by Pam McNutt

Healthcare CIOs are understandably concerned about the scope of the work they'll be facing in implementing electronic health records. The promise of stimulus funding for healthcare organizations that "meaningfully use" electronic health records has definitely raised the profile of these clinical systems.

My peers' concern was apparent in a recently completed survey by the College of Healthcare Information Management Executives (CHIME), which showed that CIOs are concerned about their ability to implement applications that are based on standards under consideration by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services.

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The survey drew responses from nearly 15 percent of its members, including CIOs and top information executives of provider organizations.

This past summer, the HIT Standards Committee, which is advising ONC on standards for clinical records systems, recommended roughly 20 standards for the electronic exchange of health information. Implementing applications that use those standards are expected to impact health organizations' chances of qualifying for stimulus payments related to meaningful use.

Nearly two-thirds of all respondents said they were at least somewhat worried about their ability to implement standards-based applications and how that would affect meaningful use determinations for their organizations. Only 8.3 percent said they were not worried about achieving deadlines. Some 37.3 percent of respondents said they were either very concerned or worried about meeting deadlines for implementing standards; 27.8 percent said they were somewhat worried; 26.6 percent said they were a little worried.

One of my colleagues, fellow Texan David Muntz, CIO at Baylor Health Care System, notes that there are challenges in implementing standards-based systems. "Early attempts at standardization were not rousing successes," he said. "It's hard to believe that we will be able to adapt to new standards in time to qualify for the rewards from the stimulus."

CIOs in the survey identified several of the challenges that will need to be considered in implementing systems based on prescribed standards. Vendors that supply these systems will need to retool what they currently offer to comply with standards, and vendor readiness was the most frequently mentioned top concern of those taking the CHIME survey.

Our organizations will need staff to put these systems in place, and those who have needed skill sets are in short supply in our industry. Because stimulus funding occurs after organizations bear upfront costs for installing clinical systems, financing is another concern mentioned by CIOs.

My top concern is making sure that everyone understands that having software that can accommodate the standards is only one issue. The real nitty-gritty work is the resource-intensive task of implementing the standards. That will be a significant challenge for organizations that have already invested time and effort in existing clinical documentation systems; they'll face a retooling of that nomenclature to map to the standard's nomenclature.

As clinical systems are put in place, the work only begins. Change management then becomes the lifeblood that will help achieve the ultimate promise of these systems.

Pam McNutt is senior vice president and CIO of Methodist Health System in Dallas, Texas