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Early hopes among health-care IT executives of quickly qualifying for federal electronic health record incentives are evaporating as the realities of implementing complex e-record programs sink in, according to the latest survey by the College of Health Information Management Executives (CHIME).

The proportion of chief information officers predicting that their EHRs would qualify for incentive cash in the first six months of the program, or by April 1, tumbled over three consecutive quarterly surveys, from 28 percent last August to 15 percent in November and 7.5 percent in the latest survey, conducted in March.

"The survey shows that as CIOs begin implementing EHRs to meet the meaningful-use targets required to get stimulus funding, they are finding quite a bit of 'devil is in the details' as they move along the process," says Pamela McNutt, chair of CHIME's Policy Steering Committee and CIO of Dallas-based Methodist Health System, in a news release.

The survey also found:

• Nearly 90 percent of respondents are still concerned about meaningful-use standards. Capturing and submitting data to measure quality is their chief worry.
• Three out of four worry about legislative proposals to end incentive funding.
• Roughly 55 percent report lingering questions about the incentive program.

The good news is that a third of the chief information officers surveyed by the national professional organization say they do expect to qualify for federal stimulus funding by Sept. 30, the end of the first year of the program. Health-care providers are rewarded financially for achieving "meaningful use" of EHRs, with the meaningful-use standards expanding in scope over time.

Moreover, nine out of 10 CIOs say they will achieve meaningful use during the first stage of the incentive program, which runs through federal fiscal 2013. That number has remained steady through the last three quarterly surveys. The meaningful-use incentive program enters its second stage in fiscal 2014.

Community hospitals in particular will need more time to qualify for stimulus money, the survey indicates. Just one out of four community hospital CIOs said they could qualify for incentives by Sept. 30.

"As more guidance becomes available and the industry works through the rules, what's needed to get to (meaningful use) becomes clearer," Sharon Canner, CHIME's senior director for advocacy, says in a news release. "If the deployment of health IT and (electronic medical records) was easy, we would have implemented this technology long ago."

The online survey was taken by 200 CIOs, or about 14 percent of CHIME's membership. Respondents represented community hospitals, multihospital systems, academic medical centers and other types of health-care provider organizations.