2011 Health IT Top Trends Survey: Mapping the Changes
| As we conducted our second annual CMIO Health IT Top Trends Survey, we welcomed a second round of findings to layer onto last year’s inaugural results. Some of our second-year results—including IT implementation and business priorities—mirrored those of 2010. Others reflect the changing healthcare landscape and possibly the evolution of the CMIO’s job. Survey respondents overwhelmingly hold the title of CMIO again this year, with just shy of 48 percent of respondents holding that title (down about 2 percent from 2010). Director or manager of medical informatics was a distant second this year (15 percent of respondents) followed by vice president/medical informatics officer (9 percent). About a third of the respondents claim other titles, from director/manager of clinical informatics to chief medical officer to healthcare administrator. While the title mix is similar to last year, the number of CMIOs who aren’t MDs comprised more than a quarter of all respondents this time around. This represents an increase of roughly 5 percent from last year, and might be a harbinger of things to come as the requirements for the CMIO position continue to evolve. We see some directors of clinical services who are RNs or physician’s assistants emerging into the CMIO role. This is one data point we’ll be watching closely going forward. Multi-hospital organizations were the leading employer among respondents, with 42 percent. That number is down from 50 percent last year. Smaller facilities are increasingly likely to hire a CMIO, and our survey showed this—community hospitals again took the second spot among facility types, with close to 24 percent of respondents (15 percent in 2010), edging out academic medical centers, at 20 percent (13 percent in 2010). Physician group practices and imaging centers also were well represented among respondents this year, with an 11 percent share. Likewise, most respondents tell us they work in facilities or organizations with 101 to 500 beds—exactly one-third of the field, up from about 27 percent last year. Organizations with 501 to 1,000 beds accounted for about 24 percent of respondents, with zero to 100 beds at just under 22 percent, up from 14 percent in 2010. Only 4 percent of the survey base works for an organization with 10,000 beds or more. Meet the Survey Base | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | Job Title 48% Chief Medical Information/Informatics Officer 14% Director/Manager, Medical Information/Informatics 9% VP/Medical Informatics Officer 7% Director/Manager Clinical Information 5% Chief Medical Officer/Medical Director 5% Healthcare Administrator 4% Director of Clinical Services 4% Physician Informaticist 4% Chief Information Officer | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | Facility Type 42% Multi-hospital Organization 24% Community Hospital 20% Academic Medical Center 11% Physician Group Practice/Imaging Center 3% Government or Military Hospital | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | What role do you perform in purchasing? Recommend Specify Supplier or Vendor Final Decision | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Purchasing powerThe CMIO is clearly a decision maker. Their scope of strategic authority is substantial: 62 percent of respondents in this year’s survey develop clinical IT strategy for their entire organization or enterprise; 12 percent develop clinical IT strategy for one facility; and 11 percent develop clinical IT strategy for a group of facilities.The CMIOs who responded to our survey wield more influence over clinical IT purchases than over IT infrastructure purchases, which is consistent with traditional CMIO-CIO tasks. Ninety-six percent of respondents have a role in clinical IT purchases in their facility. (Some 26 percent said they specify vendors for clinical IT purchases). Some 60 percent of respondents make recommendations in facility IT infrastructure purchasing, while 52 percent recommend clinical IT purchases. About twice as many respondents (18 percent) are key influencers in final clinical IT purchases decisions than in final facility IT infrastructure buys (10 percent). | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Old Tech Rules Data InputWith all the attention that mobile devices and smartphones have been getting, it was a bit surprising to see that the technologies used most often for data input among CMIO respondents were still stationary workstations, desktop PCs and computers on wheels.What devices do clinical professionals most often use to input and review data?
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Business & IT PrioritiesAdopting new technology tops the CMIO’s business priority list over the next 12 months. Planning for meaningful use ranks second. ICD-10 analysis/transition debuted as a top priority, vaulting into third place. Nurses’ adoption of new technology ranked fourth, with physician/clinician training on new systems rounding out the top five. With the exception of ICD-10 analysis/transition, the top five business priorities are consistent with last year’s results.When it comes to the top healthcare IT implementation priorities, clinical decision support and quality improvement/reporting tools tied for the top spot. EHRs were next, reflecting the arrival of meaningful use time frames. HIE ranks fourth on the priority scale for IT implementation, followed closely by computerized provider order entry (CPOE). Compare that to our 2010 IT implementation priorities: CDS, CPOE, quality improvement/reporting tools, EHRs and workflow management systems. The HITECH Act has driven health IT priorities and expenditures, and will continue to do so for the foreseeable future. There are some pain points associated with this, of course. When we asked respondents to identify the top challenges for achieving the goals of the HITECH Act (and to name all that applied to their organization), their top list included:
Other challenges included physician and staff adoption, reporting requirements, system integration and transitioning from legacy EHRs to certified systems. Implementing CPOE was the top pain point in our previous survey as well. In our 2010 results, financing the required system changes was the third most-mentioned worry, named by 19 percent of respondents. Some 35 percent of respondents to the 2011 Top Trends survey indicated their organization shares data with related health facilities via a health information exchange. This is down from 44 percent in the 2010 survey. Another 19 percent of this year’s respondents reported that their facility shares information with out-of-network facilities via HIE—down from 23 percent in 2010. These results don’t mean there are fewer functional HIEs than last year, but the numbers might be an indication that more respondents to the 2011 survey work in organizations that are not early adopters. CMIOs are progressive technology adopters, working for facilities often well ahead of the health IT curve. But what technology do facilities already have? CPOE is in close to 54 percent of respondent’s facilities—a jump of about 10 percent since last year. About 34 percent of respondents plan to implement CPOE in the next 12 months (down from 40 percent last year). Likewise, almost 69 percent of respondents said EHR technology has been implemented in their organizations; another 26 percent said their organization would implement EHR systems in the coming year. This puts our respondents way ahead of the national curve. By comparison, 15 percent of acute care non-federal hospitals had adopted an EHR as of 2009, according to the most recent American Hospital Association Survey of IT Adoption, released in July 2010. The same survey found that nearly 81 percent of acute care non-federal hospitals planned to apply for Medicare/Medicaid EHR incentive payments. Preliminary 2010 estimates showed that almost 51 percent of office-based physicians reported using all or partial EMR/EHR systems, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics data. Last year 57 percent of respondents said their facilities had an EHR system installed. Meaningful use for sure has spurred adoption. At the end of May, CMS reported that more than 67,000 eligible providers and hospitals had registered for Medicare and/or Medicaid EHR incentive payments. Leading the “not there yet” category, RFID is the least-implemented of the technology options, with 16 percent of respondents saying it’s installed in their facilities, and 13 percent planning to implement it in the next 12 months. However, 21 percent expect to do so in the 2012-2013 timeframe. This may indicate organizations’ need to put other health IT in place—possibly for meaningful use and other regulatory requirements—before tackling this technology. Electronic caregiver notification devices are in place in almost 26 percent of facilities, with 28 percent of respondents planning to implement these devices in the next 12 months, and 14 percent planning to implement in 2012-2013. Rounding out the bottom three installed technologies is something of a surprise—tablet computers/mobile IT/mobile phones, implemented in just more than a third of organizations. But look for these numbers to grow: nearly 41 percent of respondents said they’re planning to purchase mobile IT in the coming 12 months. This is the second-highest percentage of expected implementation, trailing only clinical decision support (with an expected implementation of 45 percent in the next 12 months). aining Health Information Exchange | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | Does your facility share data via an HIE with related health facilities? 56% No 35% Yes 9% Unsure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | Does your facility share data via an HIE with out-of-network health facilities? 70% No 19% Yes 11% Unsure | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Budget Surge: IT & TrainingIt comes as little surprise that CMIOs tell us their facilities are investing heavily in clinical IT projects. The largest chunk of respondents report having a 2011 clinical IT operating budget of $1 million to $5 million, followed by $5 million to $10 million, and then $10 million to $15 million.These numbers point to more health IT spending overall in many organizations: Close to 50 percent of respondents said their clinical IT operating budget has increased from 2010; 17 percent said it was unchanged. Only 8 percent saw a budget decrease from 2010. This represents positive movement from last year’s survey, just over 41 percent said their clinical IT operating budget increased from the previous year, whereas 21 percent reported no change and 11 percent reported a decrease from the previous year. Sixty-five percent of respondents said EMR/EHR systems will be the primary focus of training during the next 12 months, followed by CPOE (56 percent) CDS (46 percent) and medication management (43 percent). Physicians are most likely to be the recipients of that training in almost 52 percent of those organizations; 36 percent of respondents said nurses and physicians assistants will receive the most training. Technicians and residents/fellows will be the training focus for almost 7 percent and nearly 6 percent, respectively. The bill for training this year will run about $100,000 at 14 percent of respondents’ organizations. Close to 10 percent will spend $1 million to $5 million on training; 8 percent said their training expenses would be $250,000 to $500,000, and 7 percent planned to spend $100,000 to $250,000. Overall, dollars dedicated to training have increased from last year, according to almost 50 percent of respondents. About 10 percent said training expenditures were unchanged from last year. With Stage 2 and 3 of meaningful use, accountable care organization planning and the migration to the ICD-10 code set in the offing, the 2012 Top Trends survey will, in all likelihood, show more clinical operating budget increases, and possibly more and shifting costs for training. As the connection point between clinicians and IT, CMIOs (and those who have the duties if not the title) will have their work cut out for them making sure systems and caregivers alike stay functional. Our two years of data show that planning for everything that comes next is going to be an even more important role in 2012 and beyond. What can your EMR do? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | What are the capabilities of your ambulatory EMR? Clinical documentation E-prescribing Results reporting, management EMR quality measure collection, reporting for specified conditions CDS for patient tracking Tools for managing chronic care Two-way exchange of labs, test results, prescription data, CCD-compatible documents | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 | What are the capabilities of your hospital EMR? Clinical documentation CPOE Integrated pharmacy (CPOE and EMAR) Results reporting, management Medication reconciliation Clinical decision support tools Single-source electronic problem and allergy list Integrated eMAR with barcoding EMR quality measure collection, reporting for specified conditions Consultations/transfers of care Quality, pay-for-performance metrics from EMR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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The fine printThe CMIO 2011 Health IT Top Trends Survey results analysis includes answers from all qualified respondents who took the survey during the 23-day period from Wednesday, April 20, to Friday, May 13, 2011. During this time, 183 completed responses were received. Percentages have been rounded. |