As those of us who work in health care prepare to analyze Stage 2 Meaningful Use rules – which are due any day now – it will be helpful to consider new data commissioned by the Optum Institute and conducted by Harris. The research finds that hospitals are progressing with adoption of electronic medical records (EMRs) but that the adoption is not creating the type of provider connectivity we need to support a more collaborative and aligned healthcare system.
To be sure, the survey of 301 U.S. hospital chief information officers has some very encouraging findings. In particular, the research finds that nearly nine out of 10 hospitals surveyed (87 percent) now have EMR systems in place – up significantly since 2011, when the Health Information and Management Systems Society (HIMSS) reported that only slightly more than half of CIOs had a fully operational electronic health record in at least one facility in their organization.
In addition, the survey finds that 70 percent of CIOs report their systems have attested to meaningful use 1 criteria (MU1) and three quarters anticipated being able to meet expected meaningful use 2 (MU2) criteria by 2014.
However, the survey also identifies six critical technology concerns facing hospital CIOs:
· Technology-related spending continues to rise: CIOs are making new investments to modify their systems, link with other systems, purchase upgrades, or buy entirely new systems. Nearly 80 percent of respondents said they had to modify their system significantly in some way or purchase another system entirely. For those that have implemented EMR and health information exchange (HIE) systems, hospital CIOs report that new capabilities have so far raised hospital costs, not reduced them.
· Gaps in key care information: Almost two-thirds of hospitals said they own their own HIE, but key care information, including hospital discharge information, computerized prescriptions, physician clinical notes, and lists of patient allergies and medications, is available only about half the time.
· Interoperability among the major concerns: Among those participating in an HIE, data is on average accessible for only 60 percent of patients through the HIE. Two-thirds of respondents found data accuracy/completeness to represent the biggest business and technical issue they faced in using HIE capabilities, followed by inaccessible proprietary systems and high costs of interoperability.
· Compliance barriers: 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).
· Extending systems to the cloud: Recognizing the benefits of cloud computing, 59 percent of those who have an HIE/EMR system plan to invest in cloud-based open systems.
· Reform readiness: Hospital CIOs report being more prepared to assume broader responsibility in managing patient care than financial risk. Still, only one in four CIOs report that hospitals in their community are extremely/very prepared for increased responsibilities from managing patient care, and only 15 percent say they are extremely/very prepared for managing the associated financial risks.
As we all begin to debate the appropriateness and feasibility of new MU requirements, we need to think critically about whether they do enough to support the type of interoperability envisioned by new care models such as accountable care organizations. We are clearly making important progress with adoption and use of health information technology, but we must make sure investments today support the connected health systems of tomorrow.
The full issue brief and survey results are available here.
Carol J. Simon, PhD, is a senior vice president and director for the Optum Institute of Sustainable Health. She has more than 20 years experience in health care consulting and economic policy research. Prior to her role with the Optum Institute, Simon served as vice president in the Health and Human Services Policy practice of The Lewin Group.