Technology
What Can IT Do for You?
By Alden Solovy
The nation's 100 Most Wired hospitals and health systems are more likely to define, measure and evaluate both the financial and nonfinancial returns from their investments in information technology than other hospitals, providing the data needed for both senior management review and governance oversight of these critical projects.
These findings come from the 2005 Hospitals & Health Networks' Most Wired Survey and Benchmarking Study, released last July (2005). Each year since 1999, Hospitals & Health Networks (H&HN) magazine has surveyed the nation's hospitals on their use of information technology to accomplish key goals, including their safety and quality objectives.
The survey is a joint project of H&HN, IDX Systems Corp., Accenture and the College of Healthcare Information Management Executives. Based on a detailed scoring process, H&HN annually names the 100 Most Wired Hospitals and Health Systems. This year, 502 hospitals and health systems representing 1,255 hospitals participated in the survey.
The 2005 Most Wired data show that the nation's top tech organizations are actively assessing the benefits of information technology at significantly greater levels than other organizations. The Most Wired are more likely to:
- Formally define financial, quality, safety and patient satisfaction measures to be evaluated for each project
- Develop a baseline comparison and a target level for each measure
- Develop specific plans for measurement, evaluation and review of each measure.
This focus on project evaluation provides both management and trustees with dashboard data to track whether projects meet the stated goals when developed and approved. "Clinical systems can impact quality, outcomes and the patient experience," says Lewis Redd, Accenture's partner-provider practice leader. "I strongly believe that clinical systems can improve quality and decrease costs. As a board member, that matters."
The reason boards are becoming more active in IT oversight is because of the broad impact information technology can have on both clinical operations and financial results. "Effectively, these projects can either stop operations or dramatically improve them," says Graham Hughes, M.D., vice president of product strategy for IDX. "More and more, these projects are getting board level review, in particular CPOE (computerized physician order entry)."
Redd says that board members should require that management provide a business case for major IT investments. But that's not enough. "Board members should insist on monitoring those goals," he says.
The nation's top tech hospitals are doing just that. More than 60 percent of the Most Wired formally define metrics and set baseline measures for finance, quality, safety and patient satisfaction for at least 61 percent of their IT projects. By contrast, less than 8 percent of the nation's Least Wired hospitals define metrics for 61 percent or more of their IT projects. (See "Measuring ROI On IT," next column.)
Hughes says the technology itself creates an opportunity for measurement and evaluation. "Because they have these tools, hospitals can set performance targets that they can track."
Both Redd and Hughes say that boards should require broad "dashboard" data for oversight purposes, but should also ensure that hospital management is routinely evaluating a more detailed set of data.
These conclusions come on the heels of July's cover story in Hospitals & Health Networks showing that, on average, the 100 Most Wired have risk-adjusted mortality rates that are 7.2 percent lower than other hospitals. The conclusion is valid at the 99 percent confidence level and remains valid even after controlling the data for the size of the hospital and teaching status. That analysis was the first showing that hospitals with broad use of information technology across a variety of projects also have better outcomes. However, the analysis does not establish a causal relationship between IT and outcomes. For a full discussion of those results, go to www.hhnmag.com.
The difference in IT approaches and quality vary widely among hospitals. Information technology can play a supporting role, an organizing role or a catalytic role in quality and safety efforts. Rarely, if ever, does it play the leading role in quality initiatives. In most cases, however, senior executives say that IT is one of the key ingredients necessary for improving outcomes generally and a core element of most individual safety efforts.
Safety and Quality Efforts
Hospitals are attempting to use IT to both eliminate specific errors and improve care in general. The promise of specific technologies, such as computerized physician order entry and bar code medication matching, is to eliminate specific types of medical errors. The promise of a more systemic approach, including decision support, electronic surveillance and ubiquitous access to information, is to increase the use of evidence-based medicine, clinical protocols and adherence to best practices, decreasing errors of omission in the process.
Reducing errors through CPOE hinges on a careful analysis of the effect of IT on clinical processes, as well as on physician acceptance. Reports indicate that CPOE is most effective when combined with clinical decision support--and that mirrors the experience of the 100 Most Wired.
Physician Adoption of Order Entry
The Most Wired Survey looks at key components of electronic medical information distribution on a detailed level, examining nurses', physicians' and pharmacists' use of 14 specific applications in four general categories: basic patient information retrieval, decision support tools, order entry and clinical results review. In general, all groups in the 100 Most Wired hospitals have high-level adoption of all 14 functions, but the differences are significantly larger among physicians. For this analysis, "full adoption" of a technology by physicians, nurses or pharmacists is defined as use by at least 61 percent of those professionals.
The differences are staggering. Among the Most Wired, 41 percent say they have achieved full adoption of pharmaceutical order entry by physicians, more than five times the 8 percent full adoption rate among the Least Wired.
The results are similar for lab and radiology order entry as well. The full adoption rate for clinical alerts ranges from 19 percent for the Least Wired to 65 percent among the Most Wired. Similarly, the difference in the full adoption rate for clinical guidelines ranges from 13 percent for the Least Wired to 59 percent among the Most Wired.
One factor that could affect adoption rates is the availability of order entry. The Most Wired hospitals provide clinicians with access to CPOE functions from more locations: At least 30 percent of respondents say they provide access from physicians' offices, ambulatory care settings or other remote locations, compared with no more than 5 percent among the Least Wired.
Adoption rates measure the percentage of clinicians who routinely use the technology, establishing a baseline for organizational comparison. But they do not distinguish between frequent and infrequent use of computerized physician order entry or whether top admitters have embraced IT. As a result, adoption rates are a relatively weak proxy for the volume of clinical level activity managed electronically.
Medication Safety
At the clinical level, the Most Wired Survey asks respondents to estimate the percentage of medication orders that are entered electronically and who enters them. It also asks respondents to estimate the number of medication doses that are matched electronically to the patient.
The Most Wired excel at both ends of the medication delivery process. Among the 100 Most Wired, 28 percent of medication orders are entered electronically by physicians, more than twice that of all respondents and 14 times greater than the Least Wired, where less than 2 percent of medication orders are entered electronically by doctors. The results are duplicated at the other end of the medication delivery process. Among the Most Wired, an average of 23 percent of medications are electronically matched to the patient and the order at the bedside, compared with 14 percent for all respondents and 1 percent among the Least Wired.
Decision Support
Both provider and academic literature identify the use of decision support as key to the successful use of IT to improve care. Pharmacists are most likely to use decision support, but there is still a large gap between the nation's Most and Least Wired. The gap is even larger among nurses, but they are reaching full adoption rates for alerts and reminders faster than physicians.
The contrast in full adoption rates is most dramatic for physicians. Among the Least Wired, only 10 percent have achieved full adoption of allergy alerts by doctors. For each of the seven other types of alerts surveyed, no more than 5 percent of the Least Wired have achieved full adoption among physicians. The nation's Most Wired also provide decision support more broadly to doctors via their physician portals.
Alden Solovy is associate publisher, Health Forum, and executive editor, Hospitals & Health Networks.
Measuring ROI on IT
The percentage of respondents in each benchmark group that say that they conduct each of the following activities for 61 percent or more of their IT projects.
| All Respondents |
Most Wired |
Least Wired |
|
| Define financial metrics | 35% | 62% | 8% |
| Define quality, safety and satisfaction metrics | 38% | 62% | 12% |
| Establish baseline for each metric | 33% | 62% | 6% |
| Set target for each metric | 34% | 60% | 10% |
| Specify plans for measurement and evaluation | 33% | 56% | 9% |
| Set formal times for reviewing projects with stakeholders | 42% | 66% | 13% |
Source: 2005 Hospitals & Health Networks' Most Wired Survey and Benchmarking Study
This article 1st appeared in the December 2099 issue of Trustee Magazine.
To respond to this article, please click here.
