Most wired’ hospitals widen gap over others

Wide range of offerings, emphasis on IT education

In much the same way as top performing hospitals continue to improve at a more rapid pace, so too are the most technologically adept facilities widening the gap between themselves and their competitors, according to the sixth annual Most Wired Survey and Benchmarking Study.

The study is a joint venture of Hospitals & Health Networks, the journal of the American Hospital Association, IDX Systems Corp., and the College of Healthcare Information Management Executives.

The survey asks hospitals to report on their use of information technology (IT) to address five key goals: safety and quality, customer service, business processes, work force, and public health and safety. A total of 482 hospitals and health systems completed the survey, representing 1,298 hospitals contacted.

This year, there were actually four categories recognized:

  • 100 Most Wired — The 101 organizations that scored highest on the survey.
  • The Most Wireless — The 25 organizations that scored highest on the survey questions focused on wireless applications.
  • The Most Improved — The 25 organizations not appearing on the Most Wired list whose score improved the most from 2003 to 2004.
  • The Most Wired-Small and Rural — The 25 small and rural organizations not appearing on the Most Wired list that scored highest on the survey.

And what are these top facilities doing differently? According to this year’s survey, the nation’s "100 Most Wired Hospitals and Health Systems" accomplished the following:

  • More than 90% of the most wired conduct either pre- or post-implementation return-on-investment analyses to justify expenditures, compared with only 59% of the least wired. (The least wired are the 100 respondents who scored the lowest on the survey.)
  • The most wired have a wide variety of offerings available over the Internet for patient service and customer support, ranging from on-line patient registration to disease-specific self-triage.
  • IT education is a priority among the most wired hospitals and health systems. The most wired have physicians and nurses dedicated to IT training and support. The most wired also are beginning to offer continuing medical education credits to participate in technology training.
  • The most wired have significantly higher adoption rates among physicians and nurses across a broad set of clinical activities, such as clinical order entry and results review, compared with the least wired hospitals.

In addition, the survey found that 90% of the most-wired hospitals provide access to current patient medical records on-line; 87% provide on-line access to medical history; 88% provide on-line access to patient demographics; and 69% provide on-line access to nurses’ notes.

Furthermore, 90% of the most-wired hospitals provide on-line radiology report reviews; 88% provide on-line lab results; and 84% have on-line radiology image review.

CPOE is widespread

CPOE, or computerized physician order entry, is 10 times more likely to be used at most wired organizations than at least wired facilities.

On average, nearly 27% of medication orders are entered electronically by physicians at most wired organizations, compared with 2.7% at the least wired institutions.

What’s more, the least wired also are more likely to have medications that are ordered manually. In fact, 20% of medications at the least wired organizations are ordered manually, compared with an average of 3.1% of medications ordered manually at the most wired.

Furthermore, nearly 35% of the most wired say 81% to 100% of their medications are matched electronically to the patient and order at the time of administration. This compares with only 5% of the least wired, 84% of which do not electronically match any medications to the patient at the time of administration.

Education is emphasized

Training in IT is another strategy that sets the most wired facilities apart. According to the survey, more than 95% of these facilities have a nurse dedicated to IT training, compared with 41% of the least wired.

In addition, more than 60% of the most wired have a physician dedicated to IT training, compared with 3% of the least wired; and 8% of the least wired do not provide any educational resources on IT whatsoever.

Approximately 60% of the most wired offer continuing education credits to pharmacists and IT professionals who participate in technology training. This compares with 6% or less among the least wired. More than 75% of the most wired provide education credits to physicians and nurses; but only 31% of the least wired provide credits for physicians, and 15% provide them for nurses.

Adoption rates at the most wired facilities also are much higher. For example, in terms of routine access to patient medical histories, 72% of most wired organizations say that their physicians have achieved the highest adoption rate measured on the survey: that 81% to 100% of their physicians routinely use IT to access medical histories. This compares with 29% of the least wired organizations responding that their physicians have achieved the highest adoption rate.

Clinical quality a key area

There also is a dramatic difference between the most wired and the least wired in terms of tools for improving clinical quality.

More than half of the most wired (54%) report they have achieved the highest level of adoption for physician use of drug interaction alerts — an 81% to 100% use rate — compared with 16% of the least wired. And 56% of the most wired report they have achieved the highest level of adoption for nurse use of drug interaction alerts, compared with 17% the least wired.

More than 80% of the most wired provide bedside access to drug interaction alerts, compared with only 15% of the least wired. In terms of bedside pharmacy order entry, 79% of the most wired provide this service, compared with 19% of the least wired.

Many of the most wired, and all of the 25 organizations named to this year’s Most Wireless list, are providing ubiquitous access throughout their organizations using wireless systems.

Many organizations are beginning their initiatives by providing wireless access in clinical areas of their institutions.

More than 75% of the most wired provide wireless access to clinical information functions such as drug interaction alerts, pharmacy order entry, and lab results review.

Only 13% of the least wired provide wireless access to drug alerts; 14% provide wireless pharmacy order entry; and 24% provide wireless lab results review. Adoption rates among the least wired for wireless access to clinical information are minimal.

(The 2004 Most Wired and Benchmarking Study can be found at: www.hhnmag.com.)