"Those upgrades will consume our 2011 budget and all of our resources," he said. "So I have to be done or I can't fund the projects. You really have to look at what you're asking these IT departments to do."
Apart from ICD-10, Veltri said he must also meet new transaction standards that cover medical claims and remittances under the Health Insurance Portability and Accountability Act (HIPAA), and he has to roll out new ambulatory and inpatient electronic medical record (EMR) systems. Otherwise, his operation won't meet the government's meaningful use criteria by 2013 -- and won't receive reimbursement for the work it has work.
"Normally, all that would be three or four years' worth of projects from a funding standpoint," he said.
Veltri said his organization is well on its way to implementing EHRs and has already installed a computerized physician order entry system. But he worries about smaller physicians practices and rural hospitals with little technical support.
"Where are they going to get the expertise without partnering with facilities like mine to do security and virtualization of servers and fault tolerant failover of clustered servers?" he said. "I have dedicated teams that do that. You look at some of these 100-bed hospitals, and they have like five IT people. I have five IT people just for security. So that's kind of scary."
One common refrain from those who have pushed ahead with EHR systems is that many physicians and nurses resist the technology.
Pushback from doctors and nurses was Veltri's single biggest hurdle. "We thought everyone browsed the Internet at night and used a BlackBerry, and that a computer mouse wasn't a frightening tool," he says. "What we found out was that nurses don't even answer their e-mails. E-mail applications are foreign to them. They're just used to doing everything on paper."
Once clinical staff warmed up to technology, however, there was no looking back, Veltri said.
In November, Denver Health completed an 18-month rollout of Soarian Clinicals workflow technology for nurses from Siemens Medical Solutions USA. The software helps nurses coordinate tasks, synchronize patient handoffs, speed up communications, and provide automated assistance for the processes.
"With Soarian, they loved the [user interface] and off they went," he says. "The product has an embedded rules engine that allows you to guide workflows based on data inputs coming in. It's like a rules engine on steroids."
Denver health also involved the nurses themselves. Over the 18-month rollout, the nursing staff put in 7,000 hours helping to shape the deployment and learning to use it, he said.