By John Halamka, MD

Every year I write about the projects and trends which keep me up at night.   Here’s my list for FY12:

1. Workforce recruitment/retention – $27 billion in stimulus funds from HITECH have increased demand for experienced IT staff to implement and support electronic health records.   In many ways, it’s a mini “dot com” boom for healthcare IT experts.    This makes recruiting and retaining qualified staff even harder.  Tomorrow, I’m meeting with a consulting team to formulate an FY12 workforce strategy.

2. 5010/ICD10 –  5010 describes a set of X12 standards used for administrative transactions (benefits/authorization. referral authorization, claims).   Payers and providers must support 5010 by January 1, 2012 or risk disruption of the revenue cycle.   BIDMC completed all its 5010 work and is now in final testing with every payer.   Most payer and provider stakeholders will meet the deadline, but significant resources have been pulled from other projects.   ICD-10 implementation is required by October 1, 2013 and I’ve written about those challenges.  Billions will be spent, many healthcare IT projects will be deferred for the next 2 years, and the end result will be no cost savings (coding costs are likely to increase 50%), no quality improvement, no increased safety, and no efficiency gains.  If we complete the ICD-10 project on time, no one will notice, but customers will all be angry at the IT department (and the CIO) for the work on other projects that was deferred.

3. Vendor Product Quality – over the past year, I’ve had several bad experiences with infrastructure and application vendors which delivered products that did not have the reliability, security, or performance promised.   Why?

* the pace of innovation is so fast, that time for quality assurance is diminished

* the economy has stressed companies and they are focused on making as many sales as fast as they can while controlling development  and support costs

* the end result is less satisfied customers

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