Implementation blues

Meanwhile, Chuck Christian worries that although critical access hospitals are eligible for stimulus funds, they may suffer by virtue of their size. "They just don't have the resources that a large organization has," he said. The 232-bed Good Samaritan Hospital has an IT staff of 25. "I'm one of those 25. I've got some really smart and well-educated, well-trained individuals that know how to run very complex systems.


"We have a hospital that's 35 miles south of us that's a critical access hospital. Their director of IT is also the network engineer. At one time, the only IT person they had was the network guy, and the IT director was also the CFO. Because of the size of the organization, they don't have the appropriate level of resources. That means they depend upon their vendors and others in the surrounding area to provide a hand. So I think they're at risk because they just don't have the resources. This is not a matter of plugging stuff in," he added. "It's not a matter of plugging in and flipping the switch and everything working. The standards are much better today than they have been in the past, but there are many things - if you look at the certification criteria, some of the nomenclature and taxonomy standards - they're not all there yet."

Ashish Jha, M.D., M.P.H., is associate professor at the Harvard School of Public Health and lead researcher on a 2009 study funded by the ONC and the Robert Wood Johnson Foundation that examined the "digital divide" among hospitals that serve the poor. One of his worries is Medicaid's ability to administer funding.

"State Medicaid programs have the option to comply with the federal standard or come up with their own definition. Coming up with this definition is not a trivial issue. The federal government has been going through a very in-depth process. National experts have been working on it for a year, and if state Medicaid programs decide, 'Okay, that's easy, we'll just do what the federal government is doing,' I think those states will probably do fine. What I worry more about, especially right now, given how much states are struggling, how much Medicaid is suffering with cuts, their ability to really administer funds, their ability to think through alternative definitions of meaningful use - I think they'll be a lot of state Medicaid programs that are unable to do it," he theorized. "There are state Medicaid programs (whose)...ability to really handle the influx of money the federal government has earmarked for health information technology is going to be really limited, and they're not going to do a good job of making sure that money is spent effectively."

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