Hospitals need to scramble on stimulus fund goals

By Cynthia E. Keen, staff writer

March 3, 2010 -- ATLANTA - Speculation about every aspect of healthcare IT adoption is the name of the game at the Healthcare Information and Management Systems Society (HIMSS) annual meeting this week. Statistics and formal trend analysis presented in an educational session titled "KLAS and HIMSS Analytics Speak Out: What's Real and What Isn't" provided a reality check.

HIMSS Analytics, a research unit of Chicago-based HIMSS, maintains the HIMSS Analytics Database, the largest and most comprehensive repository of information about healthcare IT purchases and utilization trends in U.S. and Canadian hospitals. It surveys all nonfederal hospitals in the U.S. (5,235) and Canada (679) on an annual basis and provides quarterly reports of key trends and IT adoption milestones.

"Hospitals in the U.S. are making substantial progress but have a long way to go," Dave Garets, HIMSS Analytics president and CEO, told session attendees. "Some healthcare institutions will not achieve the level of healthcare IT adoption required to meet meaningful use criteria within the timeline required to receive federal stimulus funds."

Healthcare IT spending is indeed on the upswing. In the fourth quarter of 2009, 52% of U.S. hospitals reported a budget increase, compared with 18% in the fourth quarter of 2005. Garets predicts that this percentage will steadily increase throughout 2010. Interestingly, the percentage reporting budget reductions for both years was nearly identical, at 27% for 2009 and 28% for 2005.

Progress has been made with the adoption of computerized physician order entry (CPOE) systems, but it's unimpressive.

CPOE adoption level 2005 2009
Live and operational, but not necessarily used 10.42% 24.48%
Installation in progress 1.9% 7.89%
Contract signed; not yet installed 13.44% 13.87%
Planned purchase 40.8% 2.69%
No plans yet; not automated 33.44% 51%

Garets speculated that the majority of hospitals who had gone as far as selecting a vendor for a CPOE system but had done nothing yet in 2005 comprised the majority of this category in 2009. Regarding the unexpected increase in hospitals with no plans for CPOE, he suggested that hopeful hospitals planning for a future CPOE were either more honest about their expectations or lost planned funding.

It's reasonable to assume that academic hospitals would implement CPOE faster than community hospitals because they are teaching hospitals, with rotating residents ordering exams and lab tests. This is supported by the data, which show a 100% increase between 2005 and 2009, at 31% and 61%, respectively. By comparison, community hospital adoption was 9% in 2005 and 22% in 2009. An additional 21% of academic hospitals and 15% of community hospitals were in contract negotiations with CPOE vendors in 2009.

While acknowledging the more than 100% increase in adoption over the four-year time period, Garets emphasized that 40% of U.S. academic hospitals still hadn't implemented CPOE.

Another surprising statistic was the number of hospitals that do not use barcoding for either nursing point of care or in a pharmacy for dispensing drugs. Three decades after grocery stores universally adopted barcoding, only 55% of hospitals in 2009 (compared with 10% in 2005) use the technology for drug dispensing, and only 41% in 2009 use it for nursing point of care (compared with 6% in 2005).

Much more expensive by orders of magnitude, PACS penetration reached an approximate 70% penetration for hospitals that have CT, computed and digital radiography, MRI, nuclear medicine, and ultrasound modalities. In 2005, installation was 37% to 43%. Digital mammography is now at 36% penetration among healthcare facilities that offer mammograms, an increase of 8% since 2005.

"Investing in a PACS is no longer a risk," Garets said. "In fact, a hospital's risk at this stage is not implementing."

HIMSS Analytics defines electronic medical record (EMR) adoption in eight stages. About half of the hospitals surveyed had begun the process in 2002, and this percentage increased to 60% in 2005 and 84% in 2009. However, about 85% of all U.S. hospitals have only reached Stage 3.

Based on reported levels of implementation, the investment required to reach additional stages, and the typical length of time needed to evaluate, negotiate, contract, purchase, and install systems, Garets feels that many hospitals won't make the deadlines for meaningful use compliance.

Status of EMR adoption model trends (December 31, 2009)
Stage 7 Complete EMR, CCD transactions to share data, data warehousing, data continuity with ED, ambulatory OP 0.7% 2015 deadline
Stage 6 Physician documentation (structured templates) full CDSS, full radiology PACS 1.6%
Stage 5 Closed loop medication administration 3.8% 2013 deadline
Stage 4 CPOE, clinical decision support 7.4% 2011 deadline
Stage 3 Nursing/clinical documentation, CDSS (error checking), PACS available outside radiology department 60.9%
Stage 2 CDR, controlled medical vocabulary, CDS, may have document imaging, HIE capable 18.9%
Stage 1 Ancillaries (laboratory, radiology, pharmacy) installed 7.2%
Stage 0 0-2 ancillaries installed 11.5%
Source: HIMSS Analytics Database

If CPOE utilization of 10% or more is required -- and use in emergency departments is excluded -- hospitals will have to be at Stage 4 by 2011. If emergency department entries are allowed and the process is automated, hospitals may qualify at Stage 3. This is currently an unknown variable, Garets explained.

Kent Gale, founder and chairman of KLAS Enterprises in Orem, UT, a market research firm that reports on vendor performance from the perspective of their customers, explained the "vast wilderness" of factors that a potential customer needs to consider when evaluating vendors, performance, and support of a CPOE system.

The main point of Gale's detailed comparison of vendors' strengths and weaknesses was that no vendor has a product for everyone, no vendor does everything well, and it's up to the customer to weigh the importance of a complex mix of variables to select the right match.

KLAS Enterprises conducts more than 1,900 provider interviews per month, and uses a database of more than 4,500 hospitals and 3,000 doctors' offices and clinics, rating more than 900 individual products and services offered by approximately 250 vendors.

"There is no shrink-wrap solution," he advised. "Our statistics can help you sort out and narrow your options, but you still will be spending more time than you expect."

The warning from both Gale and Garets: Hospitals have less time than they think to become 21st century IT functional.

By Cynthia E. Keen staff writer
March 3, 2010

HIMSS vendors chase 'meaningful use' -- and stimulus dollars, March 2, 2010

U.S. releases $1B in ARRA funds for HIT, February 12, 2010

HHS announces $38 million in health IT grants, December 24, 2009

Hospital IT spending to reach $4.7 billion, June 11, 2009

Obama stimulus package allocates $20 billion to healthcare IT, February 19, 2009

Copyright © 2010


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