25 Aug Health information technology: Wisconsin adopts and adapts
Madison, Wis. – Dana Richardson found a lot to be pleased about in the recent Wisconsin Hospital Association report on health information technology adoption in the state, especially since hospitals and health systems have carried most of the financial burden.
Despite ongoing cost barriers, Richardson, vice president of quality initiatives for the WHA, was pleasantly surprised by the extent to which hospitals believe that investments in healthcare information technology, or “HIT,” will improve clinical performance and communication between patients and healthcare professionals.
While there are still pockets of concern, the report found that nearly 90 percent of Wisconsin’s hospitals have either partially or fully implemented five or more key health information technology (HIT) systems. That takes into account much more than the star of HIT – electronic medical records.
“As the report indicates, in order to really provide a complete picture of health information technology, hospitals have to bring in multiple systems,” Richard said. “We looked at 16 systems in this report, and although hospitals are at different places – some have implemented all 16, some have implemented 10, and some five – there are really no hospitals in the state that are not working on this journey.”
If there is one leg of the journey that will be longer than most, it is computerized physician order entry systems, which enable the electronic entry of caregiver instructions to pharmacy, laboratory, or radiology departments. Only seven percent of Wisconsin hospitals have fully implemented CPOE; in a broader sense, 33 percent either have or are implementing CPOE, and 52 percent are in the planning stage.
This full adoption rate is in line with national numbers, which Richardson said run between five and 10 percent due to the complexity and expense of the technology, and the fact that hospitals often implement many other technologies before CPOE.
“I think what we’ll see over time is a slow increase in that number, and eventually kind of an explosion in that number,” she predicted.
HIT-ting on several cylinders
Overall, the report focused on 16 HIT systems that are in use in hospitals today. It is based on a survey of 122 acute care hospitals, which had a 100 percent response rate.
In terms of the full spectrum of HIT use, 40 percent of hospitals had either fully or partially implemented 13-16 systems; 36 percent have fully or partially implemented 9-12 systems; 14 percent have fully or partially implemented five to eight systems; and 10 percent are just getting started with zero to four systems.
Regarding electronic medical records, which integrate data gleaned from multiple HIT systems, 41 percent of Wisconsin hospitals have either fully or partially implemented them, and 21 percent have fully implemented all the seven HIT systems that contribute to an EMR. Among the systems that feed data to EMRs are the core master person index database, lab information systems, pharmacy systems, enterprise medication administration records, radiology information systems, order entry and results, and inpatient charting.
With electronic medical records, 41 percent of Wisconsin hospitals have either fully or partially implemented EMRs, and 21 percent have fully implemented all the HIT systems that contribute to an EMR.
One HIT system that is used to reduce the risk of errors and improve patient safety is bedside medication verification. According to WHA, 46 percent of Wisconsin hospitals have fully or partially implemented a bedside medication system, and 46 percent are planning to.
The WHA report included information about a 2006 survey conducted by the American Hospital Association, where respondents cited several barriers to HIT adoption. The main culprits are initial costs (97 percent) and ongoing costs (87 percent), followed by clinician acceptance (82 percent) and lack of interoperability with current systems (79 percent).
That isn’t stopping hospitals from devoting significant resources to HIT, as per-bed capital spending and operating costs increased from 2005 to 2006. Per bed capital spending rose from $5,500 to $5,556, and per-bed operating costs rose from $11,538 to $12,060.
Of the 10 percent of Wisconsin institutions that have not implemented several key HITs, many of them small or rural hospitals. For these institutions, cost is an especially formidable barrier, but not only the cost of installation; citing the AMA report, Richardson noted the real cost is in operation and ongoing maintenance. “We figure once it’s here, it will take care of itself,” she said. “That’s not the case.”
Louis Wenzlow, CIO and director of health information technology for the Rural Wisconsin Health Cooperative’s information technology network, assembled a list of HIT systems in a 2006 report on the density of HIT in rural hospitals. It found pockets of high adoption, particularly 80 percent adoption of pharmacy, lab, and radiology systems, and low adoption (about two percent) of CPOE.
“I think it’s great that the WHA is collecting this data, and I agree that HIT system use in Wisconsin hospitals, including rural hospitals, is certainly increasing,” he wrote in an e-mail. “There is a difference in rates of adoption between small and large hospitals, however.”
According to Wenzlow, small rural hospitals tend to lag behind large urban hospitals because the cost of these systems is proportionately higher for small hospitals. While small hospitals generally pay less than large hospitals for a given system, they usually pay more in proportion to their volume of transactions, he explained, noting that transaction volume correlates to the ROI of the system being implemented.
Small hospitals also have limited staff to implement and support these systems, which is another key barrier, Wenzlow indicated.
“This being said, hospitals of all sizes are advancing in their HIT system purchase and use,” he noted.
Commenting on the inaugural report, WHA President Steve Brenton said hospitals can’t bear the cost alone, and stated that contributions from providers, payers, government, and patients would speed the pace of adoption.
Dr. Steve Bergin, president of the Wisconsin Medical Society and a physician practicing with Aspirus Medical Group, said Brenton makes a fair point. Among independent practicing physicians, Bergin said cost and funding have been major sticking points as to why EMRs, for example, haven’t caught on in small individual and group practices.
“The larger hospital systems, and there are 16 major systems in this state, have been able to fund this through their own financial capabilities, but when you start talking about an individual practice or a practice of up to 20 members, the amount of money becomes very significant,” he said. “Where will that funding source come from?”
Richardson said the WHA has not established a preferred funding formula, but is hopeful that the state will come up with enabling legislation and incentives that would “allow hospitals to move forward on this journey even quicker.”
Gov. Jim Doyle had proposed $30 million in state support, but only for the adoption of EMRs. That was whittled down to about $10 million in the 2007-09 budget, and prospects for expanded funding are not bright because the state’s tenuous fiscal situation.
Most of the focus of the Doyle Administration’s eHealth Board has been on interoperability of technology systems, noted Department of Health and Family Services Secretary Karen Timberlake.
“Adoption of electronic medical records is the critical first step in developing an interoperable health information exchange infrastructure as envisioned in Governor Doyle’s eHealth Action Plan,” she said in a statement. “We are very pleased that nearly 90 percent of Wisconsin’s hospitals have invested in HIT systems to improve patient safety, quality of care, and overall efficiency of healthcare to the people of Wisconsin.”
HIT adoption at Wisconsin hospitals
|Health Information Technology System||Fully Implemented||Partially Implemented||Planning||No Plan at this Time|
|Master person index database||82%||7%||7%||5%|
|Laboratory information system||88%||9%||2%||1%|
|Enterprise medication administration record||41%||22%||30%||7%|
|Radiology information system||70%||11%||14%||4%|
|Picture archiving & communication system||58%||20%||19%||3%|
|Order entry & results||66%||20%||12%||2%|
|Bedside medication verification||21%||25%||46%||8%|
|Computerized physician order entry||7%||23%||52%||19%|
|Health electronic record portal||21%||24%||37%||18%|
|Surgery management system||37%||17%||29%||17%|
|Note: Total may not equal 100% due to rounding. The survey, which had a 100 percent response rate, is available on the WHA website.|
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