During the ACHE conference this year in Chicago, John Danielsand John Hoyt of HIMSS analytics gave a presentation about the “Trends and Glimmers” on the horizon in Health Information Technology. They began their presentation by referencing the landmark IOM article, “To Err is Human: Building a Safer Health System” (1999), which was the first study to point out just how many patients die every year because of medical errors (98,000 at that time). The reason for so many deaths centered on the lack of relevant information available to the clinicians caring for those unfortunate former patients. Referring to the follow-up IOM study in 2001, “Crossing the Quality Chasm: A New Health System for the 21st Century”, the pair said that information technology assisted in the “STEEEP” climb necessary to transform healthcare. That is: Safe, Timely, Effective, Efficient, Equitable and Patient centered care. HIMSS Analytics defines trends as “supported by data that shows market movement toward or away from a certain technology or application”, and glimmers as “supported by anecdotal data, market noise and industry hype”.
Over the past six years, total IT operating expenses as a percentage of total operating expenses for hospital organizations remained at about 2.5 percent (actually in 2011 was exactly 2.5%), and ranged from a low of 2.35 percent in 2008 to a high of 2.9 percent in 2006. This year’s survey results showed 43 percent of hospitals spent more than last year, 34 percent were even with the prior year and 23 percent of respondents predicted a decline in their spending. Integrated Delivery Systems saw spending the same as last year (45%) with about 33 percent increasing budgets and 22 percent spending less.
And what are they spending money on? HIMSS Analytics predicts that the Radiology PACS market is about at its saturation point, showing that just shy of 89 percent of all hospitals reported at least one modality installed on PACS, with CT, CR, ultrasound and MRI leading the way. Only angiography and digital remained at a penetration rate of less than 75 percent. They warned PACS sales personnel that they had better move into cardiology PACS if they wanted to keep their income where it had been over the past decade. The adoption level within cardiology PACS remained at less than 40 percent last year with CT, intravascular ultrasound and nuclear cardiology well behind on the adoption curve.
With all the talk about meaningful use and stage 7 adoption in the news, a surprising statistic is that 35 percent of all hospitals surveyed do not include in their plans to implement or even contract for computerized physician order entry (CPOE). Thirty two percent have CPOE installed (up from 27% in 2010); 18 percent have contracted with a vendor and 11 percent are in some stage of implementation. CPOE adoption varies drastically by hospital type as well. Almost 70 percent of academic institutions have CPOE compared to almost 55 percent of general medical and almost 48 percent of critical access hospitals.
Data warehousing and mining appear to be on the rise, however, while clinical data warehousing and analysis continue to lag far behind that of financial data mining. The same is true of bar coding in the pharmacy and at the bed side. Although both are on the rise, bar coding in the pharmacy far outpaces that of bedside administration applications. HIE adoption among hospitals has grown rapidly over the past six years from just over eight percent of hospitals reporting HIE capabilities in 2006 to greater than 25 percent of hospitals stating that they have the capability today. It is also one of the growing areas reported in the “planning to participate” area of last year’s survey, with over 18 percent of the facilities reporting that they are planning to participate in health information exchange in the coming years.
The top ten areas for IT purchasing in 2011
Of most interest to IT vendors, but also for hospital CIOs, is to see where are the buying trends, and in what areas hospitals have indicated they are going to spend future dollars in medical applications. Here is this year’s top ten list with the percentage of hospitals planned investment in 2011:
- CPOE – 4.14%
- Physician documentation – 3.59%
- eMAR – 2.88%
- Clinical Decision Support Systems – 2.41%
- Nursing documentation – 2.41%
- Clinical Data Repository – 2.35%
- Order Entry (not sure how this differs from CPOE) – 2.35%
- Pharmacy management – 2.07%
- Medication reconciliation – 2.05%
- General ledger – 2.03%
CPOE, eMAR, Clinical Data Repository and Nursing Documentation are the only systems that remain on the list compared to the top ten list of 2006.
What is on the Horizon? Glimmers
The three main glimmers on the horizon according to HIMSS analytics revolve around mobility, interoperability and adoption of EHRs. Using a FirstWordSM Dossier report of 2010 entitled “Trends in Mobile Medicine: Smartphone Apps for Physicians (Market Intelligence Report), Daniels and Hoyt reported that there are more wireless subscriber connections in the United States than there are people. The same report stated that 72 percent of U.S. physicians own a smart phone with about two thirds of all physicians using that device for online content of a professional nature. Almost 95 percent of all physicians use some “app” for medical information. There are indications that the $2.7 million market of 2007 could develop into a $9.6 billion (yes billion) market by the end of 2012 because of the medical applications currently flooding the market.
Interoperability standards will progress as the proliferation of clinical information systems expand. Neither patients nor physicians will stand for putting information into electronic healthcare systems and not be able to have that information seamlessly move from one system to another in a useable way. The days of entering the same information over and over as patients migrate from one treatment setting to another must come to an end if we are to see a return on investment for automating the medical environment. It is also the only way we are going to see healthcare providers use the medical information entered into these systems to change the way they practice medicine. The data exchanged must be reliable and fit within their workflow resulting in actionable information at the point of care.
And finally, analysts see the adoption of a measuring mechanism similar to the seven stage HIMSS Acute Care Adoption scale being developed for the ambulatory setting. The goal of this measurement device will be to push the market toward true meaningful adoption of EHRs with a focus on health information exchange, medical device interoperability and clinical/business intelligence across the spectrum of healthcare institutions.
John Tempesco, FACHE, is the Chief Marketing Officer at ICA. This blog post was first published on ICA’s HITme Blog. John has 37 years of healthcare experience, including a two decade career in health information technology in both the government and civilian sectors. He is a Fellow in both the American College of Healthcare Executives and the Life Management Institute, as well as a Certified Managed Care Executive.