January 2011 E-Health Systems: Opportunities and Obstaclescontent.hcpro.com/pdf/content/261348.pdf · January 2011 E-Health Systems: Opportunities and Obstacles C HEAL THLEADERS MEDIunci

January 2011

E-Health Systems: Opportunities and Obstacles

C uncilHEALTHLEADERS MEDIA

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By Gienna Shaw

January 2011 | E-Health Systems: Opportunities and Obstacles pagE 2

WWW.HEALTHLEADERSMEDIA.COM/INTELLIGENCE | ©2011 HealthLeaders Media, a division of HCPro, Inc.

Foreword

Despite Numerous CoNCerNs, LeaDers see VaLue iN eHs With government requirements looming and financial incentives dangling, healthcare leaders across the nation

are working to come to grips with the e-health systems they have today and what they want those systems to be

tomorrow.

It’s not an easy task, and with it comes mixed feelings.

The proof of this is in the recent E-Health Systems: Opportunities and Obstacles survey conducted by the

HealthLeaders Media Intelligence Unit.

With respondents representing organizations ranging from small hospitals and midsize health systems to physician

organizations, this survey shows significant diversity and disparity in attitudes. For example, while more than

half of the healthcare leaders are satisfied with their health information systems’ functionality, less than half are

satisfied with their systems’ cost and value.

Among other things, the survey also revealed similarities between hospital-based settings and physician practice-

based settings in terms of their state of satisfaction and readiness to meet development requirements related to

efficient patient care. For example, overall, respondents indicate that the biggest challenge in implementing an EHS

is lack of financing or resources (the top choice, selected by 46%), followed by resistance from physicians (24%).

But among the concerns related to the technology systems themselves, we see some distinctions. For example,

consider the level of dissatisfaction regarding interoperability; for those in a clinic or physician practice setting, 6%

are strongly dissatisfied, but in the hospital setting, it’s more than double that at 14%. Similarly, regarding chart

review functionality, just 13% are somewhat or strongly dissatisfied in the practice setting, but that jumps to 27%

in the hospital setting. For ease of use, dissatisfaction again is lesser in the practice setting (24%) compared to the

hospital setting (36%).

One thing, however, does seem certain: Despite the variety of concerns expressed, respondents strongly (85%)

believe that EHS will improve care coordination at their organizations, and are similarly optimistic (81%) that EHS

will improve care coordination industrywide.

Jim Cramer

Vice President and CIO

Scottsdale Healthcare

Scottsdale, AZ



Table of Contents

Foreword 2

Methodology 4

RespondentProfile 5

Analysis 6

SurveyResults 10

Time Frame to See Quality of Care Improvements . . . . . . . . . . . . . . . 10

EHS Implementation Greatest Challenge. . . . . . . . . . . . . . . . . . . . . . . . 10

Benefits of EHS at Organization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Benefits of EHS Industrywide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Vendors of Hospital-Based EHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Satisfaction with Hospital-Based EHS Elements . . . . . . . . . . . . . . . . . 14

Capabilities of Hospital-Based EHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Vendors of Clinic- or Physician Practice-based EHS . . . . . . . . . . . . . . 15

Satisfaction with Clinic- or Physician Practice-Based EHS Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Capabilities of Clinic- or Physician Practice-Based EHS . . . . . . . . . . 17

Physician- or Hospital-Based EHS Certification . . . . . . . . . . . . . . . . . . 17

Expect to Achieve Meaningful Use by 2016 . . . . . . . . . . . . . . . . . . . . . 17

Opting Out of the HITECH Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Participation in Health Information Exchange . . . . . . . . . . . . . . . . . . . 18

Type of Health Information Exchange . . . . . . . . . . . . . . . . . . . . . . . . . . 18



Methodology

The E-Health Systems: Opportunities and Obstacles study was conducted by the HealthLeaders Media Intelligence

Unit. It is part of a series of monthly Thought Leadership studies. In November 2010, an online survey was sent

to the HealthLeaders Media Council and select members of the HealthLeaders Media audience. Respondents work

in a variety of settings, including hospitals, health systems, physician organizations, health plans, and insurers. A

total of 242 completed surveys are included in the analysis. The margin of error for a sample size of 242 is +/- 6.3

percentage points.

About The HealthLeaders Media Intelligence UnitThe HealthLeaders Media Intelligence Unit, a division of HealthLeaders Media, is the premier source for executive healthcare business research. It provides analysis and forecasts through digital platforms, printed publications, custom reports, white papers, conferences, roundtables, peer networking opportunities, and presentations for senior management.

Intelligence Report Editor GIENNA [email protected]

PublisherMATTHEW [email protected]

Editorial DirectorRICK [email protected]

Managing EditorBOB [email protected]

Intelligence Unit Director ANN [email protected]

Senior Director of SalesNortheast/Western Regional Sales ManagerPAUL [email protected]

Media Sales Operations ManagerALEX [email protected]

Copyright ©2011 HealthLeaders Media, 5115 Maryland Way, Brentwood, TN 37027 • Opinions expressed are not necessarily those of HealthLeaders Media. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.

Upcoming Intelligence Report Topics

2011 Industry Survey

Planned Capital Expenses

Accountable Care Organizations

aDVisors for tHis iNteLLigeNCe reportThe following healthcare leaders graciously provided guidance and insight in the creation of this report.

John R. GardnerCEOYuma District Hospital and ClinicsYuma, CO

Jim CramerVice President and CIOScottsdale HealthcareScottsdale, AZ



Respondent profile

Respondents represent titles from across the various functional areas including senior leaders, clinical leaders, operations leaders,

financial leaders, and information leaders. Nearly one-half of the respondents have senior leader titles. They are from a mix of

hospitals, physician organizations, health systems, health plans, and insurers.

| Title

0

10

20

30

40

50

Information LeadersFinancial LeadersOperations Leaders Clinical LeadersSenior Leaders

Senior Leaders | Administrator, Chief Executive Officer, Chief Financial Officer, Chief Information Officer, Chief Medical Officer, Chief of Staff, Chief Operations Officer, Executive Dir., Partner, Board Member, President, Principal Owner

Operations Leaders | Asst. Administrator, Chief Counsel, Dir. of Patient Safety, Dir. of Purchasing, Dir. of Quality, Dir. of Safety, VP/Dir. Compliance, VP/Dir. Human Resources, VP/Dir. Operations/Administration, Chief Compliance Officer, Chief Purchasing Officer

Financial Leaders | VP/Dir. Finance, HIM Director, Director of Case Management, Director of Patient Financial Services, Director of RAC, Director of Reimbursement, Director of Revenue Cycle

Clinical Leaders | Chief of Cardiology, Chief of Neurology, Chief of Oncology, Chief of Orthopedics, Chief of Radiology, Chief Nursing Officer, Dir. of Ambulatory Services, Dir. of Clinical Services, Dir. of Emergency Services, Dir. of Inpatient Services, Dir. of Intensive Care Services, Dir. of Nursing, Dir. of Rehabilitation Services, Service Line Director, Dir. of Surgical/Perioperative Services, Medical Director, VP Clinical Informatics, VP Clinical Quality, VP Clinical Services, VP Medical Affairs (Physician Mgmt/MD), VP Nursing

Information Leaders | Chief Medical Information Officer, Chief Technology Officer, VP/Dir. Technology/MIS/IT

Base = 289

Base =121 (Hospitals)

| Number of Beds

1–50 28%

51–199 32%

200–499 30%

500–999 5%

1,000+ 5%

| Place of Employment

Hospital 50%

Physician Org. (MSO, IPA, PHO, Clinic) 28%

Health System (IDN/IDS) 21%

Health Plan/Insurer (IHMO/PPO/MCO/PBM) 1%

Base = 242

| Number of Sites

1–5 25%

6–20 27%

21–49 21%

50+ 27%

Base = 52 (Health systems)

44%

21% 24%

5% 5%



Healthcare leaders are making headway in becoming meaningful users of electronic health

systems to meet government requirements and earn financial incentives. But that doesn’t

mean they’re completely satisfied with their systems. In fact, the mood of respondents in this

HealthLeaders Media intelligence report is decidedly ambivalent about some aspects of health

information technology, including cost, value, and functionality.

Overall, healthcare leaders say health

information systems will improve

quality and efficiency.

More than 80% say the government

push for electronic health systems

will improve quality of care

industrywide and 89% say it will

improve quality and safety at their

own organization. Most hospital

and physician leaders strongly

(47%) or somewhat (42%) agree

that electronic health systems will

increase quality and safety at their

own organizations. Seventy-one

percent say the systems will improve

efficiency at their own organizations

and 67% say healthcare will become

more efficient nationwide.

But healthcare leaders are lukewarm

when it comes to the capabilities of

their systems: About half of hospital

and health system leaders are either

very satisfied (13%) or somewhat

satisfied (41%) with the EMR systems

E-Health Systems: ambivalence and acceptance

What Healthcare Leaders Are Saying

“We are participating in community health information exchange programs but remain wary of regulations, consent issues, and liability. The environment is simply not receptive to taking much HIE risk.”

—CIO, midsize health system

“The importance of knowing the patient’s entire story outweighs ‘competition.’ It is also important to better aggregate statistical and demographic information for our area to better address and provide appropriate preventive care and education.”

—CNO, midsize hospital

“A strong patient health information exchange is the right thing to do for our community.”

—CIO, midsize health system

“Failure is not an option; we must achieve meaningful use if we are to keep our doors open and to remain a viable business.”

—VP finance, small hospital

“We must meet meaningful use if we hope to see any of the incentive money to repay for a very expensive program.”

—CEO, small hospital

“As a specialty practice, it is more important to us to select the right EHR for our situation than to be forced to use and meet guidelines that are intended for primary care. Therefore, meeting the meaningful use guidelines is not our main focus.”

—Administrator, physician practice or clinic

“The penalties [for failing to achieve meaningful use] would close our practice.”

—Administrator, physician organization

AnAlySiS



analysis (continued)

they have put in place, and among physician leaders

16% are strongly satisfied and 44% are somewhat

satisfied with the overall functionality of their

systems, for example.

“We installed our clinic EMR five years ago. It is a

continuous work in progress,” says John R. Gardner,

CEO of Yuma (CO) Hospital District and Clinics.

“From the administration’s point of view, we are now

at a ‘somewhat satisfied’ point.” Among the medical

staff, however, opinions range from “it’s horrible” to “it’s wonderful,” he says.

“Some of [the dissatisfaction stems from the] maturity of the software in the industry,” says

Jim Cramer, vice president and CIO of Scottsdale (AZ) Healthcare, a three-hospital system,

who served as the lead advisor for this report. “The belief is that with more usage all the

products and the solutions in the hospitals as well as the solutions within physician office

settings will continue to evolve based on more and more clinician input. In some respects

there’s no perfect solution. It’s what the organization does with the solution that they select to

make it work for them. The leading solutions that are out there will all continue to evolve; as

more and more requirements relative to interoperability evolve, the robustness of the products

will evolve, as well.”

Interoperability is a common concern among

respondents: Less than half of hospital and physician

leaders are satisfied with the interoperability of their

systems (43% and 40%, respectively). That’s also a

barrier to successful health information exchanges,

respondents say.

“Not all the local medical practices will be on the same

EHR system, just as the major hospitals are on different

systems,” wrote one respondent, a physician leader.

“We installed our clinic EMR five years ago. It is a continuous work in progress. From the administration’s point of view, we are now at a ‘somewhat satisfied’ point.”—John R. Gardner

83% say the government push for electronic health systems will improve quality of care industrywide.



“Something needs to be in place to let the systems talk.”

Another physician leader respondent put it neatly: “An

EMR without interfaces to other data is just a paper

chart in the computer.”

Cramer agrees that this problem must be addressed.

“Part of the core requirements of HIEs from an

interoperability standpoint will need to be dealing with

the releases of what can be shared and what can’t. And

it needs to be part of the common framework,” he says.

Despite the variety of concerns about HIEs, most

healthcare organizations (67%) are planning to join

health information exchanges, although they don’t seem

willing to share their data with just any provider just

yet. The most popular choice of HIE model is a private

regional exchange (32%) followed by private internal

exchange among affiliated entities (20%).

Yuma will join a regional exchange. “The drawback is

we are at the mercy of an organization that we don’t

have much control over. They can impose unrealistic

expectations to make it work,” Gardner says. “From a

benefit perspective, we are a remote rural area and the exchange is going to be excellent for patient

care as we help patients that see specialists in urban facilities, but rely on us for primary and

secondary care.”

Healthcare leaders also have mixed feelings about the cost and value of their systems. Less than

half of hospital and health system leaders and physician practice leaders are very or somewhat

satisfied (45% and 48%, respectively).


Mixed Feelings

45% of health system leaders are

satisfied with the cost and value of

their systems

48% of physician leaders are satisfied

with the cost and value of their systems

54% of hospital leaders are satisfied with

the overall functionality of their systems

60% of physician leaders are satisfied with

the overall functionality of their systems

71% agree that e-health systems will

increase efficiency at their own

organization.



“They could be underestimating the ongoing resources

and commitment to evolving the products,” Cramer

says. “It’s not like you go live and the cost ends. Many

times incremental resources are required to continue to

make the improvements and changes to processes and

putting in new releases. Maybe those were not all fully

understood up-front.”

That was the case for Yuma. The basic cost of the system

was not an issue because, as a rural health center, the

organization received cost-based reimbursement. But,

says Gardner, “the ongoing maintenance has been the surprise to us. The cost to modify the

system to reflect local business or individual practitioners’ preferences adds up, and then when

it is time to upgrade the knowledge base … these customizations do not automatically carry

forward, so customization work needs to be repeated.”

Leaders will continue to be disappointed in what they’re

getting out of their electronic health systems if they’re

not fully committed, says Cramer. “If the executive

leadership and the physician leadership work together

and say, ‘We support this and we’re going to make it

work,’ it will work,” he says.

Gienna Shaw is senior technology editor for HealthLeaders

Media. She may be contacted at [email protected].


“In some respects there’s no perfect solution. It’s what the organization does with the solution that they select to make it work for them.”—Jim Cramer

46% of respondents cited lack

of financing or resources as

the greatest challenge of

implementing e-health systems.



Survey Results

0

10

20

30

40

50

60

Base = 242

FiGURE1 | Time Frame to See Quality of Care Improvements

Q | What is a realistic time frame to see industrywide quality of care improve as a result of the meaningful use regulations?

38%

Fewer than 2years away

4%

51%

6%

2 to 5 years away

6 to 10years away

More than 10years away

0 10 20 30 40 50

46%

24%

9%

7%

5%

8%

FiGURE2| EHS Implementation Greatest Challenge

Q | Which of the following do you consider to be the greatest challenge of electronic health systems implementation?

Base = 242

Lack of financing or resources

Resistance from physicians

Concern about current vendor’s ability to meet meaningful use requirements

Lack of technical expertise

Lack of comfort or satisfaction with existing vendor

Other



Survey Results (continued)

FiGURE3 | Benefits of EHS at Organization

Q | How strongly do you agree with the following statements about your organization?

Base = 242

Net Agree

Strongly Agree

(1)

Somewhat Agree

(2)

Neither Agree or Disagree

(3)

Somewhat Disagree

(4)

Strongly Disagree

(5)

Electronic health systems will improve quality and safety at my organization

89% 47% 42% 7% 2% 1%

Electronic health systems will improve care coordination at my organization

85% 44% 41% 12% 2% 0%

Electronic health systems will increase efficiency at my organization

71% 38% 33% 13% 12% 4%

Electronic health systems will ensure adequate privacy and security protections for our patients

63% 24% 39% 20% 14% 2%

Electronic health systems will improve patient and family satisfaction and engagement at my organization

60% 21% 39% 26% 13% 1%

Electronic health systems will improve population and public health in our region

51% 20% 31% 33% 13% 2%

Electronic health systems will reduce costs at my organization 44% 16% 28% 25% 21% 9%




FiGURE4 | Benefits of EHS Industrywide

Q | How strongly do you agree with the following statements about the industry in general?

Base = 242

Net Agree

Strongly Agree

(1)

Somewhat Agree

(2)

Neither Agree or Disagree

(3)

Somewhat Disagree

(4)

Strongly Disagree

(5)

Electronic health systems will improve quality and safety industrywide

83% 34% 49% 11% 5% 2%

Electronic health systems will improve care coordination industrywide

81% 34% 47% 13% 5% 1%

Electronic health systems will increase efficiency industrywide 67% 29% 38% 16% 14% 4%

Electronic health systems will improve patient and family satisfaction and engagement industrywide

56% 18% 38% 26% 16% 2%

Electronic health systems will ensure adequate privacy and security protections for personal health industrywide

55% 16% 39% 23% 19% 4%

Electronic health systems will improve population and public health nationwide

54% 19% 35% 33% 10% 3%

Electronic health systems will reduce costs industrywide 43% 14% 29% 21% 23% 12%




0 5 10 15 20 25

22%

20%

19%

18%

16%

12%

11%

5%

5%

14%

FiGURE5| Vendors of Hospital-Based EHS

Q | Which vendor or vendors do you use for your hospital-based electronic health system?

Base = 187 (Among those who currently have a hospital-based electronic health system)

Multi Response

Cerner Corporation

Epic

MediTech

McKesson

Allscripts/Eclipsys

GE Healthcare

Siemens

CSI

NextGen Healthcare

Other




FiGURE6 | Satisfaction with Hospital-Based EHS Elements

Q | Considering your hospital-based electronic health system, rate your level of satisfaction with the following elements.

Base = 187 (Among those who currently have a hospital-based electronic health system)Multi Response

Net Satisfied

Strongly Satisfied

(1)

Somewhat Satisfied

(2)

Neither Satisfied or Dissatisfied

(3)

Somewhat Dissatisfied

(4)

Strongly Dissatisfied

(5)

Our system does not have this function

Overall functionality 54% 13% 41% 14% 21% 11% 1%

System speed, respon-siveness, and down time

54% 17% 37% 18% 19% 8% 1%

Ability to share information across internal departments or with other organizations such as medical groups

53% 20% 33% 13% 20% 13% 1%

Chart review functionality 51% 14% 37% 20% 18% 9% 2%

Physician portal 49% 15% 34% 21% 16% 7% 6%

Vendor training and support

48% 18% 30% 16% 20% 15% 1%

Ease of use 46% 11% 35% 19% 23% 12% 1%

Total cost and value 45% 10% 35% 22% 23% 9% 1%

Single sign-on capability 44% 15% 29% 23% 14% 10% 8%

Interoperability 43% 11% 32% 23% 19% 14% 1%

Ability to measure outcomes

40% 11% 29% 24% 20% 12% 4%

Decision support capabilities

36% 8% 28% 27% 18% 12% 6%

Ability to conduct data-driven research studies

32% 11% 21% 29% 19% 13% 6%

Patient portal and patient education capabilities

28% 9% 19% 31% 16% 11% 14%




0 5 10 15 20 25

21%

16%

11%

11%

10%

10%

7%

6%

5%

3%

1%

21%

FiGURE8| Vendors of Clinic- or Physician Practice-Based EHS

Q | Which vendor or vendors do you use for your clinic- or physician practice-based electronic health system?

Base = 178 (Among those who currently have a clinic or physician practice-based EHS)

Multi Response

Allscripts/Eclipsys

Epic

NextGen Healthcare

McKesson

GE Healthcare

Cerner Corporation

eClinicalWorks

MediTech

LSS

Siemens

ChartLogic, Inc.

Other

0 20 40 60 80 100

90%

74%

64%

58%

52%

47%

27%

21%

FiGURE7| Capabilities of Hospital-Based EHS

Q | Considering your hospital-based electronic health system, which of the following capabilities does your organization use?

Base = 187 (Among those who currently have a hospital-based electronic health system)Multi Response

Clinical documentation

Picture Archiving and Communications System (PACS)

Physician portal

Computerized physician order entry

Prescription management/e-Prescribing

Decision support

Patient disease registry

Patient portal




FiGURE9 | Satisfaction with Clinic- or Physician Practice-Based EHS Elements

Q | Considering your clinic- or physician practice-based electronic health system, rate your level of satisfaction with the following elements.

Base = 178 (Among those who currently have a clinic- or physician practice-based EHS)

Net Satisfied

Strongly Satisfied

(1)

Somewhat Satisfied

(2)

Neither Satisfied or Dissatisfied

(3)

Somewhat Dissatisfied

(4)

Strongly Dissatisfied

(5)

Our system does not have this function

Overall functionality 60% 16% 44% 17% 18% 3% 2%

Chart review functionality 56% 20% 36% 28% 11% 2% 3%

Ease of use 54% 14% 40% 19% 18% 6% 2%

System speed, responsiveness, and down time

53% 16% 37% 23% 16% 6% 2%

Total cost and value 48% 13% 35% 26% 17% 7% 2%

Single sign-on capability 48% 16% 32% 29% 8% 6% 9%

Ability to share infor-mation across internal departments or with other organizations such as medical groups

46% 17% 29% 26% 17% 8% 3%

Vendor training and support

45% 15% 30% 24% 18% 12% 2%

Ability to measure out-comes

45% 12% 33% 25% 17% 9% 4%

Physician portal 45% 15% 30% 31% 10% 3% 11%

Interoperability 40% 11% 29% 30% 21% 6% 2%

Ability to conduct data-driven research studies

38% 10% 28% 27% 20% 8% 7%

Decision support capabilities

38% 11% 27% 33% 16% 6% 8%

Patient portal and patient education capa-bilities

31% 12% 19% 33% 12% 6% 17%




Q | Considering your clinic- or physician practice-based electronic health system, which of the following capabilities does your organization use?

Base = 178 (Among those who currently have a clinic- or physician practice-based EHS) Multi Response

FiGURE10 | Capabilities of Clinic- or Physician Practice-Based EHS

0 20 40 60 80 100

93%

69%

69%

57%

52%

40%

30%

25%

Clinical documentation

Prescription management/e-Prescribing

Computerized physician order entry

Physician portal

Picture Archiving and Communications System (PACS)

Decision support

Patient disease registry

Patient portal

FiGURE12 | Expect to Achieve Meaningful Use by 2016

Q | Does your organization expect to achieve meaningful use by 2016?

Base = 242

Q | Is your physician- or hospital-based EHS certified by an approved ONC certifying body?

Base = 204 (Among those who currently have a physician- or hospital-based EHS)

FiGURE11 | Physician- or Hospital-Based EHS Certification

0

10

20

30

40

50

Yes

41%

No Don’t know

14%

45%

0

20

40

60

80

100

Yes

91%

No Don’t know

2%7%




Q | Which best describes the type of health information exchange you are participating in or considering?

Base = 163 (Among those participating or planning to participate in a health information exchange)

FiGURE15 | Type of Health Information Exchange

0 5 10 15 20 25 30 35

32%

20%

18%

10%

9%

3%

1%

6%

A private regional exchange

A private internal exchange among affiliated entities

A state-run statewide exchange

A private statewide exchange

A state-run regional exchange

A private multistate exchange

A state-run multistate exchange

Other

FiGURE14 | Participation in Health Information Exchange

Base = 242

Q | Will your organization opt out of the HITECH Act, even if that means incurring penalties for failing to achieve meaningful use by 2016 ?

FiGURE13 | Opting Out of the HITECH Act

01020304050607080

Yes

2%

No Don’t know

76%

21%

01020304050607080

Yes

67%

No Don’t know

5%

27%

Q | Are you participating in or do you plan to participate in a health information exchange?

Base = 242

Documents

January 2011 E-Health Systems: Opportunities and Obstaclescontent.hcpro.com/pdf/content/261348.pdf · January 2011 E-Health Systems: Opportunities and Obstacles C HEAL THLEADERS MEDIunci