Information Technology Capacity in Iowas Hospitals

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Information Technology Capacity in Iowas
Hospitals

• Marcia M. Ward, Ph.D.
• Dept of Health Management Policy
• University of Iowa
• Presented to Iowa HIMSS April 5, 2005

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Overview

• Rational for our 2002 Iowa survey
• Results for Iowas urban and rural hospitals
• Correlates of IT capacity
• Differences between Iowas hospitals and
  hospitals in Quebec and Ontario
• Plans for new survey

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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 Iowas urban
  and rural hospitals
• Cost estimates were affected by the existing IT
  capacity

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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

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2002 Hospital IT Survey
Computerized Physician Order Entry IT
Infrastructure
A joint project of the University of Iowa Center
for Health Policy and Research and the Iowa
Hospital Association
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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

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Survey Responses

• Survey was completed by 74 Iowa hospitals
• 13 urban hospitals
• 5 rural referral hospitals
• 28 rural PPS hospitals
• 28 critical access hospitals

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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 Lukes
• Trinity Regional
• UIHC

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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

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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

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Clinical Area Included in Survey

• Questions were divided into 8 areas
• Patient management
• Physician
• Nurse
• ER
• OR
• Laboratory
• Radiology
• Pharmacy

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Comparison of Results in Iowa Urban and Rural
Hospitals

• Results are shown separately for Iowas 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

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Patient Management Processes that Are Computerized
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Patient Management Technologies that Are Used
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Physician Documents or Activities that Are
Computerized
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Physician Technologies that Are Used
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Nursing Processes or Documents that Are
Computerized
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Nursing Technologies that Are Used
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ER Processes that Are Computerized
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ER Technologies that Are Used
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OR Processes that Are Computerized
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OR Technologies that Are Used
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Laboratory Processes that Are Computerized
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Laboratory Technologies that Are Used
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Radiology Processes that Are Computerized
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Radiology Technologies that Are Used
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Pharmacy Processes that Are Computerized
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Pharmacy Technologies that Are Used
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Clinical Processes that Are Computerized
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Technologies that Are Used
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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)

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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

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Largest Urban-Rural Differences in Processes and
Technologies

• Computerized processes that showed the largest
  differences (gt50) 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

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Largest Urban-Rural Differences in Processes and
Technologies cont

• Computerized processes that showed the largest
  differences (gt50) 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.)

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Correlates of Clinical IT Capacity

• Both the availability of computerized clinical
  systems and the use of computerized technology
  were significantly correlated (gt.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

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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

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Computerized IT Processes
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Computerized IT Processes
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Use Computerized Technologies
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Use Computerized Technologies
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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

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Need for a New Survey

• We are funded by AHRQ on a 3-year grant to
• Examine the IT capacity of Iowas rural hospitals
• Identify patient safety and healthcare quality
  issues in Iowas rural hospitals
• Develop toolkits to help Iowas rural hospitals
  make informed IT purchases that will be
  affordable and address needs
• Plans for new survey

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Plans for New Survey

• Primary goal of a new survey is to quantify IT
  capacity in Iowas hospitals
• Getting respondents from all of Iowas 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

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Clinical Systems - Examples

• Patient Registration
• Patient Scheduling
• Patient Billing
• Barcoding
• Electronic health record (EHR)
• CPOE

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Questions Asked for Current Systems

• Current Systems
• ? None
• ? Installing, not yet operational
• ? Currently operational
• Product or vendor name (if applicable)

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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)

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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)

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Request for Your Feedback

• Will this survey design get us the information we
  need on what clinical systems Iowas hospitals
  have?
• Will informed staff in Iowas hospitals complete
  the survey as designed?
• Thank you!