annual CIO survey is any indication, hospitals are doing very well on their journeys toward Meaningful Use of electronic health records (EHRs) and, eventually, safer and more cost-effective care. But health IT leaders expect to be challenged in the near future by other healthcare reforms, including the imperative to create accountable care organizations (ACOs).
A remarkable 66% of the 298 healthcare CIOs surveyed online between December and February said their organizations had already qualified for Meaningful Use stage 1, and another 4% had expected to do so before the end of 2012. And 75% of respondents, representing nearly 600 hospitals nationwide, said they plan on attesting for stage 2 in 2014, the first year of the second stage, HIMSS officials announced Monday at the organization's annual conference in New Orleans.
Nearly half (47%) of the CIOs said their IT budgets would "definitely increase" this year, and another 29% said expenditures would "probably increase." Only 15% said their budget would be flat, and 8% expected a decline.
Among the survey pool, 21% said their key health IT business objective in 2013 was to sustain the financial viability of their organizations, up from 15% last year. Nineteen percent said the top objective was to improve patient care, down slightly from 2012. A year ago, achieving Meaningful Use was the top business objective, named by 24% of respondents, but that fell to No. 4 on the list this time, at 15%.
"That's a consequence that a lot of our respondents are well-positioned to meet not only stage 1 but stage 2," Jennifer Horowitz, senior director research at HIMSS research affiliate HIMSS Analytics, said.
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Even though some struggled with attempts to measure return on investment from EHRs and others have questioned whether there can be an ROI from participating in the Meaningful Use program, most of those surveyed by HIMSS expected a positive return from stage 1.
About 30% of hospital-based CIOs said they planned on seeing an ROI of up to $2 million in stage 1. Another 23% expected a return of $2 million to $3 million in stage 1, while 16% pegged their return at $4 million to $5 million.
While the survey did not ask if anyone expected to lose money on either stage 1 or 2, HIMSS CEO H. Steven Lieber reiterated the organization's longstanding belief that the Meaningful Use bonus money was never meant to cover the full cost of an EHR and that the government was not going to "buy" health IT systems for healthcare providers. "This is much more of a policy decision [to participate in Meaningful Use] than a financial decision," Lieber said. "It really is about long-term value" in terms of quality and patient safety gains.
When asked where IT can have the most impact on patient care, 31% said it was on improving quality outcomes, down from 38% a year ago, but still the most common response. Another 25% said it was on reducing medical errors, while 12% endorsed standardizing clinical care. "The top three areas here really are direct patient outcomes," Horowitz said.
Interestingly, enabling remote access of data was far down that list, at just 5%, while merely 3% said providing remote monitoring of patients could have the greatest effect on patient care. Last year, nobody named remote patient monitoring.
"Everyone is discussing that and realizing it can make a difference in accountable care," said Mike Rozmus, VP and CIO of RMH Healthcare, an affiliate of Sentara Healthcare that operates Rockingham Memorial Hospital in Harrisonburg, Va.
However, accountable care remains a pipe dream in many quarters and has taken a back seat to building general IT infrastructure. "You have to pave the last mile before you can ride that highway," according to Rozmus. At this point, CIOs have not thought much about it yet.
Other aspects of healthcare reform are on the minds of CIOs, too. About 37% named healthcare reform as the business issue having the most impact on healthcare this year, down slightly from 40% in 2012. This, according to Horowitz, included ACOs and payment reform. The second most common response was financial considerations, named by 16% of respondents. Policy mandates, including meeting Meaningful Use, fell to 14%, from 23% a year ago.
The primary clinical IT focus among CIOs was getting a fully operational EHR in place, named by 19% of respondents, down from 25% last year. Focus on physician systems and linking clinical systems to quality measures tied for second place on that question, at 16% each. "The top three here really are some key systems," Horowitz said.
Some 21% of respondents expressed concern that they would not be able to keep up with staffing needs, and their greatest need is for expertise in clinical informatics. This is in line with earlier reports suggesting a serious health IT workforce shortage.