Despite calling the Centers for Medicare & Medicaid Services' recent announcement of increased flexibility for hardship exemptions in relation to Meaningful Use Stage 2 "vital relief" for hospital CIOs, College of Healthcare Information Management Executives President and CEO Russell Branzell says that many concerns still remain.
"It was significant the number of members that came up to us [at HIMSS14] in Orlando--ones who we thought were actually doing OK--who said they, in fact, weren't doing OK," Branzell says. "One of our greatest concerns was that if you wait too late, you create and amplify the perfect storm. The concerns that we expressed last year--that we're reiterating this year--are truly starting to come to fruition."
In an exclusive interview with FierceHealthIT, Branzell talks about what the government can and should do to alleviate provider concerns about federal mandates, as well as CHIME's priorities for the year ahead.
FierceHealthIT: Do you think Marilyn Tavenner's announcement at HIMSS about more flexible hardship exemptions is satisfactory for hospital CIOs?
Russell Branzell: Many organizations still don't have the resources and aren't getting the updates they need from their vendor partners. And some are just giving up. Some very large systems have announced that they're not going to do Meaningful Use Stage 2 this year, and if they get penalized, they get penalized.
The next part of this is taking an appropriate review of what CMS has offered up. The question really is "what did they really offer to the average organization out there?" We still need to do a little bit more detailed review of that.
I've heard everything from CIOs ranging from "based on that loose criteria, I can make anything work" to "based on this criteria, [CMS] could turn anything down." It really comes down to whether they truly want to provide the flexibility that is needed now--organization by organization--instead of a broad, sweeping approach. Do they have the capacity to handle several hundred, if not several thousand applications for hardship? Is [the exemption language] so vague in description that every organization thinks they apply to it, but the reality is that it's so vague that CMS could turn every one of them down? We see the potential that this could help, but until it's put into operation, we won't know.
FHIT: Are you holding out any hope that CMS still might revisit a potential front-end extension of Stage 2?
Branzell: Based on my interaction with them, at all levels, including my most recent talks with Dr. [Karen] DeSalvo, what I believe--and maybe I'm being a little too altruistic on this--is that in the end, they're always going to try to do the right thing. I don't think these are harsh, bureaucratic people who are just trying to shove a program down our throats. My only concern is if they waited too late to do the right thing if this gets out of hand and people start dropping out. I think this is the first salvo of help, and if it continues not to help they will have to do something, because they can't let this program falter any more than it has already.
FHIT: Intermountain Healthcare CIO Marc Probst mentioned that in a conversation with ONC's Judy Murphy, she expressed concern that CIOs might let off the gas if an extension were granted. He said he thought such an estimation did not give CIOs enough credit. Do you agree?
Branzell: I think the hardship helps if it works out for individual organizations, but it doesn't smooth this out for the whole industry. We still think that there's flexibility needed for the whole industry, which his front-end, Stage 2 flexibility meaning basically, waiving penalty requirements for this year so people can smooth this out with the other big initiatives.
Even with flexibility, there's still more work than we should be doing. We still don't have time to do all the other stuff we need to get done. To assume that means anybody's going to take their foot off the gas is ridiculous. What [flexibility] means is that we'd continue to work the pace and the appropriate process, but with appropriate sequencing, meaning work on ICD-10, get it right; continue to work on Meaningful Use, but not have them overlapping in resources.
FHIT: Federal mandates aside, what are CHIME's top priorities for 2014?
Branzell: Obviously, our No. 1 priority is always supporting our members. With that in mind, part of what we're doing is some new expansion or extension of the programs we have in place for CIOs. We are significantly expanding our education programs to take topical education out to [CIOs] in their marketplaces. We'll also ramp up our online, real-time education efforts.
We're also putting our own internal advisory services board together for our foundation group. We want to make sure we're doing everything we can to advance the industry.
Another area of significant expansion for our organization is the launching of three new membership groups. We've historically had the CIO membership group, which is what CHIME has always been. Our three new groups will be for chief security officers or like titles, chief technology officers and chief application officers; essentially the c-suite of the CIO. We want to make sure that in every way possible, the health IT executives are getting the education, support and networking they need to advance the industry. Those areas have all grown significantly in the last three to five of years.
FHIT: What is your timeline for launching those other groups?
Branzell: In concept, we've launched. We'd like to get the chief security officers' membership group officially going by early summer--June or July. We'd like to have the other groups going by Q3 of this year.
FHIT: How much growth do you anticipate this will provide for your organization?
Branzell: From a pure membership capacity, most CIOs of large organizations have somebody in those roles. There's probably at least half the capacity of what we have in our CIOs, maybe more, so you're talking between 750 and 1,000 [members] in each one of those new entities. It'll take us a while to ramp up to those numbers and put all the structure in place, but if you look back 21 years ago, CHIME started with, I think, 33 CIOs. This is just an area of significant need, and one that we want to service.
Editor's note: This interview has been edited for length and for clarity.