30 Jul HIMSS Analytics data shows small EMR advance, up-and-coming techs
The analytics division of the Healthcare Information and Management Systems Society (HIMSS) has released figures on the budgets and technology adoption of U.S. hospitals, showing slightly increasing advancement of electronic medical record (EMR) capabilities and other technology trends.
Download slides that recap some of HIMSS’ latest data, including EMR adoption and hospital budgets (PDF)
Electronic medical record adoption
HIMSS uses an eight-stage model (zero through seven) to chart EMR adoption among U.S. hospitals (see slides). The hospitals must answer detailed questions about what technologies they have implemented, and how fully, and they are then ranked at one of these levels. Most hospitals in the first quarter of 2008 are now at stage two (35.3 percent) or three (28.4 percent), with the largest movement since 2007 being into stage three.
“What usually drives people to the higher levels is they either have an executive team who has committed to improve patient outcomes and patient safety, or they are in a competitive environment where they believe that if they don’t keep pace with competitors in the market they’ll be left behind,” said Mike Davis, vice president of HIMSS Analytics.
By HIMSS’ count — and the organization verifies hospitals’ capabilities, rather than relying on them to rank themselves — there are no stage seven hospitals, and only 13 hospitals have made it to stage six. At stage six, full physician documentation using structured templates is implemented in at least one area of care. Full clinical decision support is implemented. Radiology picture archiving and communications systems (PACS) provide digital medical images to physicians using no film.
“In the hospitals that have stage six, which is a pretty high achievement … most of these are not done off of return on investment.” Davis said. They do, however, expect significant advantages to patient care and safety, he said.
Paperless?
Stage seven incorporates fully paperless operations and compliance with a standard for continuity of care documents (CCD), a minimal set of patient data that can be shared between providers to aid the current caregiver. There are paperless or mostly paperless hospitals now, but none that qualify for HIMSS’ stage seven.
“The most dangerous thing, in my opinion, are people that have mixed environments, paper and electronic, because they you are trying to keep up two different environments, and that’s where mistakes get made,” Davis said.
Furthermore, in stage seven HIMSS is looking for hospitals to use data warehousing and mining to improve their processes. About 20 percent of hospitals had some sort of data warehousing/business intelligence installed that had to do with clinical applications in 2007; that number was higher for back-office financial functions, but lower for rules engines to help automate processes such as payer transactions.
Up-and-coming technologies: RFID, security and virtualization
Radio frequency identification (RFID) tags have seen limited adoption, but Davis called them out as an area of increasing, though as yet limited, interest. According to HIMSS data, less that 10 percent of U.S. hospitals used RFID in any way, and five percent used it for patient tracking. The cost and difficulty of implementing them throughout the hospital are barriers to adoption, but there’s a payoff: RFID on equipment can answer questions like “Where’s that X-ray machine?” and “where are those wheelchairs?” and increase efficiency.
“They may not need as much equipment, because they’re much more efficient with the use of that equipment,” Davis said.
Meanwhile, hospitals will spend approximately eight to 10 percent of their IT budgets on security in 2008, the organization estimates. This amount may increase, however, if the Centers for Medicare and Medicaid Services (CMS) pushes for better security based on HIPAA compliance audits it is currently conducting.
Virtual servers are a technology with the potential for quick adoption, due to their cost-saving role.
“It’s much like what we saw in PACS five years ago,” Davis said. “The adoption uptake of PACS has been very quick, and I think you’ll see the same from things like virtual servers.”
In high availability and fault tolerance, however, he sees a lack of resources where more could be needed. While hospitals may be pushing for more and more functionality, they are also building dependence on systems that are highly critical.
“I don’t see a lot of focus right now on what happens if those systems go down,” Davis said. “And that would be a very career-limiting move for a lot of CIOs if that was not well-planned.”