Safeguarding Information

A data breach involving sensitive patient information is every CIO's worst nightmare. Breaches may result when employees do not follow information security policies, often accidentally, or misuse access privileges. All Most Wired hospitals and 93 percent of all responding hospitals provide IT security training for employees. As the health delivery system moves toward a more integrated model though, where data is flowing among all types of providers, building in effective safeguards becomes even more important, notes Al White, senior vice president of business services, Broadlawns Medical Center, Des Moines, Iowa.

Security technologies hospitals use to protect information

 

  2011 All 2011 Most Wired
Physical device locks 90% 95%
Firewalls 99% 100%
Encryption for laptops and/or use of virtual desktop technology 85% 100%
Smart phone encryption 57% 76%
Encrypted SAN (storage area network) 37% 47%
Encryption for server databases 36% 53%
Tape encryption 47% 59%

Rapid clinical-data recovery when disaster strikes

This is not a drill. How quickly can your hospital recover clinical data when a disaster strikes and the primary data center is wiped out? A greater reliance on digital records puts pressure on CIOs to ensure that data can be restored quickly in the event that systems go down. Most Wired hospitals are much better equipped than other hospitals to restore data within 24 hours. Recent disasters have put many hospitals to the test and even prompted Will Showalter, vice president and CIO of Sisters of Mercy Health System, Chesterfield, Mo., to suggest a new survey category-Most Wired Mobile Medical Unit. "With the recent events in Joplin, Mo., we have brought up a fully digital field hospital that is operating with all the systems and devices that we had in our St. John's Regional Medical Center."

Estimated speed to restore clinical information system operations in the event of a complete loss of the primary data center

 

  2011 All 2011 Most Wired
0-4 hours 30% 51%
5-8 hours 11% 13%
9-24 hours 16% 18%
25-72 hours 25% 18%
73 hours to 7 days 11% 0
1 month + 3% 0
Tape encryption 2% 0
Don't know 2% 0

Source: Hospitals & Health Networks' Most Wired Survey, 2011


Medication Management

When asked what clinical IT systems have the greatest impact on patient safety and quality, closed-loop medication is most frequently cited by Most Wired organizations. Two-thirds of Most Wired hospitals use bar coding during medication administration at the bedside to verify five "rights" of medication safety—right patient, right medication, right route, right time and right dose.

Meaningful use requirements have put CPOE implementation on the fast track. At Most Wired hospitals, 62 percent of medications were ordered electronically by physicians and other authorized providers this year, up from 57 percent last year, compared with 46 and 33 percent of all responding hospitals in 2011 and 2010, respectively. CPOE at Truman Medical Centers, Kansas City, Mo., averages well over 90 percent for provider orders. Mitzi Cardenas, vice president and CIO says, "This has a direct impact on medication access by decreasing pharmacy turnaround times from 30 to six minutes."


Vital Stats

Patient demographics, vital signs, status and documentation such as an up-to-date problem list are to be recorded as structured data according to the meaningful use requirements. Structured data reporting has more value because it is more relevant and searchable.

Patient demographics

For more than 50 percent of patients admitted to the hospital's inpatient or emergency department, the following demographics are recorded as structured data (using certified or noncertified EHR or clinical-information system).

 

  2011 All 2011 Most Wired
Race/ethnicity 93% 100%
Preferred language 83% 90%
Date and preliminary cause of death (in the event of mortality) 68% 77%

Patient documentation

For more than 80 percent of patients admitted to the hospital's inpatient or emergency department, the following patient documentation is recorded as structured data (using certified or noncertified EHR or clinical-information system).

 

  2011 All 2011 Most Wired
Up-to-date medication list 81% 93%
Up-to-date medication allergy list 85% 98%
Up-to-date problem list of current and active diagnosis 52% 70%

Patient list for quality improvement

Hospital is able to generate at least one listing of patients with a specific condition for quality improvement, reduction of disparities, research or outreach.

 

  2011 All 2011 Most Wired
Yes 93% 100%
No 7% 0%

Source: Hospitals & Health Networks' Most Wired Survey, 2011


Digital Radiology

Radiology departments are improving their workflow and report turnaround time through advances in digital dictation, structured reporting and voice recognition. The integration of the PACS and the EHR are providing faster diagnostic results to clinicians.

 

Radiology digital clinical images integrated with... 2011 All 2011 Most Wired
...digital dictation, structured reporting,
and voice recognition with PACS
71% 83%
...EHR 77% 89%

Source: Hospitals & Health Networks' Most Wired Survey, 2011


Finding Value

Value-based purchasing, bundled payments and accountable care will require better linkages between quality and cost information. Most Wired hospitals are leading in the use of automated systems to record patient services and charges to the patient at the point of care. Hospitals are not as far along in such quality validations as monitoring denials and performing medical necessity-criteria checks. Broader use of contract-management tools would improve a hospital's ability to model the impact of pricing and contractual changes.

Revenue-cycle validation activities using automated routines and/or software (weighted average)

 

  2011 All 2011 Most Wired
Charge and order matching 76% 87%
Charge-capture reconciliation 69% 82%
Contract management 61% 76%
Denial management 64% 78%
Medical necessity criteria checks 68% 76%

Source: Hospitals & Health Networks' Most Wired Survey, 2011

Care Continuity

Sharing data across the health care continuum is an important step in care coordination. When a patient shows up in the ED, having an up-to-date medical history and recent test results can speed up the diagnosis and treatment. In the future, hospital staff, primary care physicians, specialists, skilled care and home care providers will need to share information about the patient and be able to check up on a patient's status.

Electronic exchange of patient information among providers

Hospital/health system has the ability to incorporate a continuity of care document (CCD) prepared from a physician-office EMR.

 

  2011 All 2011 Most Wired
Yes, only from employed physician practices 11% 8%
Yes, only from independent physician practices 1% 1%
Yes, from both employed and independent physician practices 39% 69%
Cannot accept a CCD from a physician-office EMR 49% 22%

Hospital/health system has performed at least one test of EMR's capability to exchange an electronic continuity of care document (e.g., discharge summary, procedures, problem list) among providers of care and patient-authorized entities.

 

  2011 All 2011 Most Wired
Yes 43% 69%
No, cannot exchange a CCD 57% 31%

Source: Hospitals & Health Networks' Most Wired Survey, 2011