John Halamka: Looming HIT mandates 'too big in scope'

In the wake of the much maligned rollout, John Halamka, CIO at Boston-based Beth Israel Deaconess Medical Center, says that he sees signs that even "well resourced" health institutions will have a hard time with various health IT mandates that are on the horizon.

In a recent post to his Life as a Healthcare CIO blog, Halamka, a FierceHealthIT Editorial Advisory Board member, says that despite hard work, appropriate priority setting and adequate funding, the scope for such efforts--including Meaningful Use Stage 2 attestation, ICD-10 implementation, HIPAA Omnibus Rule readiness and Affordable Care Act implementation--is too big, while the timeline isn't big enough.

Talking about ICD-10, for instance, Halamka expresses concern that the Centers for Medicare & Medicaid Services won't have enough time for full end-to-end testing of all functionality with its trading partners.

"Will new documentation systems, clinical documentation improvement applications and computer assisted coding to ensure auditable linkage between the clinical record and the highly granular ICD-10 billing data be in place? Doubtful," he says. "Will RAC audits discover that not enough time was available for training, education, testing, innovation and workflow redesign? Certainly."

To remedy such issues, Halamka suggests a series of deadline extensions and pilot tests. Meaningful Use Stage 2 attestation and ICD-10 enforcement deadlines each should be extended by six months, he says.

"The Oct. 1, 2014 [ICD-10] deadline may work for some providers and payers … however, a six-month extension will enable providers and payers to revise and improve systems before a mandatory full cutover," Halamka says. "We need to do this to avoid another situation."

In another recent commentary--this one posted to HIT Consultant--Halamka likens such constant pressure on hospital CIOs to boiling a frog.

"Although not literally true, some leaders describe the unwillingness to react to significant change by noting that a frog placed in boiling water will jump out, but a frog placed in cold water that is slowly heated will be cooked to death," he says. "IT professionals have experienced constant change so gradually over the past decade that we're not aware of the boiling water we live in every day."

To learn more:
- read Halamka's Life as a Healthcare CIO post
- here's his HIT Consultant piece