Many hospitals and health systems across the country have put the technological pieces in place to drive efficiencies and improve patient care and the patient experience, but they still have room for further integration of systems and processes and to conduct population health management.
That's the bottom line from the 2017 Health Care's Most Wired survey, conducted by Trustee's sister publication Hospitals & Health Networks and the American Hospital Association with the assistance of several experts from the field.
Among the bright spots: More than ever, hospitals are using data and analytics to foster a culture of self-improvement. They are strengthening patients' ability to obtain, use and share their own data and records securely. And they are offering innovative access to care through secure messaging, telehealth and mobile app services. They are taking cybersecurity seriously with frequent system audits and staff training.
“I think we see a shift here from, 'How do I get this tech?' to 'How do I deploy this for our strategic objectives?'" said Chantal Worzala, vice president of health information technology and policy operations at the AHA.
Even the Most Wired, however, have room for improvement on integration. This includes integration of electronic health record systems with population health tools, generating clinical quality measures from the EHRs, and incorporating data from outside entities like retail pharmacies.
“While integration tools exist, they are costly and labor-intensive, and the resulting interfaces are often not highly usable," says Neal Ganguly, chief information officer at JFK Medical Center in Edison, N.J., echoing a common sentiment among survey respondents.
Sixty percent of the Most Wired respondents said they have health care–associated infection surveillance integrated with their EHR, while 40 percent have the data on a departmental system. Sixty-nine percent said they interface EHR data with population health management tools. Only half said they can incorporate data from retail pharmacies, and 41 percent said they can incorporate data from governmental agencies, according to the survey results.
Even without seamless integration, hospitals and health systems are advancing their access and use of data to foster a culture of continuous improvement. For instance, 39 percent of Most Wired respondents said their hospital or system delivers applicable quality measures electronically to clinical leaders in real time. That's up from 32 percent in 2016 and 26 percent in 2015.
And 82 percent said they employ tools for retrospective analysis of clinical and administrative data to identify areas for improving quality and reducing costs. More than 70 percent are providing data analytics tools training to physicians and nurses. And three-quarters use sophisticated analytics such as predictive modeling and data to improve decision-making across multiple departments.
“The quality dashboards we’ve built over the last year with our EHR data have led to workflow improvements within our health system. For example, we’ve seen measurable improvements in starting our [operating room] cases on time,“ reports Dr. Jon Morris, chief technology officer and chief information officer at Wellstar Health System in Marietta, Ga.
We “now have access to data we previously never saw possible,” says Steven J. Hess, chief information officer at UCHealth in Aurora, Colo. "With our new partners and more on the horizon, we are able to analyze years of historical and case log data to create predictive algorithms. But we are just getting started in realizing how we can use that health care data and influence the next generation of health care IT and operational intelligence."
Patients' access to their own information is becoming more available. In 2017, 74 percent of the Most Wired respondents said they offer patient-specific education in multiple languages. And 68 percent provide patients with the ability to electronically transmit information about a hospital admission to another care provider. Open notes sharing is becoming more common, with 46 percent reporting the ability to share visit notes written by clinicians with patients.
Harnessing technology to improve access to care providers is also well underway among the Most Wired hospitals and health systems. Three-quarters offer secure messaging with providers on a mobile device and secure emailing; 40 percent offer virtual physician visits; and 68 percent allow prescription refill requests by mobile devices.
For the first time, the survey included detailed questions on how quickly data could be restored in the event of a disaster that causes the complete loss of the primary data system. More than half of the Most Wired (58 percent) said clinical information systems such as EHRs, and laboratory and radiology systems would be available within four hours (compared with 49 percent of all respondents). Close to half of the Most Wired respondents also said that within four hours they would have access to financial systems, human resources and staffing, and supply chain management within four hours.
This could be partly attributed to a move to cloud-based computing. A full 70 percent of the Most Wired respondents said they have back-up cloud-based services for clinical data, up from 49 percent of Most Wired respondents who reported clinical data backup in the cloud in 2015.
Indeed, security of data continues to take on importance among providers. A full 97 percent of Most Wired respondents use intrusion detection systems; 96 percent perform data access audits; and nearly 90 percent run targeted phishing exercises to teach employees and providers to question suspicious emails. And 82 percent engage a third party to conduct annual security audits.
Some of these changes are required, says Sony Jacob, chief information officer at Presbyterian Healthcare Services in Albuquerque, N.M. “We have invested significantly in cybersecurity and disaster recovery planning so as to meet some of our insurance plan requirements," Jacob wrote in response to the survey.
Rebecca Vesely is a freelance writer based in San Francisco.
IT strategy helps critical access hospital remain independent
In picturesque and evergreen western Washington state, a 25-bed critical access hospital is setting a new standard for independence and tech-savviness, with both as the basis of a multiyear strategy for improved population health.
Mason General Hospital in Shelton, a rural community founded on the logging, fishing and oyster trade about 20 miles west of Olympia, launched its health information technology strategy 17 years ago. Today, the Most Wired–designated hospital has a robust, cloud-based electronic health record system, clinical decision support, telemedicine, and virtual visits, and it will soon launch disease registries and a data warehouse.
“Our whole purpose is to create relationships rather than affiliations so we can remain independent and best serve our community," says Tom Hornburg, chief information officer at Mason General. “Our technology initiatives reflect that."
Despite its small number of beds, Mason General keeps busy. The hospital has about 27,000 active patients, 22,000 emergency department visits per year, 10 outpatient clinics and 650 employees. About 80 percent of patients are covered by Medicare or Medicaid.
While health IT had been a focus for many years, Mason General's efforts in this area gained sharper focus about a year and a half ago when it joined an accountable care organization, Rocky Mountain ACO. The ACO participation has pushed Mason General further into care coordination and population health management, says Chief Medical Officer Dean Gushee. Mason General will soon have an enterprise data warehouse to access internal and payer data on quality and costs. It is also building patient registries for common chronic conditions.
“We are removing burdens and barriers for providers to conduct work on social determinants of health,“ Gushee says.
Telemedicine, too, is a staple at Mason General, as is an online patient portal.
An active community board and a CEO who support technology innovation have been important factors in Mason General's success, says Hornburg.
“It seems we are nimble on getting things done," he says. “We push for change, and we don't accept no for an answer." — Rebecca Vesely
Physician perspective helps health system's wired integration
Joseph Mannion, M.D., sees patients in his solo internal medicine practice in Avon-by-the-Sea, N.J., on two weekday afternoons and Saturdays.
During the rest of his workweek, Mannion serves as chief information officer at Hackensack Meridian Health, a 13-hospital system based in Edison, N.J.
It's an unusual combination that has helped Mannion design, test and implement health information technology systems that work well for practicing physicians and their patients.
Hackensack Meridian Health has achieved a high level of clinical integration with technology through a robust electronic health record, clinical decision support tools, telemedicine, online quality reporting and physician ratings.
“My recipe for success is to be in the trenches,” Mannion says. “I feel it is very important that I practice medicine and use the systems. Walking the walk is a priceless asset to have.”
Indeed, four physicians at the health system are in the IT department.
In July 2016, Hackensack University Health Network and Meridian Health merged to become Hackensack Meridian Health. The combined entity has 28,000 employees and 6,000 physicians and is the second-largest health system in New Jersey.
The main IT priority that came out of the merger, Mannion says, was to put all the hospitals and clinics on one electronic health record system. That integration is expected to be completed in 2018. The merger has also required removing other IT redundancies.
With those efforts well underway, Mannion and his team are now working on offering all volunteer physician practices affiliated with Hackensack Meridian Health the opportunity to move to the same EHR system.
Another project that is coming out of the merger is expanding the use and functionality of a patient-centered app developed at Hackensack several years ago.
“I opened my practice in 1991, and in the old days I would stop back at the hospital before I went home for the night,” Mannion says. “Now I can check in on my patients remotely throughout the day. Technology gives us much better accessibility to patients.”— Rebecca Vesely
Most Wired hospitals and health systems
Here is a sampling of this year's Most Wired hospitals and health systems, in alphabetical order:
- Abington (Pa.) Jefferson Health
- Abraham Lincoln Memorial Hospital | Lincoln, Ill.
- Adirondack Health | Saranac Lake, N.Y.
- Adventist Health | Roseville, Calif.
- Adventist Health System | Altamonte Springs, Fla.
- Advocate Health Care | Downers Grove, Ill.
See the full list and more coverage.