When it comes to effectively using all of the data that is captured from EHRs, providers still have a long way to go, according to the HealthLeaders Media Industry Survey 2010. Nearly 70% of providers (69.79%) said they have only basic decision-support capabilities, defined as being able to aggregate data in one record from lab, radiology, and clinical findings. Yet decision support is what many healthcare executives claim is truly needed to realize value and be meaningful users of the technology. Only 3.13% of respondents said they are advanced users of decision support with personalized patient records and genetics data, 14.58% were intermediate users with a smart record that can offer real-time decision-support and data-mining capabilities, and 12.5% did not have any decision support capabilities.
Joanne Sunquist, RN, CIO for Hennepin County Medical Center in Minneapolis, MN, and 2009 board chair for the College of Healthcare Information Management Executives, wasn't too surprised by the findings. "Everyone I know is struggling with this, including us—it is very complex," she says. "Typically, people are so busy getting electronic health records in place that decision support is an afterthought." But if organizations are going to realize the benefits of health information technology, decision support should be incorporated into their HIT strategy sooner than later.
"This is where the new investment has to be to turn all of the transactions that we are collecting in all of these HIT systems into meaningful information and actions to reduce variability and improve quality," says Jack Kowitt, chief information officer for Parkland Health and Hospital System in Dallas.
The good news is that CIOs seemingly have more resources now than in past years to purchase and install health information technologies. Thirty-four percent of respondents said that their operating IT budget as a percentage of the overall operating revenue is between 4% and 6% —up 10 points from last year's survey (24%), and nearly doubled from the 17% response in our 2008 HealthLeaders CIO Survey. The percentage of respondents with IT operating budgets that were 7% or more of the total operating budget increased from 3.35% in 2008 to 5.19% in 2009 to 12.5% in 2010. The majority of providers still falls into the one to three percentage range of the overall operating budget at 47.92%, but that number has dropped from 70.95% in 2008 and 61.69% in 2009.
The increase in IT operating budgets does appear to be fueled by the smaller organizations—18.52% of small hospital respondents, which have less than 200 beds, said their IT operating budget was 7% or more. Similarly, 14.29% of critical access hospitals spend 7% or more of their operating budget on IT. "To get meaningful use it takes supporting the product, upgrading the products, and getting a new type of staff to do the analytics to get the really meaningful data out of the systems," says Kowitt. "It could be the smaller hospitals realizing that they have to invest heavily in IT."
One area that both small and large hospitals should be investing in is health information exchanges. Yet only 9.28% of respondents expect to have an interoperable healthcare system where providers, payers, patients, and public health entities can exchange health information in the next two to three years, and 62.88% of technology executives said they expected it to take longer than six years. Sunquist hopes that those who rated interoperability in the six- to 10-year range (47.42%), were thinking of the low end of that timetable. "I'd like it to be more in the four to five year range," she says. "With meaningful use you start to be penalized in 2015."