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HealthLeaders 2008 CIO Survey

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Bullish on Hospital IT

More than 40 percent of the respondents to this year's HealthLeaders Media Annual CIO survey are looking to boost their spending on information technology significantly during the next five years. By itself, that number may not seem impressive, given the industry's "behind the times" state. Yet this commitment to IT spending suggests that hospitals both large and small are putting their money where their mouths are when it comes to clinical advances and patient safety.

No doubt, IT dollars are hard to find. The vast majority of the 180 technology executives who responded to our survey devote 3 percent or less of revenues to IT. However, a look at the technologies in place at these organizations shows that for many, a seemingly modest budget has not deterred progress. More than four out of five have results viewing--and a wireless network to support it--in place. The third most common technology (in place at 79 percent of the surveyed hospitals) is picture archiving. As they work their way along the automation continuum, many hospitals are well-prepared for the future. Some two-thirds of the respondents have already deployed nursing documentation, enterprise scheduling, a clinical data repository, and physician-centric technologies such as a portal and electronic signature.

The survey reveals a hospital landscape in which the status quo is about to be upended. Although only one-sixth have physician order entry in place, nearly two-thirds say they plan to implement the technology within three years. The same goes for closed-loop medication administration technology. In other words, hospitals are looking to solve problems from top to bottom--or perhaps more precisely, from the care unit to the pharmacy and back again. Given the scope of departments involved, these are difficult technologies to deploy. That may explain the one significant shift from last year's survey: a more pronounced presence of senior-level executives in IT planning, oversight and governance. The chief executive, financial, medical, nursing and operating officers are well-represented at the two-thirds of hospitals with formalized IT steering committees, with increased representation compared to 2007. For example, last year, about three-fourths of the hospitals with IT steering committees had the CNO on board. This year, it's 93 percent.

The technologies that our respondents are postponing include single sign-on (9 percent will wait five or more years) and an interactive patient portal (13 percent will wait that long). That does make sense. After all, single sign-on does not become an issue unless you have plenty of applications to juggle (and a big chunk, nearly three out of five, of our respondents run single-source shops). Moreover, the interactive patient portal carries with it a host of thorny identification and policy issues. The looming question is the degree to which patient connectivity leaders will gain market advantage over competitor hospitals that are postponing such services as online appointment scheduling, bill paying, and personal health records.

Bearish on RHIOs

We added some new questions this year on data exchanges and certification. Respondents have jaundiced views on both topics. A little more than one-fourth of respondents think that regional health information organizations "will take hold during the next decade." One-third agree that RHIOs will more likely fizzle out due to management issues, while the remainder question their very value. Nearly 40 percent agree that RHIOs put the "cart before the horse; we need hospital and medical group automation first."

Likewise, almost one-fourth think that federally endorsed product certification is a good idea that will facilitate IT purchasing decisions. The majority agree--with one caveat. Some three out of five say that vendor interoperability must be part of the package for certification to work. Thus, respondents are saying, "we think certification is a good thing, but it will need to go much further to be effective." That is a polite way of withholding judgment for the time being, while acknowledging that getting disparate systems to communicate with one another is a critical issue for the industry.

Taken as a composite, the survey suggests a CIO who is at once idealistic (willing to embrace often unproven applications as viable tools in attacking entrenched problems) and practical (surrounding himself or herself with key power executives in the hospital, and staying detached from possible resource-draining ventures beyond the walls of the home base). No wonder three-fifths of the respondents identify the CIO as a key leader and strategist. The scope of CIOs' responsibilities is expanding, now that clinical IT has gained such a strong foothold.

-Gary Baldwin