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Healthcare CIOs Juggle Obamacare, Traditional Projects

Newly empowered healthcare CIOs struggle to find their way in regulatory landscape while defending budgets, says Deloitte report.

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CIOs of hospitals and healthcare systems are juggling a bevy of short-term and long-term priorities, according to a new report from the Deloitte consulting firm. Although focused on specific projects such as Meaningful Use and the ICD-10 transition, they are also increasingly engaged in achieving their organization's long-range objectives related to value-based reimbursement and accountable care.

The biggest priorities for the 12 CIOs recently interviewed by Deloitte were navigating the regulatory environment, laying the foundations for more capable and reliable IT systems, and preparing for accountable care and payment reform.

All but one of these CIOs said that their organizations were "prepared" or "very prepared" to meet the Meaningful Use requirements. Seven of the 12 IT leaders said that the deadlines in the government EHR incentive program made no difference in their implementation of clinical information systems. Three, however, said they were grateful for the extra year provided to them to prepare for Meaningful Use stage 2.

[ Why do some doctors resist the next phase of MU? Read Docs, Hospitals Say Delay Meaningful Use Stage 3. ]

"Many of those we interviewed had been on the road of EHR adoption prior to Meaningful Use, so the program didn't make them adjust their timetable," said Harry Greenspun, one of the report's authors, in an interview with InformationWeek Healthcare.

Among the other major challenges that the CIOs face, according to the report, are:

-- Increased performance reporting requirements for Affordable Care Act (ACA) demonstrations and pilots, including those for medical homes, bundled payments and accountable care organizations.

-- Increased requirements for talent and IT capacity to structure and manage data, synthesize it as useful information, and support decision making.

-- Integrating independent practice IT systems and personnel into system-wide solutions and strategies.

-- Intensified regulatory oversight related to fraud and abuse.

-- Privacy and security issues in a connected system of care.

CIOs are having some difficulty in balancing these near-term demands against the long-range priorities, noted Greenspun, who is senior advisor of health transformation and strategy for the Deloitte Center for Health Solutions.

"They know what they have to do -- they have to become payer-esque and track all sorts of information to deliver value and quality care," he said. "Their concerns are around whether there will be technology to support that, and whether they'll have the right leadership and the right skill sets within the organization to do some very new things."

CIOs are also taking on new roles in their organizations, he said. Whereas in the past they focused mostly on "tactical" projects such as getting a PACS up and running, they're now "an integral part of the strategic future of the organization." That means they have a seat at the table for strategic planning, and they must be able to interact effectively with the financial and clinical leaders of the organization.

One finding of the Deloitte report suggests there are still tensions over the growth in health IT spending. Although few of the CIOs said they face challenges in convincing their colleagues that the financial costs of health IT are worth the investment, the current annual rate of growth in health IT costs -- around 10% in these organizations -- still raises eyebrows on hospital boards.

"Everyone recognizes we have to do this, but health IT is competing with clinical services and that new MRI and the new robot for the operating room," Greenspun explained. "At one time, technology was often a smaller investment with a separate budget. It wasn't elevated up to the level we're seeing now. Everybody realizes the importance of these things, but because the dollars have gotten big and the lifespan of these projects has increased, it's a different type of discussion."

Deloitte advises CIOs to present "credible ROI estimates" to their CEOs and boards. Although an increasing number of studies show a positive return on investment, Greenspun noted, this is about more than just dollars and cents or whether it takes doctors less time to order tests through computerized physician order entry (CPOE).

"It's about delivering value and how they're measuring value in terms of contracting or quality and safety improvements, consumer engagement or patient satisfaction scores," he said. "The bottom line is that ultimately, they need to be a data-driven organization -- it's something they have to do. So how CIOs can demonstrate the value of these investments is important, but there isn't just one element that dictates whether they should proceed or not."

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