Top Health IT Trends Survey & CMIO Census
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If federal healthcare IT mandates and the sour economy mean this is the best of times and worst of times for health IT, how good/bad is it to be a CMIO right now? We conducted the 2010 CMIO Top Trends Survey during May and early June to try to find some answers. The take-away: Technologies that will enable meaningful use of healthcare information are becoming mainstream or will be in the near term—among them EMRs, CPOE, clinical decision support and reporting tools—even as respondents raise doubts about whether health IT will actually be a prescription for higher-quality care.
Respondents’ top five business priorities for 2010 are:
- Clinical adoption of new technology by physicians (85 percent)
- Planning for Meaningful Use (84 percent)
- Implementation of new IT projects (71 percent)
- Physician training on new systems (44 percent)
- Clinical adoption of new technologies by nurses (39 percent)
It should come as no surprise that the federal imprimatur (funding) is a big factor in determining which projects get the nod, according to the 212 survey participants. Nor is it a shock that our respondents are IT super-users. For example, 57 percent of respondents say their facilities have an EHR system installed, while 39 percent plan to either implement or purchase an EHR this year. About 44 percent have CPOE installed, with 40 percent expecting to implement or purchase it in 2010.
At the other end of the adoption spectrum are the technologies that might improve patient care or streamline workflow, but are sidelined as organizations scramble to comply with meaningful use and HITECH requirements. For example, only 15 percent of respondents say they have RFID technology installed, and more than half our survey participants say they have no plans to acquire it. The same holds true for clinician notification devices, installed in close to 19 percent of respondents’ facilities, but not planned in more than 40 percent.
HITECH, high skepticism
Even as the HITECH Act influences IT decisions, CMIOs are ambivalent about its prospects for actually lowering healthcare costs and improving care through use of health IT within a five-year time frame. It’s a very close call: About 48 percent are very confident or confident that HITECH goals of improving the efficiency and quality of healthcare through health IT and health information exchanges (HIEs) will be achieved within 5 years. Roughly the same percentage says they are not confident or doubtful.
A bit more than 54 percent say more money will be necessary for HITECH to accomplish its set goals, but close to one-third say they don’t know. Among participants who think more funds will be needed, there is no shortage of opinions as to how much more (think billions). Where should the money go? Participants say put it toward HIEs and regional health information organizations, EHR and EMR standards and deployment, training programs, and clinical decision support tools and guidelines.
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Closer to home, CPOE tops the list of respondents’ biggest challenge for their own organizations’ meeting HITECH’s goals (see chart to right).
That said, CMIOs are taking steps to reach those goals. “The next few years are all about scrambling to meet the [meaningful use] guidelines, whatever they may be,” says Donald Levick, MD, MBA, medical director of clinical informatics at Lehigh Valley Health Network in Allentown, Pa. “Then it will be the next five to 10 years that organizations attempt to optimize these systems and take advantage of the technology and what it can do. But the next few years will be about meeting the guidelines.”
We asked participants to name their top five healthcare IT implementation priorities for 2010 from a list of 24. Clinical decision support came out tops, (66 percent) followed by CPOE (52 percent); quality improvement /reporting (51 percent); EHRs (48 percent); and workflow management systems (44 percent).
The five least-named choices? Stationary computers/workstations (1 percent); laboratory information systems (4 percent); storage and archiving (7 percent); practice management systems and revenue management systems (8 percent each); and enterprise resource planning (9 percent). These results match responses for these same technologies—particularly laboratory information systems and storage and archiving—as already installed in most facilities.
For 2011, the top healthcare IT implementation priorities named were almost the same: CDS again leads the charge, (68 percent), followed by CPOE (48 percent); HIEs and quality improvement/reporting (47 percent); and EHRs (39 percent).
The state of EMRs
Some 62 percent of survey participants already utilize a hospital EMR and 55 percent say they have an ambulatory EMR. More than a third say they have multiple EMRs in their organization. Just about 6 percent say they have a hospital information system (HIS) but no EMR, and only 5 percent say they have no EMR or an HIS.
The response that 16 percent share data from their EMR with an HIE “shows that people answering this survey are from advanced organizations as there are not many HIEs operating in the country,” Levick says. “For almost a sixth of the people to say they are participating is impressive.”
MU requirements figure significantly into what these systems can do—70 percent of respondents say their ambulatory EMRs have clinical documentation and results reporting/management capabilities. About 60 percent say e-prescribing features are part of their ambulatory EMR. Among respondents with hospital EMRs, 75 percent say they have results reporting/management and about 70 percent have clinical documentation. CPOE is part of the package for 65 percent, while about 60 percent say their EMR integrates pharmacy (CPOE and electronic medical administration record) features. Only 33 percent say their hospital EMR includes quality and pay for performance metrics.
Budgets: Still up (for some)
A majority of CMIOs say they play a key role of influencing IT purchases and specifying vendor choices (see the CMIO Census on page 8). So it was surprising to us that a third say they don’t know their organization’s 2010 operating budget for clinical IT (or maybe they chose to keep their cards to their chest?). The largest percentage of respondents in the know on the IT operating budget reported budgets in the range of $1 million to $5 million (14 percent). Ten percent report having an operating budget of more than $50 million and 7 percent report an IT operating budget of $10 to $15 million.
And are budgets increasing or decreasing? About 41 percent say their operating budget has increased over 2009; 20 percent say their budget is unchanged year over year, and 11 percent reported a decrease for the period.
Capital budgets are in a similar situation. Again, those with budgets in the $1 million to $5 million range make up the largest section of the chart at nearly 17 percent—among those who know what their capital budget is—followed by those with capital budgets of more than 50 million, 9.5 percent.
With clinical adoption high on the IT business priority list for 2010, it’s not surprising that nearly 37 percent of respondents say they intend to spend more on IT-related training than last year. Fifteen percent expect no change in their training budget and 6 percent say they will spend less this year than they did in 2009. Training will be a $100,000 to $250,000 expense, according to 10 percent of respondents; 9.5 percent say they will spend $1 million to $5 million. Only 15 percent report they will spend less than $100,000 on IT-related training.
Most clinician training will focus on EHR/EMR use, say 65 percent of survey participants, followed by CPOE systems (59 percent), and medication management (56 percent). CDS support (44 percent) and RIS/PACS training (almost 24 percent) followed. The technologies specified in the “other” category (11 percent) of respondents, included communication tools/social networking tools, bar coded medication administration, and physician and extended clinical documentation.
Survey participants are more likely to use in-house training programs than independent or vendor-based training, but many report using a combination of all three. About 55 percent say they will devote most of their health IT training to nurses, 37 percent say physicians will receive the most health IT training. Technologists top the training roster for almost 7 percent of respondents.
And there could likely be more people to train as well—with 63 percent of respondents saying they expect to hire more IT staff in the coming year. About 27 percent say staffing will remain the same, and just shy of 9 percent predict the IT staff level will drop. Apparently most organizations believe that they’ll not only need new technologies and systems to get and keep regulatory compliance and improve patient care; they also need additional expertise to survive in a healthcare system that’s changing rapidly.
Admittedly, the pool of CMIOs is still fairly small, and the respondents to this survey work for some of the most technologically engaged organizations in the country. Their answers reflect this bias toward health IT. Nevertheless, this inaugural Top Trends Survey plants a statistical stake in the ground. It’ll be interesting to see how today’s trends evolve as more CMIOs enter the field, and early adopters are joined by less tech-focused facilities.
The fine print
This report contains a detailed statistical analysis of the results to the survey titled CMIO 2010 Top Trends Survey and CMIO Census. The results analysis includes answers from all respondents who took the survey in the 30 day period from May 3 to June 2, 2010. A total of 212 completed responses were received to the survey during this time.
| HIE: Sharing is Still Limited | |||||||||
More than 44 percent of respondents say their facility participates in a health information exchange (HIE) and shares data with related health facilities. Fewer share with unrelated facilities and less than 10 percent belong to multiple HIEs.
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| CPOE: Having It & Using It Aren’t the Same Thing Limited | |||||||||
Close to 40 percent of respondents have implemented housewide CPOE, 15 percent have it in some units and another 30 percent are in the process of implementing it. Although 24 percent say physicians in their organization use CPOE between 90 and 100 percent of the time, almost a third of survey participants report that 10 percent or fewer physicians use CPOE. Slightly more than half of respondents say their organization mandates CPOE use by physicians, just edging out those that don’t mandate CPOE use.
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| Data Input: The Coolness Factor | |||||||||
When it comes to modes of data entry, cool gadgetry doesn’t trump a bigger screen and keyboard just yet. More than 38 percent of survey participants say mobile computers and handheld devices are deployed at their facility and another 26 percent plan to implement them this year. However, physicians still most often rely on workstations, desktop PCs and computers on wheels (COWs) as their primary means of inputting and reviewing data.
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| EMR Capabilities | |||||||||
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| CMIO Census trends toward more time on IT vs. patient duties; 50+ CMIOs outnumber younger ones | ||
This first go-round, which included 16 questions, yielded plenty of interesting results, and like the Top Trends stats, it establishes a baseline with which to compare future results. Our analysis includes answers from the 212 qualified respondents who took the survey in the 30-day period from May 3 to June 2, 2010. It likely won’t surprise you that CMIOs are predominantly male, nor that most are internal medicine practitioners, pediatricians and ER doctors. That said, there are plenty of specialties represented, with the “other” heading accounting for 17 percent of our results. Nursing, which has been a hot zone for growth in informatics interest, made the list too, and more CMIOs might well come from a nursing background in the future. (See CMIO’s cover story on nursing informatics in the April 2010 issue.) The title of chief medical information/informatics officer applies to about 50 percent of respondents. Another 25 percent of respondents are directors or managers of clinical information systems or directors or managers of medical information systems. Most CMIOs work in larger healthcare practices—50 percent in multi-hospital organizations and IDNs, 58 percent of which have more than 500 licensed beds—and are most likely to report to the chief information officer, CEO or CMO. They are most likely to have a staff of fewer than 10, and 35 percent have no staff at all. Some 40 percent of CMIOs are in the range from 51 to 60 years old, while 31 percent are 41 to 50 years old. Their tenure in health IT still reflects the relative newness of the CMIO position: A full 25 percent of respondents report that they’ve been in the field for three years or less, and roughly 67 percent have less than a decade of experience in health IT. CMIOs have a lot to say about what healthcare technologies come into their organizations. In response to the question “What role do you perform in the purchase of IT infrastructure?” 65 percent say they recommend IT systems; 17 percent specify suppliers and vendors, and 10 percent report that they make the final decision on these purchases. The patient care/IT project balance is not an even split: some 50 percent of CMIOs say they spend less than 10 percent of their time seeing patients. The second-largest group, 11 percent, say they spend 20 to 29 percent of their time with patients. When we asked how much time they spend on medical informatics projects, about 38 percent say they devote 90 to 100 percent of their time here. These results could be a reflection of increasingly complex IT projects demanding more of the CMIO’s time, and the corresponding expectation that being a CMIO is a now a full-time IT job. |
