Information Technology Capacity in Iowa s Hospitals

1. Information Technology Capacity in Iowa’s Hospitals Marcia M. Ward, Ph.D. Dept of Health Management & Policy University of Iowa Presented to Iowa HIMSS – April 5, 2005

2. Overview Rational for our 2002 Iowa survey Results for Iowa’s urban and rural hospitals Correlates of IT capacity Differences between Iowa’s hospitals and hospitals in Quebec and Ontario Plans for new survey

3. Rational for 2002 Iowa Survey We were funded to assess the impact of the Leapfrog Group patient safety initiatives in Iowa hospitals Assessment of impact of CPOE required estimates of the cost of implementing CPOE in Iowa’s urban and rural hospitals Cost estimates were affected by the existing IT capacity

4. Source for Survey Paré G. & Sicotte C. Information technology sophistication in health care: An instrument validation study among Canadian hospitals. International Journal of Medical Informatics, 63: 205-223, 2001

5. 2002 Hospital IT Survey

6. Disclaimers The survey content was developed for use in Canadian hospitals and may not apply to Iowa hospitals Our survey was conducted in fall 2002 The survey purpose was to provide input for cost estimates for CPOE

8. Survey Responses Survey was completed by 74 Iowa hospitals: 13 urban hospitals 5 rural referral hospitals 28 rural PPS hospitals 28 critical access hospitals

9. Participating Urban and Rural Referral Hospitals Alegent Health Mercy Broadlawns Covenant Genesis Iowa Methodist Jennie Edmundson Marshalltown Mary Greeley Mercy Hospital – Iowa City Mercy – Cedar Rapids Mercy – Des Moines Mercy – Dubuque Mercy – North Iowa Mercy – Sioux City Ottumwa St Luke’s Trinity Regional UIHC

10. Who Filled Out the Survey? Job title 50% completed by CIO or IT director in urban 30% completed by IT director in rural Years of IT experience 12.3 years for urban hospital respondents 5.1 years for rural hospital respondents Years employed in current hospital 6.7 years for urban hospital respondents 7.1 years for rural hospital respondents

11. Questions on Clinical IT Capacity Respondents were asked to check a box indicating whether each of 56 clinical processes were computerized Respondents were asked whether each of 41 clinical technologies were used Respondents were asked to indicate the extent of integration among 16 clinical systems

12. Clinical Area Included in Survey Questions were divided into 8 areas: Patient management Physician Nurse ER OR Laboratory Radiology Pharmacy

13. Comparison of Results in Iowa Urban and Rural Hospitals Results are shown separately for Iowa’s urban and rural hospitals “Urban” refers to the average of 13 urban and 5 rural referral hospitals; average levels are shown in blue bars “Rural” refers to the average of 28 rural PPS hospitals and 28 critical access hospitals; average levels are shown in red bars

14. Patient Management Processes that Are Computerized

15. Patient Management Technologies that Are Used

16. Physician Documents or Activities that Are Computerized

17. Physician Technologies that Are Used

18. Nursing Processes or Documents that Are Computerized

19. Nursing Technologies that Are Used

20. ER Processes that Are Computerized

21. ER Technologies that Are Used

22. OR Processes that Are Computerized

23. OR Technologies that Are Used

24. Laboratory Processes that Are Computerized

25. Laboratory Technologies that Are Used

26. Radiology Processes that Are Computerized

27. Radiology Technologies that Are Used

28. Pharmacy Processes that Are Computerized

29. Pharmacy Technologies that Are Used

30. Clinical Processes that Are Computerized

31. Technologies that Are Used

32. Most Frequent Computerized Processes Some processes were computerized in over 80% of urban and rural hospitals. These are probably “basic” processes that are computerized in almost all hospitals: Inpatient admissions Outpatient admissions Dictation systems for physicians’ notes PCs at nursing stations Registration of patients in radiology Medication purchasing Telemedicine for diagnosis in radiology (may pertain to Iowa hospitals but not to other states)

33. Least Frequent Computerized Processes Some processes were computerized in less than 20% of urban and rural hospitals These are probably “stretch” processes that are computerized in only a few hospitals: Patient waitlist management Staff workload management OR – anesthetic notes recording OR – touch screen systems for notes transcription

34. Largest Urban-Rural Differences in Processes and Technologies Computerized processes that showed the largest differences (>50%) between urban and rural hospitals were: Scheduling systems for outpatients Physician connection to external databases OR – materials (tools) management OR – operations booking OR – smart scheduling of operations Pharmacy – historical information storing Pharmacy – IV admixtures management

35. Largest Urban-Rural Differences in Processes and Technologies – cont’ Computerized processes that showed the largest differences (>50%) between urban and rural hospitals were: Laboratory – patient registration and admission Laboratory – recurring test management Laboratory – blood bank management Laboratory – specimen pick-up rounds scheduling Laboratory – specimen archiving Radiology – results capturing and validation Radiology – electronic requisitions for tests Radiology – access to images via workstations/web browser Radiology – digital (filmless) radiologic images Radiology – bar coding (for envelopes management, films, etc.)

36. Correlates of Clinical IT Capacity Both the availability of computerized clinical systems and the use of computerized technology were significantly correlated (>.50) with the following variables: Hospital category (urban, rural referral, rural PPS, critical access hospital) Number of hospital beds Hospital total FTE personnel Net patient revenue Number of IT personnel

37. Comparison of Iowa and Canada The original paper by Pare & Sicotte (2001) reported data from 186 hospitals in Ontario and Quebec We computed differences between the values reported in Canada and the survey responses for Iowa hospitals The following four tables show the items with the greatest differences

38. Computerized IT Processes

39. Computerized IT Processes

40. Use Computerized Technologies

41. Use Computerized Technologies

42. Summary of Iowa-Canada Differences Hospitals in Iowa appear to have fewer computerized processes than hospitals in Canada Hospitals in Iowa appear to use more computerized technologies than hospitals in Canada

43. Need for a New Survey We are funded by AHRQ on a 3-year grant to: Examine the IT capacity of Iowa’s rural hospitals Identify patient safety and healthcare quality issues in Iowa’s rural hospitals Develop toolkits to help Iowa’s rural hospitals make informed IT purchases that will be affordable and address needs Plans for new survey

45. Plans for New Survey Primary goal of a new survey is to quantify IT capacity in Iowa’s hospitals Getting respondents from all of Iowa’s hospitals is critical, so survey must be brief and easy to complete We are proposing that the new survey essentially consist of an inventory of clinical IT systems

46. Clinical Systems - Examples Patient Registration Patient Scheduling Patient Billing Barcoding Electronic health record (EHR) CPOE

47. Questions Asked for Current Systems Current Systems ? None ? Installing, not yet operational ? Currently operational Product or vendor name (if applicable)

48. Questions Asked for Planned Systems Planned systems ? No Plans ? Planning – no budget commitments ? Budgeted and reviewing vendors ? Budgeted install – vendor selected ? Budgeted upgrade with present vendor Product or vendor name (if applicable)

49. Next Steps We hope to finalize the “Inventory” survey Once we get surveys back, we will follow-up with respondents who have specific clinical IT systems, such as: Electronic health records Pharmacy – medication dispensing (Pyxis) Picture archival (PACs)

50. Request for Your Feedback Will this survey design get us the information we need on what clinical systems Iowa’s hospitals have? Will informed staff in Iowa’s hospitals complete the survey as designed? Thank you!