastructure capabilities are being questioned. Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow 24X7, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records.

Collaboration Characterizes Early Adopters

According to PricewaterhouseCoopers, one of the keys to successful meaningful use of EHRs is getting buy-in early on from physicians and increasing the involvement of physicians and other clinicians in quality initiatives.

"Nowhere would the meaningful use of EHRs be more valuable than in a hospital emergency department, where it could mean life or death for a patient," added Garrett.  "Emergency department physicians aren't eligible for stimulus incentives but their meaningful use of EHRs is crucial to the hospital and its patients. Hospitals that do not see the path to meaningful use of EHRs as part of a bigger transformational opportunity to improve healthcare quality could be on a long path toward meaningless use."

PricewaterhouseCoopers' CIO survey found distinct patterns of collaboration among hospitals and health systems furthest ahead in achieving meaningful use. The survey found:

  • Health systems that have connected with physicians, patients and health insurers around meaningful use are more likely to be ready to apply in 2011 for incentives. They are three times more likely to incorporate patient input, 87 percent more likely to work with health insurers and 63 percent more likely to assist physicians with regard to meaningful use than are those planning to apply for the first time after 2011.
  • Health systems that include patients in the planning for EHRs are more confident about meeting meaningful use requirements. Seventy-four percent of CIOs who had involved patients responded that they would be among those applying for stimulus incentives in 2011, compared with 50 percent of all hospitals and health systems surveyed.  Yet, fewer than 20 percent of CIOs surveyed said their organizations are incorporating patient input into meaningful use initiatives.
  • Sixty-three percent of CIOs said their organizations are either already working with physicians around meaningful use issues or plan to do so within the next six months. Moreover, an overwhelming 88 percent responded that meaningful use is somewhat or very likely to increase the involvement of non-administrative physicians in quality initiatives.
  • Most health systems are missing out on opportunities to connect with health insurers around meaningful use. Only 6 percent of CIOs said meaningful use would improve alignment with health insurers over the next two years, and only 24 percent said it would improve alignment long-term. Academic medical centers appear most unclear about how they will work with health insurers around meaningful use; 81 percent of their CIOs said their organizations either do not plan to work with health insurers at all or do not know whether they will do so, compared with 47 percent among all hospitals.

"Success in achieving meaningful use standards hinges on closer integration with key constituents – physicians, health insurers and patients," said Kelly Barnes, U.S. leader, health industries, PricewaterhouseCoopers. "Meaningful use of EHRs is an ambitious goal that requires significant clinical, operational and cultural changes, and patients need to be at the center of all planning. Healthcare organizations have an opportunity to be listening much more closely to what patients are telling them they want and need, and through meaningful use of EHRs, they can deliver care in a more personalized, coordinated way."

The PricewaterhouseCoopers report outlines five milestones that hospitals will have to meet to achieve meaningful use. These include: Governance and tone set by the top of the organization; a balance among competing priorities; forging new public-private and community partnerships; a decision to make patients the purpose; and collaborating with physicians and payers.

A full copy of the report Ready or not:  On the road to meaningful use of EHRs and health IT is available at http://www.pwc.com/us/meaningfuluse.

Methodology

PricewaterhouseCoopers' Health Research Institute surveyed 120 CIOs and health IT executives, who are members of the College of Healthcare Information Management Executives (CHIME) during the second quarter of 2010. In addition, HRI conducted in-depth interviews with 14 CIOs and health leaders from health systems, health information exchanges, health insurers and regional extension centers.

About PricewaterhouseCoopers' Health Research Institute (HRI)

PricewaterhouseCoopers' Health Research Institute (http://www.pwc.com/hri) is a leading resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries.

About PricewaterhouseCoopers' Health Industries Group

PricewaterhouseCoopers' Health Industries Group (http://www.pwc.com/healthindustries) is a leading advisor to public and private organizations across the health industry, including payers, providers, academic institutions, health sciences, biotech/medical devices, pharmaceutical companies, employers and new non-traditional market participants in the dynamic healthcare space. PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the U.S. dedicated to the health industries.

PricewaterhouseCoopers' Health Industries' clients include 40 of the top 100 hospitals in the U.S. and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world's major pharmaceutical companies; all of the top 20 commercial payers in the U.S.; municipal, state and federal government agencies and many of the world's preeminent medical foundations and associations. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About PricewaterhouseCoopers

PricewaterhouseCoopers (www.pwc.com) provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 163,000 people in 151 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.

"PricewaterhouseCoopers" refers to PricewaterhouseCoopers LLP or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate and independent legal entity.

© 2010 PricewaterhouseCoopers LLP. All rights reserved.

SOURCE PricewaterhouseCoopers



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