Headline Continued Progress

Headline Continued Progress Hospital Use of Information Technology 2007  Summary of Findings H ospitals realize the promise of health informat...
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Headline

Continued Progress Hospital Use of Information Technology

2007



Summary of Findings

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ospitals realize the promise of health information technology (IT) to improve quality of care. Despite the financial and implementation challenges of health IT adoption, hospitals continue to accelerate their use of health IT, with 68 percent reporting fully or partially implemented electronic health records (EHRs) in 2006.

interactions. In 2006, 51 percent of hospitals were using real-time drug interaction alerts, up from 23 percent in 2005. • Certain kinds of hospitals are further ahead in adoption of health IT. Larger hospitals, those in urban areas, teaching hospitals, and hospitals with positive margins used more health IT. In addition, large and urban hospitals also showed greater rates of growth in IT use than their smaller and rural counterparts.

To gauge the extent of health IT use among U.S. hospitals and better understand the barriers to further adoption, the American Hospital Association (AHA) surveyed hospitals in fall 2006. The results provide the most complete picture of hospital IT use currently available. The survey asked about use of EHRs and other specific kinds of health IT, financing of health IT systems, barriers to greater use, and involvement in arrangements to share clinical information. More than 1,500 community hospitals — about 31 percent of all U.S. community hospitals — responded to the survey. This sample fairly represents all community hospitals by size, location, and teaching status. This is the AHA’s second survey of hospital health IT use; the first was conducted in spring 2005.

• Hospital spending on health IT is high and increasing. Not surprisingly, therefore, the most commonly cited barrier to further IT adoption continued to be cost. • About one-half of hospitals shared electronic patient data with others in both 2005 (53 percent) and 2006 (49 percent). Their most common partners included private-practice physician offices, laboratories, payers, and other hospitals. The data show continued progress in health IT adoption in hospitals, but we remain far from the goal of universal adoption. The patterns displayed in the survey data suggest that certain kinds of hospitals — generally those with greater financial resources — are gaining ground faster than others. Accelerating adoption among all kinds of hospitals will require a shared investment between providers, payers, and purchasers. Hospitals currently bear almost all the costs of IT investment, with no increase in payment for the use of these new technologies. However, many of the financial benefits of IT — such as decreased need for repeat tests, lower readmission rates, and shorter lengths of stay — accrue to those who pay for care.

Key findings include: • Over two-thirds of hospitals (68 percent) had either fully or partially implemented EHRs in 2006.1 The 11 percent with fully implemented EHRs were more likely to be large, urban, and/or teaching hospitals. • Health IT use is growing. In 2006, 46 percent of community hospitals reported moderate or high use of health IT, compared to 37 percent in 2005. Health IT use was determined by the number of clinical IT functions — such as medication order-entry, test results review, or clinical alerts — a hospital had fully implemented.

When looking at how to finance health IT adoption, policymakers should give special attention to hospitals with less stable finances, smaller hospitals and rural hospitals. Other barriers to IT use, such as lack of systems that share data easily, challenges in managing work process changes, and lack of trained IT staff also must be addressed by policymakers and the hospital field.

• Computerized physician order-entry (CPOE) is gaining traction. In 10 percent of hospitals, physicians routinely ordered medications electronically at least half of the time in 2006. For laboratory and other tests, physicians routinely placed orders electronically at least half of the time in 16 percent of hospitals. • Hospitals reported dramatic increases in the use of computerized alerts to prevent negative drug 

Introduction he potential of health information technology (IT) to improve the care patients receive and the overall efficiency of the health care system has become a central part of the national health care debate. Many hospitals and health systems have embarked on the challenging journey of IT adoption. However, use of health IT is not yet universal due to financial, technical, implementation, and policy barriers.

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The AHA surveyed all U.S. community hospitals — both members and non-members — to ensure as complete a picture as possible. More than 1,500 community hospitals — about 31 percent of all U.S. community hospitals — responded to the survey. This sample fairly represents all hospitals by size, location, and teaching status. The technical appendix contains more details on the survey methodology.

To further develop our understanding of the level of health IT use by hospitals and the barriers to further adoption, the AHA conducted a second survey of hospitals in the fall of 2006 (a previous survey was fielded in the spring of 2005). The survey asked about the use of specific technologies, such as electronic health records (EHRs) and computerized physician order-entry (CPOE), as well as other clinical and non-clinical applications, such as administrative and department-specific information systems. The survey also asked about financing for IT, barriers to use, and efforts to exchange clinical information with others.

This report provides a comprehensive picture of hospital IT use. It first discusses adoption of the most comprehensive clinical IT tools – EHRs and CPOE. It then explores the evolutionary nature of clinical IT adoption, which often involves implementation over time of separate systems in different departments of the hospital, such as the pharmacy or laboratory, that provide data to the EHR. The report places hospitals along a spectrum of IT adoption and considers the factors that drive greater IT use. It then looks at the use of other supportive technologies, such as bar-coding and telemedicine. The final sections examine the barriers to adoption and increasing efforts to share clinical data with others.



Hospitals are adopting electronic health records

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mong other technologies, the survey asked hospitals about their use of EHRs, defined as systems that integrate electronically originated and maintained patient-level clinical health information, derived from multiple sources, into one point of access. An EHR replaces the paper medical record as the primary source of patient information.

More than two-thirds of hospitals had fully or partially implemented EHRs Percent of hospitals reporting EHRs*, 2006 Fully implemented 11%

Sixty-nine percent of hospitals reported having either fully or partially implemented an EHR. Larger hospitals, those in urban areas, and teaching hospitals were more likely to be among the 11 percent with fully implemented EHRs. Hospital size bears a systematic relationship to progress on EHR implementation; as bed size increases, so does use of EHRs. While 23 percent of responding hospitals with 500 or more beds have a fully implemented EHR — and 92 percent have a fully or partially implemented EHR — only 3 percent of hospitals with fewer than 50 beds have fully implemented EHRs. Among the smallest hospitals, 55 percent have no EHR. Given that larger organizations are more likely to have EHRs, and a larger share of all hospitalizations occur in large hospitals, more than 11 percent of patients with a hospital stay in 2006 likely had an EHR as their primary medical record. For example, in 2005, 23 percent of hospital admissions occurred in hospitals with 500 or more beds, compared to 4 percent in hospitals with fewer than 50 beds. EHR implementation also varies by hospital location. Urban hospitals are three times more likely to have a fully implemented EHR than their rural counterparts (16 percent versus 5 percent). Among rural hospitals, 43 percent have no EHR. The advantage held by urban hospitals remains, but is lessened, when partial implementation is also considered (77 percent versus 58 percent). 

No EHR 32%

Partially implemented 57%

*NOTE: This question was first asked in 2006.

Larger hospitals more likely to have EHRs than smaller hospitals Percent of hospitals reporting EHRs by bed size, 2006 92% 87% 79% 63% 46%

66%

64%

69%

56% 43% 3%

7%