Technology
Are Patients Happier at Most Wired Hospitals?
By Alden Solovy, Suzanna Hoppszallern and Sarah B. Brown
Patients favor hospitals with advanced information technology. An analysis of data from the 2008 Most Wired Survey and Benchmarking Study finds that patients at top technology hospitals have a better overall assessment of their stay and specifically are more satisfied with the admissions process and the manner in which tests and treatments are handled.
In a separate analysis, the nation’s 100 Most Wired Hospitals and Health Systems have better outcomes on a variety of quality measures, including risk-adjusted mortality rates.
Taken together, the patient satisfaction and quality indicator analyses provide the strongest evidence in the 10-year history of the Most Wired Survey and Benchmarking Study that information technology makes a difference in both the patient experience and the quality of care.
Yet, an irony emerges from the data. While analyses show that top tech hospitals excel in providing quality, patient-centric care, industrywide progress in adopting clinical IT remains elusive. Overall gains in the use of information technology appear remarkably slow.
The quality and satisfaction results are compelling. This is the fifth consecutive year that an analysis shows that Most Wired hospitals have better outcomes on a variety of quality measures. It is the first year in which Hospitals & Health Networks (H&HN) closely examined the potential link between the use of information technology and patient satisfaction. H&HN worked with Press Ganey Associates Inc. for the satisfaction analysis and with Thomson Reuters for the quality analysis.
“Facilities that are more progressive with regard to IT are also those that are more progressive with regard to changes that improve the processes of care,” says Dennis Kaldenberg, Press Ganey’s senior vice president of research, knowledge management and strategic planning.
“Health IT has shown incredible promise in helping us improve the quality and safety of the care hospitals deliver every day,” adds Rich Umbdenstock, president and CEO of the American Hospital Association. “The results of the Most Wired Survey confirm that today’s patient also understands the benefits of IT in improving care and improving the overall hospital experience.”
A growing body of evidence suggests that IT is a key component of successful quality, safety and satisfaction initiatives. While these analyses show an association between IT and results, they do not show that adoption or use of IT caused those results.
“We may be measuring a commitment to quality,” says Press Ganey’s Suzanne Coshow, a research associate.
Lydon Neumann, senior executive at Accenture LLC, agrees that investment in information technology needs to be coupled with other efforts to drive exceptional results. “Being ‘most wired’ is not the only thing at which these organizations excel. It’s characteristic of leadership that looks at all the elements they need in order to be high-performing organizations,” he says.
Neumann adds that the investment in information technology demonstrates the organizational commitment to patients, caregivers, physicians and clinicians, staff and administration. “It indicates a willingness to invest in areas that advance organizational effectiveness,” he says.
Hospital executives concur. “The evolving relationship between quality and outcomes has always been at the heart of decisions regarding investment in technology solutions. Our focus continues to be supporting a quality patient care experience that delivers desired outcomes,” says Bonnie Sessa, interim CIO of Continuum Health Partners Inc., New York, a 2008 Most Wired and Most Wireless organization.
“The role of IT in delivering exceptional outcomes through quality patient encounters is no longer questioned. It’s becoming essential to a health care organization’s ability to thrive,” Sessa says.
IT and Patient Satisfaction
Press Ganey evaluated patient satisfaction results from its client database; 268 Press Ganey hospitals responded to the 2008 Most Wired Survey. Patients at Most Wired organizations are more satisfied than patients at other hospitals.
In the Press Ganey methodology, satisfaction was measured in different categories, each with questions. This top-line result, which is a composite of all the questions on the satisfaction survey, is statistically significant at the 95 percent confidence level (see figure 1).
| Figure 1 | |
| 2008 Most Wired Patient Satisfaction Analysis | |
| The 100 Most Wired achieve better patient satisfaction results than other hospitals in the following areas: | |
| Statistically significant at: | |
| Patient satisfaction with... | |
| Admission process | 99% |
| Room | 95 |
| Nurses | 90 |
| Tests and treatments | 99 |
| Visitor and family interactions and services | 95 |
| Physicians | 95 |
| Addressing personal issues | 95 |
| Overall assessment of the hospital | 99 |
| Composite score | |
| All sections of patient satisfaction survey | 95 |
| Sources: Hospitals & Health Networks’ Most Wired Survey and Benchmarking Study, 2008; H&HN and Press Ganey Associates analysis, 2008 | |
“As the consumer starts to shop more and more based on quality scores and pricing, how the consumer sees you in the marketplace will have an impact on what patients you get, what payer mix you maintain, lose or grow, and overall performance,” says Roger Neal, assistant vice president and CIO of Duncan (Okla.) Regional Hospital, a 2008 Most Wired–Small and Rural organization. “We will be implementing systems and changes to systems to help us report consumer-based information externally.”
Most Wired hospitals achieved higher patient satisfaction ratings, to different degrees of statistical significance, in eight of 10 categories. “Any action that an organization takes to improve communication, such as IT, is going to have an effect on patient perspectives,” says Press Ganey’s Kaldenberg.
The Most Wired hospitals have employed techniques ranging from patient portals to personal health records to foster strong customer relationships.
“Patients perceive this as technology protecting them,” says Merrie Wallace, R.N., vice president and solution line manager, McKesson Corp. “They feel the presence of that technology and they feel the safety.”
Press Ganey researchers found two aspects of the analysis particularly noteworthy. First, satisfaction with the discharge process did not produce a statistically significant association with IT. Researchers expected patient satisfaction with three areas—admission, discharge and the handling of tests and treatments—to be strongly associated with information technology, in part because hospitals have been active in using IT to address these areas.
Second, researchers found a higher-than-expected association between IT and the overall patient rating of the hospital. In particular, the patient’s likelihood to recommend a hospital is significantly higher among the Most Wired than other organizations.
“I would speculate that the visible presence of technology in an organization improves its image as a progressive or cutting-edge delivery system,” Kaldenberg says. “Patients are most likely to recommend places with excellent service, display up-to-date technologies and provide their needed clinical outcomes.”
Hospitals’ goal is to produce the best clinical results and the best customer experience possible, says Kevin Burbules, CIO of Civista Medical Center, LaPlata, Md., a 2008 Most Improved organization.
As part of the study, Press Ganey conducted separate analyses to control for other factors that might influence the results, such as bed size and status as a critical access hospital or members of the Council of Teaching Hospitals or a Magnet hospital as designated by the American Nurses Credentialing Center. Although specific results for a few patient satisfaction variables changed, the overall conclusion—that hospitals with greater investments in information technology have higher patient satisfaction—remained intact.
“In organizations that are more wired, patients perceive that clinicians are working together better,” Press Ganey’s Coshow says, adding that patients may associate the presence of information technology—such as workstations on wheels—with high-quality care.
IT and Quality
Based on five years of analysis, the presence of IT in a hospital is, indeed, associated with better outcomes.
Thomson Reuter’s analysis of the effect of IT on outcomes among the 2008 Most Wired includes four measures of quality and two measures of cost. The quality variables are: risk-adjusted mortality rates; risk-adjusted complication rates; and two composite indexes—one created from the Agency for Healthcare Research and Quality’s patient safety measures and one created from a subset of the Joint Commission’s Core Measures based on data reported on the Hospital Compare Web site. The cost variables are: severity-adjusted average length-of-stay and case-mix wage-adjusted expenses per adjusted discharge.
The Thomson Reuters analysis was conducted twice, once comparing Most Wired hospitals with all other hospitals nationally—known as an out-of-sample analysis—and once comparing the Most Wired with all survey respondents, an in-sample analysis (see figure 2). The results were consistent between the in- and out-of-sample analyses:
- For the out-of-sample analysis, the 100 Most Wired had better results than all other hospitals nationally for four of the six measures: risk-adjusted mortality rates, core measures, patient safety and average length of stay. This is statistically significant at the 99 percent confidence interval.
- For the in-sample analysis, the 2008 Most Wired had better results than other hospitals in the survey for the same four measures, with the difference for patient safety and average length of stay statistically significant at the 99 percent confidence interval and the difference for risk-adjusted mortality rates and core measures significant at the 95 percent confidence interval.
| Figure 2 | ||
| Most Wired Quality Indicator Analysis | ||
| The 100 Most Wired achieve better quality indicator results than other hospitals for each of the following measures: | ||
| 2007 Most Wired Significant at: | 2008 Most Wired Significant at: | |
| Mortality rate | 99% | 95% |
| Patient safety index | * | 99 |
| Core measures index | 99 | 95 |
| Average length of stay | 99 | 99 |
| *Indicates a statistically insignificant in-sample difference. Patient safety index is a composite created from AHRQ measures. Core measures index is a composite created from data from Hospital Compare. Sources: Hospitals & Health Networks’ Most Wired Survey and Benchmarking Study, 2007, 2008; H&HN and Thomson Reuters analysis, 2008 |
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“By asking the question in two ways and getting the same results, it adds more evidence to support the hypothesis that these hospitals are different in terms of safety and quality,” says David Foster, chief scientist at Thomson Reuters’ Center for Healthcare Improvement.
Thomson has conducted the outcomes analysis for H&HN for the past four years.
The evidence of systemic gains in quality and satisfaction from investment in information technology among the Most Wired is strong. These top tech hospitals are employing IT in the pursuit of quality. Yet, the evidence of a slow slog toward widespread technology adoption and use among hospitals, in general, is equally as compelling.
Alden Solovy is executive editor of H&HN and associate publisher of Health Forum. Suzanna Hoppszallern is senior editor of data and research and Sarah B. Brown is Most Wired project specialist, H&HN. This article is excerpted from an article in the July issue of H&HN.
The IT + Data = Quality Equation
What the computer knows may save a life, or perhaps thousands of lives. One by one, alerts driven by information technology have the power to bring clinical interventions to individual patients more rapidly than simple human observation. Taken in total, the data collected by IT systems can help drive changes in clinical practice and processes that could improve the care for hundreds, perhaps thousands, of patients.
The combination is powerful: using IT tools and understanding the resulting data. Together, these two techniques are the hallmarks of how the nation’s Most Wired hospitals and health systems have applied information technology to improve quality. For the past five years, studies of the 100 Most Wired hospitals and health systems show that, in general, organizations with advanced information technology have better outcomes.
“As an organization, we are keeping a laser-sharp focus on investments that tie back to improvements in quality and patient safety,” says Yousuf Ahmad, senior vice president and CIO of Mercy Health Partners of Southwest Ohio in Cincinnati. This year marks the organization’s second appearance on the Most Wired list. “Detecting and documenting conditions that are present on admission will be the first projects that warrant technology investment, both diagnostic technology and information technology,” he explains.
In fact, Most Wired hospitals have begun to implement electronic surveillance for present-on-admission reporting. One-fifth of the Most Wired use this technique, compared with 6 percent of hospitals generally and none of the least wired (the 100 survey respondents with the lowest scores). Nearly two-thirds of the Most Wired have some form of surveillance-driven alert system.
Half of the Most Wired use systems that provide an automated review of key Centers for Medicare & Medicaid Services indicators to provide compliance alerts. Those alerts are sent to a variety of clinical areas, including critical care units and the emergency department.
“It is our goal to use the technology to proactively track and monitor our compliance with the core measures and other performance improvement initiatives that can improve patient outcomes,” says Karen Graham, vice president and CIO of Cooper University Hospital in Camden, N.J., recognized in 2008 as a Most Improved and a Most Wireless organization. “Evidence-based tools will enable us to deliver a high-quality standard of care and assist us in identifying in real time where standards of care are not being met.”
The top-tech hospitals have employed electronic surveillance systems that track unusual trends in patient diagnoses and symptoms. More than 40 percent of the Most Wired use fully electronic surveillance systems for tracking hospital-acquired infections and most of the rest have partially electronic systems. The same trends are true for disease and syndromic surveillance. The Most Wired are also using electronic systems to assist with the medication reconciliation process through the creation of electronic medication lists.
“Many of the systems implemented today require significant realignment of process to achieve the expected outcomes,” says Joe Diver, CIO of Berkshire Health System, Pittsfield, Mass. The organization is making its eighth appearance on the 100 Most Wired list. “New technology will only be 20 percent of the requirement to reach the goal. The 80 percent needed will come from change in the way we think, manage and operate.”