2013 Reader Survey: Health IT Leaders Speak Up on Priorities, Staffing & Strategies

We asked health IT leaders about their current and future IT plans, and they answered. From ICD-10 to Meaningful Use (MU) to privacy and security, there are a lot of initiatives to manage. And, the findings indicate that healthcare organizations are facing those initiatives at varied paces.

Snapshot of respondents:

• Respondents’ titles include CEOs, CMIOs, CIOs, Chief Innovation Officers, VP/Director of Medical Informatics, Physician informaticists and other healthcare professionals.
• Most respondents work at an integrated delivery network (28%).
• Most respondents have 1,000-4,999 affiliated physicians at their organization (26%).
• Most respondents have 11-49 FTEs in their IT department (30%).

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Quality first

When asked to name their top three priorities, the respondents put clinical quality and safety at the top of the list (75 percent), distantly followed by patient experience/satisfaction and Meaningful Use. Those rankings aren’t very surprising, says Donald Levick, MD, MBA, CMIO at Lehigh Valley Health System in Bethlehem, Pa.

Patient safety “is kind of like motherhood and apple pie. Who’s not going to list quality and safety as a priority?  The question, especially from the technical side, is how is that being achieved and how is IT contributing to that," says Levick. "A lot of this turns out to be process and workflow change. IT becomes the tool that helps achieve that and not really a primary driver.”

Regarding those changes, it remains to be seen what new solutions will be truly innovative, says Naomi Fried, PhD, chief innovation officer for Boston Children’s Hospital. “Innovation is about risk and uncertainty. When you know the outcome, it’s not necessarily innovative.”

[[{"fid":"17359","view_mode":"media_original","type":"media","attributes":{"height":250,"width":640,"style":"width: 460px; height: 180px;","alt":" - Figure 2. Regarding clinical quality improvement, what are the greatest strategic challenges for your organization?* ","title":"Figure 2. Regarding clinical quality improvement, what are the greatest strategic challenges for your organization?* ","class":"media-element file-media-original"}}]]

Brian McDonough, MD, CMIO of St. Francis Hospital in Wilmington, Del., isn’t surprised by this top priority either. “There is no doubt that the move to EHRs is expensive and can negatively impact productivity for quite some time, but if quality can be improved and we can measure the impact on quality it is well worth any price. The key is taking the data and using those elements to drive better care.”

Levick adds that MU “will remain a priority until it’s over, if that ever happens.” Some hospitals, however, are beginning to reconsider whether MU is really worth the effort, he says. These organizations are finding that “the cost is just too high compared with the rewards.” Those organizations will improve their systems and use certified EHR systems, but are skipping the additional MU requirements.

Costs, staffing & more

When asked to name the top three drivers of their organization’s costs, respondents said government laws and mandates; uninsured and underinsured patients; and facility costs.

[[{"fid":"17360","view_mode":"media_original","type":"media","attributes":{"height":352,"width":640,"style":"width: 460px; height: 253px;","alt":" - Figure 3. What are the top three drivers of your organization's healthcare costs?*","title":"Figure 3. What are the top three drivers of your organization's healthcare costs?*","class":"media-element file-media-original"}}]]

Levick finds the fact that government laws and mandates topped the list “interesting. That shows the cost [burden] of participating in accountable care organizations, MU, quality initiatives and readmission penalties. It’s taking a tremendous investment to either recoup those dollars or avoid losing those dollars,” he says, and not everyone is going to participate going forward.

Not surprisingly, 39 percent of respondents identified a data breach as their biggest privacy and security concern, followed by a HIPAA violation (23 percent). “Anyone who has witnessed the conversion to electronic data in other industries is terrified of a data breach,” says McDonough. “We need to carefully guard and protect our patients’ records.”

 [[{"fid":"17361","view_mode":"media_original","type":"media","attributes":{"height":268,"width":640,"style":"width: 460px; height: 193px;","alt":" - Figure 4. Privacy and security: What is your top concern?","title":"Figure 4. Privacy and security: What is your top concern?","class":"media-element file-media-original"}}]]

When it comes to the biggest IT staffing challenges, budgetary issues and competition for resources tied for the top of the list. “As we move toward ICD-10, the need for coders and ICD-10-knowledgeable people will continue to increase,” says Levick. “They are getting harder and harder to find but that’s more of an HIM [health information management] staffing issue. However, people on the systems side who understand ICD-10 will become more valuable. Like many organizations that are migrating toward a single source, integrated system, finding people with the appropriate knowledge and keeping those staff members will be an ongoing challenge.”
[[{"fid":"17370","view_mode":"media_original","type":"media","attributes":{"height":278,"width":640,"style":"width: 460px; height: 200px;","alt":" - Figure 5. What is the biggest staffing challenge for your organization's IT department?","title":"Figure 5. What is the biggest staffing challenge for your organization's IT department?","class":"media-element file-media-original"}}]]
Once hospitals train people in certain EHR systems, those workers are likely to be poached by other systems and consulting firms. Levick cites one hospital that had a turnover rate of existing and new staff of 30 percent.

Also related to ICD-10, 13 percent of respondents said they have not started preparing for ICD-10 yet, while 20 percent have gone as far as initiating testing. That 13 percent figure “a little scary,” says Levick.  The implementation date is just 18 months away, and the change represents “a significant change for providers. Our evaluations have revealed that it touches virtually every system. We’re deep into planning and testing, and upgrading systems to make those systems compliant.”

[[{"fid":"17362","view_mode":"media_original","type":"media","attributes":{"height":250,"width":640,"style":"width: 460px; height: 180px;","alt":" - Figure 6. Will your organization be part of an accountable care organization within the next three years?","title":"Figure 6. Will your organization be part of an accountable care organization within the next three years?","class":"media-element file-media-original"}}]]

The number of physician queries will go up because coders will need much more detailed information than they’re getting now to abstract and code accurately, Levick says. “Even electronic progress notes may not be enough if they don’t help providers document in an ICD-10-compliant way.”

Another significant change that widely impacts healthcare organizations is the shift to accountable care. Almost half (47 percent) of respondents plan to be part of an ACO in the next three years, 30 percent do not plan to be part of an ACO and 13 percent already are part of an ACO. “I’ll be interested to see how many actually achieve ACO status or whether they get right to the door and then back away because they decide the financial risk is too high,” says Levick.

[[{"fid":"17363","view_mode":"media_original","type":"media","attributes":{"height":276,"width":640,"style":"width: 460px; height: 198px;","alt":" - Figure 7. What steps has your organization taken in preparation for the transformation to ICD-10?*","title":"Figure 7. What steps has your organization taken in preparation for the transformation to ICD-10?*","class":"media-element file-media-original"}}]]

Many organizations don’t have the data infrastructure necessary to support taking on the risk, he says. Back in the 1990s when HMOs first emerged, “people didn’t have enough data to truly manage the risk and their utilization.” ACOs have similar but even broader requirements. “Not all resources are going to be owned by the main institution. The need for data is going to increase tremendously. I’m not sure institutions are able to handle that or have the capacity to do that.”

McDonough agrees that many organizations may not feel the effort is worth the reward. “The bigger question might be: who hasn’t considered it but will have it thrust upon them,” he says.

[[{"fid":"17364","view_mode":"media_original","type":"media","attributes":{"height":250,"width":640,"style":"width: 460px; height: 180px;","alt":" - Figure 8. What are you doing to improve patient engagement?*","title":"Figure 8. What are you doing to improve patient engagement?*","class":"media-element file-media-original"}}]]
When asked about efforts to increase patient engagement, 75 percent of respondents said they are implementing patient portals and 73 percent are using marketing and advertising. Sixty percent said they are using public outreach and 55 percent using social media. Patient portals need to become more personalized than they are today, says Levick. That includes determining which format patients prefer for receiving and consuming the information—whether that’s email, text messaging or old-fashioned snail mail. “That’s how you tailor the content. Email links about their diseases are not going to be enough for patients to be successful.”

Overall, healthcare organizations are supportive of their IT departments. Almost one-third of respondents (30 percent) said their organization is very supportive of the IT department and its needs; 48 percent said it is somewhat supportive. “It is all part of a learning curve,” says McDonough. “There are still some administrators with their heads in the sand. This is why clinician leaders need to help explain the need for the proper use of this technology. Ultimately, I envision many more leaders with a strong, relatively current clinical background.”

[[{"fid":"17365","view_mode":"media_original","type":"media","attributes":{"height":316,"width":640,"style":"width: 460px; height: 227px;","alt":" - Figure 9. How would you rate your organization's appreciation and understanding of the IT department and its needs?","title":"Figure 9. How would you rate your organization's appreciation and understanding of the IT department and its needs?","class":"media-element file-media-original"}}]]

The responses to IT support could tie closely to the responses about job satisfaction. Twenty percent said they are very satisfied; 63 percent are satisfied; 10 percent are neutral; 7 percent are dissatisfied; and none said they are very dissatisfied. Compared with many areas in medicine, “this is quite good,” says McDonough.

Levick doesn’t find these numbers surprising. He recently attended a meeting with approximately 25 CMIOs where they discussed the most frustrating aspects of the job. The consensus was that since the CMIOs are responsible for more than $1 billion in total revenue, “they feel that they should have a stronger strategic voice. A lot of the work remains operational and that’s the thing that keeps CMIOs from being very satisfied with their position. They start as operational implementers and get promoted to a C-level role but a lot of their responsibilities remain the same.”

[[{"fid":"17366","view_mode":"media_original","type":"media","attributes":{"height":263,"width":640,"style":"width: 460px; height: 189px;","alt":" - Figure 10. Describe your overall job satisfaction.","title":"Figure 10. Describe your overall job satisfaction.","class":"media-element file-media-original"}}]]

‘The path forward’

More and more facilities have added or plan to add an innovation or transformation officer role to take the lead for positioning and guiding technology decisions for the future. Fifteen percent of respondents say their organization has added a full-time innovation or transformation position, 23 percent have a part-time position and 62 percent have no innovation or transformation role.  

“I’m pleased to see that people are thinking about the creation of the role,” says Fried. She finds the fact that close to one-third of respondents either already have the role in place or are thinking about implementing the role “very encouraging.  Everybody needs innovation. It’s an important strategy for survival and preparing for the future. The only people who don’t need to think about innovation are those who don’t think they will be around in the future.”

[[{"fid":"17367","view_mode":"media_original","type":"media","attributes":{"height":253,"width":640,"style":"width: 460px; height: 182px;","alt":" - Figure 11. Does your organization have an innovation/transformation officer role? Figure 12. Do you plan to create an innovation/transformation officer role?","title":"Figure 11. Does your organization have an innovation/transformation officer role? Figure 12. Figure 12. Do you plan to create an innovation/transformation officer role?","class":"media-element file-media-original"}}]]

In fact, Fried says most healthcare organizations can’t afford not to think about innovation given the changing regulatory environment. “Innovation is the path forward. An innovation leadership role needs genuine support and adequate time to demonstrate its impact. The impact of an innovation program can’t be felt  overnight. Support for innovation needs to be at a high enough level in the organization that when it comes to implementing a change, the necessarythere is support and sponsorship is there.”

Last but not least, we asked respondents what they think is the most innovative endeavor their organization faces this year. The most common answers were health information exchange, ICD-10 and patient portals. While none of these really meet the strict definition of innovation, Fried says “anything can be a catalyst for innovation and can provide a path to try something truly novel and uncertain.” Implementing a patient portal, for example, could produce numerous opportunities to explore new ideas and solutions.

Levick says that moving to a single source, integrated system across the enterprise will be his organization’s most innovative endeavor. “I’m not sure it counts as innovative but for the organization it will be. For us, the other big innovative effort is the push we’re making on data and knowledge management and the use of advanced analytics.”

We’ll find out next year if those efforts are producing results for these organizations.