Catholic Healthcare West (CHCW), Intermountain Healthcare and Kaiser Permanente, known as leaders in information technology, have implemented EHRs, but all have gaps and face challenges trying to meet meaningful use criteria.

Executives of three large integrated delivery networks voiced concerns with the notice of proposed rulemaking for meaningful use definitions to attendees at the Regional Healthcare Stimulus Exchange Conference here on Tuesday.

"Probably no one is doing exactly everything in meaningful use Stage 1 today," said James Ferguson, executive director of health IT strategy and policy for Kaiser Permanente. Despite the advances Kaiser made with its HealthConnect EHR, Ferguson emphasized, "There will be work to do."

CHCW, the eighth largest hospital system in the country, faces a challenge of diversity in standardization, which adds approximately 30 percent cost to its IT infrastructure. "We have to have a balance of standards and customization," said Richard Roth, senior director for strategy and business development.

CHCW set a goal to implement a robust, meaningful use EMR across its 41 hospitals within seven years, he said. Through its EHR Alliance Program, CHCW is deploying Meditech to its inpatient facilities, Allscripts to its ambulatory employed physicians and MobileMD to its community physicians.

So far, eight hospitals have completed EHRs with computerized physician order entry (CPOE). More than 80 percent of CHCW's orders are through CPOE, he said.

Still, the proposed meaningful use criteria are "too high and too many," Roth said. He was critical of the "all or nothing" stipulation, the hasty timing and the lack of grandfathering in what many providers have accomplished to date. "These are all challenging," he said.

There's a deep need for a lower-cost EMR in the $30 to $40 per month range, he said. "We'd love to see that level of innovation" coming from health IT vendors, he said.

Intermountain Healthcare identified the need to fill 26 of the 61 Stage 1 criteria, and 19 of the 29 criteria for security and privacy, said Len Bowes, MD, senior medical informaticist.

The Utah-based IDN does not exchange clinical data from its EHR, and its quality measures reporting is derived from its data warehouse, not its EHR system. Intermountain Healthcare will also be challenged with getting data into its EHR.

To boot, its EHR, which was developed in-house in the 1970s, needs to be ARRA certified, Bowes said. "There will be significant time and resource commitment required to demonstrate the meaningful use measures," he said.

Intermountain Healthcare's goal for 2010 is to complete a gap analysis and implement technology and processes to meet the criteria, Bowes said.

Despite the challenges, Ferguson said, "Meaningful use will really improve health." It will create more engaged and informed patients, provide more complete data for clinical decision making and provide the "ability to make the right thing easy to do," he said.

The next regional Healthcare Stimulus Exchange Conference will be held in Boston on Feb. 9-10. The Atlanta regional conference will be held April 20-21, and the last regional conference will be hosted by Chicago on May 4-5.

For more information on the Healthcare Stimulus Exchange, visit www.healthstimulusx.com.