The Consequences of Healthcare CIO Overload

At HIMSS' annual conference in Orlando, many conversations among CIOs were conducted mostly in acronyms — MU, ICD-10, ACO, HIPAA. Individually, each of these acronyms represents a major IT project or initiative for 2014. Together, they represent the biggest challenge facing CIOs this year.

"People ask me what the number one problem for CIOs is right now — it's overload," says Russ Branzell, CEO of the College of Healthcare Information Management Executives. "Any one of these things would be manageable. All of them together are a disaster. No one has enough resources to do them all."

To help CIOs this coming year, CHIME has launched several new initiatives, more than have been launched annually in the past. The organization plans to gather industry experts to share their knowledge at regional events and online. A new Speakers' Bureau aims to provide a formal mechanism for matching experts with eager audiences, and CHIME will expand its offerings to include resources for chief technology, chief application and chief security officers to further support all of a hospital's IT efforts.

"What we want to do is lessen that burden for them as much as we can. Provide them best practice sharing, try to share resources across the whole nation," says Mr. Branzell.   "And this is just the start."

CHIME leadership has plans to continue to evaluate and develop ideas for new programs to help CIOs be prepared for the coming challenges. Launching four, five or more initiatives annually will become routine for CHIME, says Mr. Branzell, as he and CHIME know the demands on healthcare CIOs are not about to abate.

Among all the demands facing hospital CIOs, meaningful use attestation has become a main concern with high stakes. During HIMSS, Mr. Branzell heard from a growing number of CIOs who believe missing meaningful use stage 2, and the resulting loss of incentive payments and penalties in 2016, would bankrupt their hospitals. "Not, 'I'll have financial problems,'" he says. "They're saying, 'This will bankrupt my hospital.'"

CHIME Board Chairman Randy McCleese, the CIO of St. Claire Regional Medical Center in Morehead, Ky., is currently working on attesting to the second year of meaningful use stage 1. The hospital is struggling to get a patient portal installed and running in time to begin stage 2 next fiscal year. Because of the financial consequences of not attesting, the hospital now has to make difficult decisions on where to find the money in the hospital's budget.

"We're at the point where if we don't have those meaningful use dollars, we're in the red," says Mr. McCleese. "And we can't stay in the red, we can't continue to operate in the red."

Mr. McCleese, like other CIOs from organizations of various sizes, has also not yet received the software that will allow his hospital to conduct dual coding. It's expected in June, giving the hospital a mere four months to get the system up and running, and train all the employees. He's not alone — another CIO told Mr. Branzell at the conference nine of the 10 software packages he needs to transition to ICD-10 are not available. "Not just not delivered, not available," says Mr. Branzell.

These two projects are demanding CIOs' attention at the same time healthcare reform and increased HIPAA penalties for data security violations means a hospital's financial and operational well-being is directly dependant on data security, population health and other projects being done perfectly during the exact same timeframe.

"We have enough time that if we focused on ICD-10, we could get ICD-10 done for a vast majority," says Mr. Branzell. "But if they do ICD-10, meaningful use, cybersecurity, ACOs, population health, and try to do them all at the same time, none of them will work."

It's not that CHIME and its member CIOs do not believe in the necessity of meaningful use objectives, the benefits of switching to ICD-10, the need for data security or the care improvements that will result from paying more attention to population health. It's that limited resources at many hospitals coupled with the short timeframe to handle both the technical and workflow changes may prove to be too much.

"All of this needs to be done. We know it needs to be done. We just don't have enough resources," says Mr. McCleese. "I have a very small staff. I can't go out and hire five more people. I can't hire one more person. I'm trying to do all of these things with the same amount of staff that I had six years ago."

"They are in a no-win situation," says Mr. Branzell. "I have been doing this now for over 20 years. This is the first time I have ever seen it where the odds are so stacked against everybody. We are literally in a lose-lose situation." Mr. Branzell acknowledges that a few hospitals and health systems have such an abundance of resources that they're able to handle all these projects simultaneously. But even many of these larger, technologically advanced systems are having difficulties completing all these projects.

Intermountain Healthcare, a 22-hospital system based in Salt Lake City, recently announced it will not attest to meaningful use stage 2 in 2014. Intermountain leaders have decided the risks, especially to patient safety, of pursuing meaningful use attestation during its current transition to a Cerner electronic health record system outweigh the benefits, according to a statement provided by the health system. Intermountain will forgo incentive payments for this year, as well as incur penalties in 2016.

Intermountain is not alone in its worries about the pace of change compromising patient safety. Mr. Branzell says he doesn't know a single CIO in the 1,400-plus member organization who would let their organization do anything that would potentially harm a patient. "And there is that level of concern, that we're going to do things so fast that we're going to place patients at risk," he says.

These concerns are likely result in more organizations joining Intermountain in postponing some of these projects and accepting the penalties. "If you do it incorrectly, you could kill someone." Mr. McCleese. "From the CIO standpoint, we have to make sure it is done correctly," even if that means missing deadlines.

Mr. Branzell believes it will also result in CIOs leaving their post rather than fail to do what may well be impossible. He knows of a couple prominent CIOs who plan to retire early: "They say to me, 'Russ, there's no way. There's no way I can run this hard, this fast anymore.'…These people love this job. They love the industry, they love the patients they're caring for. But personally, they just can't do this anymore."

Mr. Branzell believes these few CIOs who have told him of their plans to resign will not be the only ones. "It's like a tsunami. First you see a little wave, and then you look up and there's the big wave," he says. "We've seen the pullback, we've sent the first few little waves. I think we'll see, as people consider their options, we'll see more people pulling out."

That's why many of the initiatives CHIME has launched include opportunities for communication between CIOs on challenges faced, and conversations on how to best tackle them.

For Mr. McCleese, events like HIMSS and the events put on by CHIME are crucial not just to learn but to find support systems for what promises to be one the most challenging years for CIOs. "I find out who my peers are, who has my same systems, who can I talk to that's on the same page," says Mr. McCleese. "It's so important," he says, to have a network of executives facing the same challenges.

"[CHIME] is safe," says Mr. Branzell. "And they need that…Our greatest asset as an organization is that safe outlet for them."

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