100 Most Wired
Even this year's 100 Most Wired winners feel the tension between cutting capital costs and moving forward on IT
Team Coverage By
Alden Solovy, Suzanna Hoppszallern and Sarah B. Brown
These are strange times for clinical information technology. On one hand, providers are being urged to step on the gas, with the federal government poised to distribute $20 billion in stimulus funds to wire doctors, hospitals and patients. On the other hand, the economic crisis is forcing many hospitals to hit the brakes on capital investments. Even this year's 100 Most Wired Hospitals and Health Systems are torn between building on their IT successes and keeping a sharp eye on budgets.
"We have reduced the amount of capital we are spending on IT projects, which in turn is causing us to delay the implementation or launch of new initiatives," says Rob Frieden, vice president and chief information officer, Genesis Health System, Davenport, Iowa, which appears on the 100 Most Wired list for the sixth time in 2009. "We are staying focused on projects with a higher rate of return."
Jamie Mooney, vice president and chief information officer of Norwalk (Conn.) Hospital, says "the economic slowdown has forced us to look very critically at our IT spending. We have delayed discretionary projects, focusing on fixing what is 'broken' right now." Norwalk appears on this year's Most Improved list.
And at Battle Creek (Mich.) Health System, "we have changed our focus from implementing new systems, to really driving the full value out of the systems we have," says Jim Keller, information services director. "We still have some implementation and integration projects under way, but even these projects have a more increased focus on driving value." His system appears on the 100 Most Wired list for the second time in 2009.
To complicate matters, the great unknown of health care reform looms in the near future, and that doesn't include a number of regulatory changes already heading down the pike.
"I'm a bit concerned over the number of large IT initiatives that will be required over the next three years, such as the [coding system] change to ICD-10 and the 5010 transaction standards, work to ensure recovery audit contractor rules and regulations are met, and now [the American Recovery and Reinvestment Act, or ARRA] security regulations and the yet-to-be-determined meaningful use definition and certification process," says Gregory Veltri, chief information officer at Denver Health, which makes its second appearance on the 100 Most Wired list in 2009. "Many of these items will require a large level of funding in the 2010-2012 timeframe. I believe we will have to stop some projects and slow down others in order to fund projects that ensure adherence to the new regulations, security and direction put forth by these changes."
Nevertheless, Most Wired hospitals are doing their best to stay the course. "As leaders, we realize that IT solutions can help reduce the bottom line or generate revenue," says Edward Marx, CIO of Texas Health Resources of Arlington. "We continue to work closely to maximize the impact of technology to transform, run and grow the business." His organization appears on the Most Wired list for the 10th time in 2009.
Even as hospitals appear to be cutting the total dollars they spend on information technology, IT spending as a percent of total capital and operating budgets is actually increasing, says Sunny Sanyal, president of McKesson Provider Technologies. McKesson Corp. is a major sponsor of the Most Wired survey. Hospital executives "clearly recognize that in spite of lower budgets they still need to invest in IT," he says.
However, Sanyal says, "we're seeing hospitals reprioritize." Information technologies with more immediate return on investment, such as revenue cycle projects, are gaining momentum. "They are trying to affect the top line."
Norwalk Hospital's Mooney even sees an "upside to all of this. It is giving our team a chance to spend time optimizing current systems, making sure that we are getting the most out of each IT dollar spent."
While the economy slows IT spending, ARRA is intended to stimulate it, with the goal of creating a nationwide electronic medical record system.
"The promise of economic stimulus funding beginning in 2011 is allowing us to move forward on an EMR project," says Linda Shanley, chief information officer, Stony Brook (N.Y.) University Medical Center, which appears on the Most Improved list in 2009. However, she adds, "when and if this happens, we will need to prioritize our IT projects based on our strategic initiatives and where our resources can be used wisely," which may include a delay in upgrading or replacing other systems.
Hospitals' access to stimulus funding hangs on the definition of "meaningful use." The Department of Health & Human services is expected to propose a definition of the term in late 2009.
"We are going with the assumption that 'meaningful use' includes CPOE, bar-coded medication administration and documentation as foundational," says Norwalk's Mooney. "To that end, we are focusing on completing our clinical documentation project."
The economic slowdown has caused Citizens Memorial Healthcare in Bolivar, Mo., to limit all expenditures, including IT, to the "minimal essential level," says Denni McColm, chief information officer. "Included in essential will be whatever is necessary for us to take advantage of the stimulus funding."
For some organizations, the timing of the stimulus funding coincides with the scheduled completion of major projects.
"We will complete our EMR implementation at all hospitals and physician practices about four months before stimulus funding becomes available," says Daniel Barchi, senior vice president and CIO, Carilion Clinic, Roanoke, Va.
"When we began our EMR project in 2006, our goal was to implement the system for all inpatient, physician practice and billing applications as soon as possible. We could not then have foreseen the need for the stimulus package, but the timing of the program with our project completion is fortuitous." This is the seventh year that Carilion has appeared on the Most Wired list.
Despite the many challenges, senior leaders at Most Wired organizations remain enthusiastic about IT.
"Perception of IT has not really changed in the past year," says Arlo Jennings, vice president and CIO of Mission Health System in Asheville, N.C. "Our senior leadership, including our board, recognizes the importance and the need to support information technology. Since most of what we do with clinical services involves IT in today's environment, our executive suite is intimately involved in making appropriate decisions to support on-going technology." Mission makes its second appearance on the 100 Most Wired list in 2009.
Daniel Morreale, CIO of AtlantiCare in New Jersey, has seen "a dramatic change" in the way information technology is perceived. "The management team understands that clinical transformation is about changing the business practice and in so doing have become vested and participatory in the process." In 2009, AtlantiCare makes its first appearance on the 100 Most Wired list.
Executive leadership at the University of Arkansas for Medical Sciences Medical Center has also begun to understand that business units must take responsibility for the use of IT and for the return on investment for those systems, says Kari Cassel, CIO. This led to an increase in adoption, a better partnership with the IT staff in project implementations, and increased satisfaction with their systems. UAMS makes its seventh appearance on the 100 Most Wired list in 2009.
"There has been an increasing understanding of the importance of IT systems to the delivery of health care and increasing IT involvement in all aspects of the business, including the design of new buildings," Cassel says. Balancing the high cost of IT with the increasing demand for IT services will continue to be a difficult exercise."
This edition of Hospitals & Health Networks marks the 11th release of the list of 100 Most Wired Hospitals and Health Systems, which is based on the annual Most Wired Survey and Benchmarking Study. Hospitals are named to the list based on a detailed scoring process. This year's survey was made possible through a partnership among H&HN, McKesson Corp., the American Hospital Association and the College of Healthcare Information Management Executives. The survey asks hospitals to report on how they use information technology to address five key areas: safety and quality, customer service, business processes, workforce, and public health and safety. This year, 556 hospitals and health systems completed the survey, representing 1,314 hospitals. Along with the 100 Most Wired, H&HN uses the results to name the 25 Most Improved, the 25 Most Wireless and the 25 Most Wired—Small and Rural.
This article first appeared in the July 2009 issue of H&HN magazine.