Advisory Panel: Top 2014 Priorities and Concerns

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are your organization’s top three IT priorities for 2014 and the concerns you have about executing them?

(1) ICD-10.
(2) Data center relocation to a CoLo.
(3) Complete enterprise EHR rollout.

The only one I’m really concerned about is ICD-10. There are just so many uncertainties around how the providers and the payers will make the transition.

Our top three IT priorities for 2014 all revolve around our Epic platform.

(1) We need to finish our enterprise-wide Epic implementation.
(2) Once we survive our go-live, we will enter into an extended period of optimization of the system, which I anticipate will take at least three to four months.
(3) Subsequent to that, we will begin to develop the capabilities within IT to begin to extend our Epic platform to other entities across our state.

My biggest concern for all of these is the ability to maintain my current resource levels as well as adding new resources in order to address the organizational strategic outreach initiatives.

(1) We are determining whether to stay on our current EMR platform or to switch.
(2) ICD-10 is looming.
(3) We are also focused on getting our remaining hospitals to Stage 7.

(1) ICD-10. Significant work needs to be completed on all facets of this mandate. Vendor testing and validation, staff education (HIM, physicians, and billing), reporting requirements, and many more. Payors are not ready, IS vendors are not ready, and our staffs are stretched thin, so it remains my greatest concern in 2014.
(2) MU Stage 2. So much is still not known. How will we meet the patient engagement goals (absurd for a community hospital with independent medical staff that also must meet the portal goal)? What will the CQMs require for new data collection? How will the medical staff deal with electronic medication reconciliation and the requirements of the Transitions in Care electronic documentation at the hospital while also dealing with a different system and set of requirements in their office? These questions remain and the vendors will not be ready until the last quarter leaving no room for error.
(3) Pending affiliation. During all of this, we are entering into an affiliation that will dramatically change our organization and will, at some point in the near future, require a conversion to a new ERP system and EHR.

After the massive expense of our EHR and in the face of ongoing financial financial struggles (real or perceived), there will be great pressure to hold down costs, perhaps even to find a revenue-generating activity for IT. The concern is that needed education and training will be shortchanged and clinician workflows that should be corrected promptly will be allowed to calcify, requiring even more resources in the future. Many of these workarounds reflect inadequate technical support (I never knew it could do that!) or training (I never knew it could do that!)

(1) Ensuring readiness for regulatory items like ICD-10 and Stage 2 Meaningful Use).
(2) Continuing to optimize our EMR investment via new high-value clinical decision support projects. 
(3) Implementing new enterprise-wide revenue cycle solution.

(1) ICD-10. 
(2) Operational cost reductions (both IT and non-IT).
(3) Growth through acquisition.

(1) ICD-10.
(2) MU Stage 2.
(3) Financial resource management (conservation).

The three are not compatible. I’ll need resources for both of the first two while being asked to use less at the same time. 

(1) Our top IT priority is moving from Cerner to Epic, with the obvious concerns about data migration and workflow changes slowing us down initially.
(2) Appropriately using analytics (from identifying high-risk patients for outreach, to looking for otherwise hard to find adverse events), with the dual concerns of (a) not having enough report writers, and (b) not having enough people to execute on what we find. 
(3) Figuring out telehealth at our organization, with the concerns of (a) finding a technical model that works efficiently, and (2) finding a business model that makes sense (who will pay for it!)

(1) Epic optimization. Hiring and retaining qualified Epic analysts is becoming very challenging in our region. Standard now is  work from home and significant yearly salary increases due to the local competition from institutions out of build phase so analysts are free to jump ship.
(2) Windows XP support (lack thereof). The March 2014 move to Windows 7 has us very nervous – Epic and scores of integrated applications cannot be tested enough to quell the unease.
(3) ICD-10. Ouch… how am I going to get providers that don’t document well to do an even better job next October? We discovered quite quickly that Epic support is still just nudging up their own learning curve.

(1) MU Stage 2. 
(2) ICD-10. 
(3) Integrated financial and clinical systems.

(1) ICD-10. Since ICD-10 success is based on physician documentation, it’s a wildcard as to how well you will do regardless of the education effort. 
(2) MU Stage 2. MU Stage 2 criteria related to transitions of care will be particularly difficult since there are three components (i.e. 50 percent of discharges, 10 percent using CDA format, and a transaction to a different EHR.) Items 1 and 3 are easily achievable but 10 percent using CDA format could be difficult depending on where your patients transition (both inpatients and ambulatory). Many post-acute settings, for example, do not have an EHR capable of receiving this format.
(3) Privacy and security. Privacy and security is just a matter of keeping up with the regulations. Competing for resources is difficult since this area doesn’t  get enough attention until you have a problem. With the final Omnibus rule in place, fines have increased, as will audits. Business associates will be particularly vulnerable, as well they should be. There are a considerable amount of other priorities for 2014 (e.g. ACO IT, EHR optimization) but these may have to wait.

(1) Government regulations compliance.
(2) M&A integration.
(3) Growth initiatives.

My main concern is having too many top priorities competing for finite resources, both in IT and operations.

I’d be very surprised if anybody answers anything but:

(1) MU2.
(2) ICD-10.
(3) Keeping the place running.

(1) MU Stage 2. Vendor delays, expectation of patient engagement.
(2) ICD-10. Inability of vendors to deliver on time; excessive fees (CAC).
(3) Volume to value mandates (reporting, data exchange, etc.), a market mess.

(1) Meaningful Use Stage 2 and 3. Concern about areas where we don’t have full control.
(2) Expanding use of mobile and connected care connecting our enterprise and our community through mobile devices.
(3) Maintaining security in a rapidly changing environment. Expecting more and more security breaches.