Four chief information officers, who are also members of the College of Healthcare Information Management Executives (CHIME), provided testimony before the Implementation Workgroup federal panel this week on the challenges they foresee in implementing EHRs, under the current definition outlined in the interim final rule of meaningful use.

“Current reporting of core measures and other required reporting is already cumbersome and resource-intensive and we are concerned about the Centers for Medicare & Medicaid Services' (CMS) new increased reporting requirements for both the quality and functional measures for meaningful use and the resulting burden it could place on the organization,” testified Mitzi G. Cardenas, vice president and CIO of Kansas City-based Truman Medical Centers.

The Implementation Workgroup, a federal advisory panel that reports to David Blumenthal, MD, national coordinator for health IT, is charged with developing real-world implementation experiences that can be included into recommendations of the HIT Standards Committee, whose suggestions will be aimed at accelerating the adoption of proposed standards or mitigating barriers to adoption.

The rapid timeframe for implementing EHRs is a challenge facing Truman Medical Centers, Cardenas said. Currently, proposed regulations for defining the meaningful use of EHRs set out 23 objectives that providers must meet to qualify for stimulus fund payments through either Medicare or Medicaid programs, according to CHIME.

“Stage 1 requirements are well beyond our current use of the electronic record and will require our physicians and nurses to do more of their work assisted by an EHR,” Cardenas said. “The timeline for achieving meaningful use is much more compressed than a traditional implementation schedule. We have worked closely with our vendor partner to apply best practice to the implementation sequencing so we ensure the safety of our patients as well as sustainable provider adoption.”

Along with Cardenas, three other CIOs participated in an “implementation experiences panel,” including:

• Charles Christian, CIO, Good Samaritan Hospital, Vincennes, Ind.;
• David Muntz, senior vice president and CIO, Baylor Healthcare System, Dallas; and
• Michael J. Sauk, vice president and CIO, University of Wisconsin Hospitals and Clinics, Madison.

According to Muntz, implementing EHRs requires organizations to undergo significant changes in how they operate and provide care to patients. “The successful implementation of an EHR is the result of many complex, coordinated activities,” he said. “These include new technology, new processes and new behaviors on the part of clinical staff.”

To transform clinical care through the use of enabling technology “does not happen without process redesign and change management support, training, rehearsals, strong leadership and coaching to support the paradigm shift that each caregiver must experience,” Muntz added.

The meaningful use objectives in the proposed regulations target important EHR capabilities, but it’s important for other applications and processes to be in place to support clinical transformation, Christian said.

Sauk said his organization is working on quality and external reporting requirements outlined in the proposed regulations, but noted that progress is difficult because CMS is not able to accept electronic submissions of data, so University of Wisconsin Hospitals and Clinics can’t comply with the requirement until that changes.

Public comments on meaningful use requirements will be accepted until March 15.