25 Feb Medicare reimbursement cuts threaten adoption of healthcare IT
Editor’s note: This is the latest in a series of articles on healthcare information technology leading up to the annual WTN Digital Healthcare Conference, which will be held May 7 and 8 at the Fluno Center at the University of Wisconsin-Madison.
Orlando, Fla. – The ability to deliver quality healthcare may be driving investments in clinical technology, but Medicare and Medicaid cutbacks and managed care fee reductions are creating uncertainty about the ability to fund such investments in the near future, according to the 19th annual Leadership Survey sponsored by Cisco and the Healthcare Information and Management Systems Society.
The results were announced as HIMSS convened its 2008 Conference & Exhibition in Orlando. In the survey, healthcare officials said the desire to reduce medical errors is driving the implementation of technology such as electronic medical records (EMRs) and computerized practitioner order entry (CPOE), but these and other investments could be undermined by the level of government reimbursement for Medicare.
A continued focus on the implementation of clinical information systems is among the top priorities of healthcare IT professionals, according to the 300 people who participated in the survey. Investments in EMR technology will be the top IT priority at their organizations in the next two years, but other priorities include clinical information systems for the delivery of clinical knowledge, which was cited by 23 percent of the respondents, and upgrading data warehousing and data mining capabilities, which was mentioned by 20 percent.
The flip side
But while the survey should build confidence that healthcare providers are adopting new technologies to improve patient care and collaboration among their fellow care providers, there was a clear message that Medicare and Medicaid cuts already are having an impact on IT investment. Although 75 percent of respondents said their budgets would increase this year, 26 percent of the IT professionals indicated that Medicare and Medicaid cuts significantly impede their success and are the main barrier to implementing IT.
Given the slowing economy and the federal government’s fiscal situation, John Wade, chairman of HIMSS, said the current financial situation will have a greater negative impact on hospitals that are struggling with profitability.
“The biggest barrier we are facing is where is the money going to come from to pay for all these (IT) systems?” he asked. “There are too many hospitals saying we don’t have the dollars. Who is going to pay for this? The federal and state governments, providers, payers?”
One the problems, according to Dr. Barry Chaiken, is that organizations have been driven by the flavor of the month in new healthcare IT applications. They have a tendency to be seduced by new technology before they have time think about the strategic use of the application, said Chaiken, chief medical officer for DocsNetwork, Ltd., and chairman of WTN’s Digital Health Conference.
In reaction to the survey, Chaiken said the real issue with respect to IT deployment is that there aren’t enough physicians and clinicians involved with IT professionals in process transformation and the building and deploying of clinical systems. “IT professionals need to understand processes and workflows,” he said, “or they will just automate manual processes and it does no good to do this!”
The self-administered, Web-based leadership survey was completed by 307 participants between Nov. 20, 2007 and Jan. 20, 2008. About 75 percent indicated they have management responsibility for functions like telecommunications, medical informatics, health information management, and biomedical engineering.
Assuming that funds for further IT adoption don’t decline in the next two years, other technologies they would like to pursue include unified communications that link voice, video, data, and mobile applications on fixed and mobile networks.
With consumers concerned about the privacy of their health information, the survey indicates a strong industry response to security matters. Security has emerged as a top priority, as nearly 1 in 4 reported a security breach in the past year, the same number that suffered a security breach the previous year. As a result, they are hot on the trail of identity management and security technologies, even after an increased focus on healthcare system security in recent years.
The top three security-related technology areas identified were: identity management, 45 percent; RFID technology, 43 percent; and security technologies, 42 percent. These investments would augment existing use of security technologies such as firewalls, which are in place at 98 percent of respondent’s facilities, user-access controls that are now used by 83 percent, and audit logs of each time a patient health record is accessed, which 81 percent have deployed.
Frances Dare, director of healthcare business solutions at Cisco, was surprised to see how high an IT priority it is to improve care, customer satisfaction, and patient safety – given that certain enabling technology was rated low on the priority list. Dare noted that intelligent patient care devices, remote monitoring, patient self-service kiosks, and customer relationship management all were rated by only two percent of those surveyed as applications they consider important over the course of the next two years.
Liz Johnson, vice president of clinical information systems for Tenet Healthcare, said the report shows the trendlines are “not about less focus on clinical systems,” but a maturation in the market and applications deployment that will lead to more development on data warehouses and increased business intelligence.
“We have a shortage of clinical informaticists and we are pondering how we attract physicians, nurses, and clinicians in IT,” she said.
Waning governance influence?
With respect to IT governance, there was a 17 percent drop – from 81 to 64 percent – from 2007 to 2008 in the percentage of IT professionals who are a member of the organization’s executive committee. Wade is concerned about this, and wondered aloud if it means that chief information officers and IT professionals are considered less strategic by their management. If so, this development could be yet another barrier to the adoption of healthcare IT.
Compared with other industries, Wade said healthcare is having an easier time teaching IT to clinicians than it is training IT workers in healthcare systems and processes.
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