An Optum Institute for Sustainable Health Issue Brief A CIO Survey of HIT Adoption Trends Summary As we enter 2012, hospitals have made impressive gains in the uptake of electronic medical records, participation in health information exchanges, and progress toward achieving meaningful use. But technology gaps remain, genuine interoperability remains elusive, and as a result, hospitals report still being some way off full readiness for the challenges headed their way in terms of managing greater population health and financial risk. This issue brief presents new national findings based on a survey commissioned by the Optum Institute for Sustainable Health on progress and challenges facing hospitals as they move toward wider adoption of health information technologies (HIT). It provides the most up-to-date snapshot available on national HIT trends and views from hospital chief information officers (CIOs) and technology leaders. The survey was conducted on behalf of the Optum Institute by Harris Interactive.
Findings: Hospital adoption of HIT accelerated in 2011. By January 2012, the vast majority of hospital CIOs 87 percent reported that their hospitals have EMR systems in place. Some 7 in 10 say they participate in health information exchanges (HIEs). Hospitals are well positioned to meet federal meaningful use requirements. Of those with systems in place, 70 percent of CIOs reported that they have met meaningful use stage 1 criteria, and three-quarters anticipated being able to meet expected meaningful use stage 2 criteria by 2014. Getting to this point has required major investments. Nearly 80 percent of respondents said they had to either significantly modify their system in some way or purchase another system entirely. Interoperability is among CIOs major concerns. Most respondents pointed to remaining technology gaps that limit providers ability to support effective, efficient, coordinated care. Notably, concerns about data accuracy, lack of interoperability, and anticipated new rounds of investments suggest many organizations are not yet prepared for the increased responsibilities of coordinating care and managing risk. CIOs reported significant technology barriers that are raising costs. New capabilities have raised hospital costs, not reduced them, according to hospitals own CIOs. The cloud is on the horizon. Nearly 60 percent of those who have an HIE/EMR system said they plan to invest in emerging cloud-based open systems with 86 percent of those planning to invest because they believe their current systems will interoperate with new cloud-based technologies. Access to applications and additional functionality were identified as the primary reasons for cloud investments. Methodology Hospital CIOs insights and experiences are critical to understanding current trends and future directions for HIT adoption. The Optum Institute commissioned Harris Interactive to conduct a nationally representative survey of hospital CIOs in late December 2011 and the first half of January 2012 1 to explore: Hospitals current HIT capabilities Progress in digitizing medical care information How far hospitals have gotten in their attestations against federal meaningful use standards Progress and challenges on system interoperability, and Perceived benefits and challenges associated with technology use. 1 The survey was conducted online within the United States by Harris Interactive on behalf of the Optum Institute for Sustainable Health from December 29, 2011, to January 16, 2012, among a national sample of U.S. hospitals (n = 301). Results were weighted to reflect the size distribution of the U.S. hospital industry. To qualify for the survey, CIOs were required to have input on evaluation and/or selection of EMR or HIE systems for their hospitals. For full methodology, including weighting variables, please contact Carol Simon at carol.j.simon@optum.com. Optum www.optum.com Page 2
Adoption profile Nearly 9 out of 10 hospitals surveyed (87 percent) now report having EMR systems in place. HIT adoption has steadily increased over the past two years: the Healthcare Information and Management Systems Society (HIMMS) reported in early 2011 that only slightly more than half of CIOs had a fully operational electronic health record system in at least one facility in their organization. 2 About 7 in 10 of hospitals surveyed currently participate in HIEs. Of those that do not currently have HIE capabilities, 74 percent plan to participate in the next 12 months. Electronic Medical Record (EMR) Use in Hospital 14% 87% Yes, use EMRs No, do not use EMRs 74% plan to participate in an HIE next year Health Information Exchange (HIE) Participation 29% Yes, participate in HIE Percents may not total 100 because of rounding. 7 No, do not participate in HIE Meaningful use Seventy percent of CIOs report their systems have attested to meaningful use stage 1 criteria; three-quarters anticipate being able to meet expected meaningful use stage 2 criteria by 2014. For those that have an EMR system but do not currently meet the criteria for meaningful use stage 1, some 78 percent indicated their hospitals would achieve first-stage meaningful use within the next 12 months. For those that have an EMR system, the largest barriers to complying with meaningful-use requirements include cost (57 percent), sufficient time (55 percent), and legacy system incompatibility (34 percent). Stage 1 Meaningful Use (MU1) 14% 16% 20% 5% Criteria met Criteria not met Not sure Percents may not total 100 because of rounding. Meet Stage 2 Meaningful Use by 2014? 70% 76% Yes No Not sure 2 22nd Annual HIMSS Leadership Survey, sponsored by Citrix, http://www.himss.org/2011survey/healthcarecio_ home.asp For the purposes of this research, an EHR was defined as electronically originated and maintained clinical health information for patients, derived from multiple clinical application sources, about an individual s episode of healthcare at a care delivery organization. Optum www.optum.com Page 3
Characteristics of Health Information Exchange Almost two-thirds of hospital respondents own their own HIE. Lab results and patient demographics are most often available through the exchange, while prescriptions, care plans, and discharge summaries are available in just less than half of all systems. HIE Ownership Information Recieved via HIE 35% Lab results Patient history and demographics Imaging results 64% 75% 83% 65% Hospital owns HIE Hospital does not own HIE Not sure Comprehensive list of patient s meds and allergies Physician clinical notes Computerized prescription orders Discharge summaries from hospital systems Care plans Patient problem list 63% 60% 54% 48% 44% 43% Immunization records Other(s) None/No answer Among those whose hospital owns an HIE system, the most common types of information managed are (1) lab results (83 percent) and (2) patient history and demographics (75 percent). While the results are promising, key care information including hospital discharge information, computerized prescriptions, physician clinical notes, and lists of patient allergies and medications is available only slightly more than half the time (allergy and physician notes are available 64 percent and 60 percent, respectively). Optum www.optum.com Page 4
Managing the patient population Technical Issues Business Issues Accuracy / completeness of data 66% Lack of access to other systems (e.g. proprietary systems) 52% Time Increased legal exposure 43% 54% Lack of certain types of data (e.g. claims data) 5 Lack of payment Loss of revenues 16% 15% High costs of interoperating with other systems due to customization, licensing or other requirements 49% Cost Technology does not interface 4 Other None/No answer 2% Licensing requirements of other vendors or HIE participants 39% Don t know Access requires customization of current systems 38% Among those who participate in an HIE, on average the data is said to be accessible for 60 percent of patients through the HIE. In prioritizing their biggest business and technical issues, two-thirds of respondents found accuracy/completeness of data to represent the biggest issue they faced in using HIE capabilities, followed by lack of access to proprietary systems and high costs of interoperability. Despite the widespread use of HIEs among the respondent base, 62 percent still need to log on to another system to access data. Optum www.optum.com Page 5
Investments and costs With systems now in place, respondents said they were looking for ways to optimize and extend the value of the investments they ve already made. Some 78 percent of CIOs reported they recently made changes to their system or purchased another system in order to meet HIT objectives. Of those, 8 percent purchased an entirely new system. Changes to EMR System to Meet HIT Objectives No, made no changes Yes, made changes to existing system via vendor support Yes, purchased entirely new system Yes, made changes to existing system via internal customization Yes, purchased updates to existing system Made any changes Total 22% 14% 32% 24% 8% 78% Costs are increasing, not decreasing: For those who have implemented EMR and HIE systems, overall costs have increased. For those who have HIE systems, costs are related to: Interoperating with other systems (49 percent) The licensing fees of other vendors to access partner systems (39 percent) Investments to modify their current system (38 percent). For those who have an EMR system, costs are related to: The need to enable vendor support (31 percent) Purchase upgrades (24 percent) Buy an entirely new system (8 percent) The cloud is on the horizon In recognition of the benefits of cloud computing, nearly 60 percent of those who have an HIE/EMR system said they plan to invest in cloud-based open systems. Cloud Based Open Systems: Plans to Invest Yes, for EMR technology Yes, for HIE technology Yes, for both No plans to invest for either Total 1 12% 36% 4 Access to additional applications (57 percent) and additional functionality (56 percent) were identified as the primary reasons for cloud investments, with respondents citing those as major advantages to cloud-based technologies. Optum www.optum.com Page 6
Ready for reform? Hospital CIOs reported being more prepared to assume broader responsibility in managing patient care than financial risk. Only 25 percent of CIOs reported that hospitals in their community are extremely/very prepared for increased responsibilities managing patient care, and only 15 percent said they are extremely/very prepared for managing the associated financial risk. Hospitals reported being more prepared to assume greater responsibility in managing patient care than financial risk Preparation for Managing Patient Care and Financial Risk How prepared are hospitals in your community to assume...? Top 2 Greater responsibility for managing patient care 25% 15% 4% 2% 2 13% 36% 33% 3% 3% Greater financial risk for managing patient care 28% 4 13% 3% Extremely prepared Very prepared Prepared Somewhat prepared Not at all prepared Not sure About the Optum Institute for Sustainable Health Optum has established the Optum Institute to serve as an authoritative source of analytical insights on the rapidly changing U.S. health care landscape, while acting as a constructive enabler of sustainable health communities. The Optum Institute works in partnership with consumers, health professionals, hospitals, employers, governments, health plans and the life sciences industry to help transform health care delivery. More information is available at institute.optum.com Optum www.optum.com Page 7
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