the state of health information technology in california ......health information technology source:...

CAL I FORNIAHEALTHCAREFOUNDATION

s n a p s h o t The State of Health Information Technology in California: Use Among Hospitals and Long Term Care Facilities

2008

©2008 California healthCare foundation 2

Health Information Technology

c o n t e n t s

HIT in Hospitals

Use of EHRs . . . . . . . . . . . . . . . . . . . . . . 3

EHR Uses . . . . . . . . . . . . . . . . . . . . . . . . . 4

Accessibility of EHRs . . . . . . . . . . . . . . . 5

Use of Electronic Patient Tracking/ White Board . . . . . . . . . . . . . . . . . . . . . 6

Use of Bar Coding . . . . . . . . . . . . . . . . . . 7

Sharing of Electronic Patient Information . . . . . . . . . . . . . . . . . . . . . . 8

Fully Implemented RFID Systems . . . . . . 9

HIT Financing in Hospitals

Financing HIT Systems . . . . . . . . . . . . . 10

Capital Investment/Spending for HIT . . 11

Projected Capital Investment/ Spending for HIT . . . . . . . . . . . . . . . . . 12

Investment in HIT Operations . . . . . . . . 13

Projected Spending on HIT Operations 14

Barriers to HIT Adoption . . . . . . . . . . . . 15

HIT in Long Term Care Facilities

Implementation of HIT . . . . . . . . . . . . . 16

Use of HIT . . . . . . . . . . . . . . . . . . . . . . . 17

Barriers to HIT Adoption . . . . . . . . . . . . 18

Top Clinical IT Priorities . . . . . . . . . . . . 19

Sources and Methodologies . . . . . . 20

Introduction

For hospitals and long term care facilities, full utilization of health information technology (HIT) offers

an opportunity to improve quality, prevent treatment errors, and boost the efficiency of the care they

provide.

However, as the findings in this snapshot show, the vast majority of California hospitals and long

term care facilities have been slow to implement HIT. Barriers include the cost of new technologies,

acceptance of them by staff, and a dearth of technology products that can readily be integrated into

existing information systems.

Among THe snApsHoT HIgHlIgHTs:

• only 13 percent of hospitals have fully implemented electronic health records (eHRs). Without

full implementation, hospitals will continue to encounter challenges in sharing and using clinical

information and coordinating patient care.

• only 12 percent of hospitals have fully implemented bar coding to track pharmaceuticals, and

25 percent of hospitals use this technology to track lab specimens.

• The initial cost of information technology tops a long list of HIT barriers, followed by staff acceptance

of new technologies and an absence of well-trained clinical staff for process redesign.

• only about one-fifth of long term care facilities use HIT for clinical purposes. The large majority use

it exclusively for business or administrative purposes.

Until the business case for adopting HIT becomes more apparent — and the tools become more user-

friendly and useful — the safety, efficiency, and quality advantages that HIT can foster will continue to

elude these institutions.


Fully implemented13%

Partially implemented42%

Not implemented45%


Source: American Hospital Association and California Hospital Association . Health Information Technology Surveys . 2006/2007 .

Use of EHRs in Hospitals, california, 2007

Thirteen percent of

hospitals reported

that they have fully

implemented an

electronic health record

(eHR) system.

in Hospitals


ImplementedconsIderIng

ImplementIngnot

Implemented

Use Fully partially testing Yes, within 3 years

Access to patient demographics 60% 29% 1% 7% 4%

Review lab results 55% 35% 2% 6% 3%

enter lab orders 50% 35% 2% 8% 5%

enter pharmacy orders 39% 36% 4% 17% 5%

Access to medical history/physical 36% 41% 3% 16% 4%

Review radiology images (including pACs*) 36% 42% 4% 11% 7%

Access to current medical records (observations, orders)

34% 47% 1% 15% 4%

Real-time drug interaction alerts 31% 39% 3% 23% 4%

Access to patient flow sheets 25% 46% 3% 22% 4%


*Picture archiving and communication system .


EHR Uses in Hospitals, california, 2007

Thirty-one percent

of hospitals reported


implemented an eHR

feature that enables them

to receive real-time drug

interaction alerts.

in Hospitals



ImplementIngnot

Implemented


emergency department 46% 15% 2% 30% 8%

Hospital inpatient departments 44% 17% 1% 32% 6%

on-site clinics 42% 17% 1% 29% 12%

on-site mD offices 37% 15% 1% 33% 15%

off-site clinics 34% 18% 1% 29% 18%

off-site mD offices 33% 18% 2% 33% 13%

other outpatient settings 29% 17% 2% 37% 16%

post-acute care settings 22% 10% 1% 42% 25%



Forty-six percent of

hospitals reported


implemented eHRs in the

emergency department,

44 percent in inpatient

departments, and

42 percent in on-site

clinics.

Accessibility of EHRs at Various Hospital Locations, california, 2007

in Hospitals



ImplementIngnot

Implemented


emergency department 31% 42% 5% 12% 11%

surgery 6% 45% 5% 30% 14%

nursing units 6% 42% 5% 33% 14%

Hospital-wide 5% 42% 5% 32% 17%



Thirty-one percent of

hospitals reported that

they use an electronic

patient tracking system

or electronic white board

in their emergency

department.

Use of Electronic Patient Tracking/White Board in Hospitals, california, 2007

in Hospitals



ImplementIngnot

Implemented


lab specimens 25% 44% 1% 25% 6%

Tracking pharmaceuticals 12% 34% 5% 43% 6%

pharmaceutical administration 11% 7% 4% 73% 5%

supply chain management 14% 13% 2% 63% 9%

patient identification 19% 35% 4% 35% 7%



Twenty-five percent



implemented bar coding

for laboratory specimens.

Fewer use bar coding

for pharmaceuticals or

patient tracking.

Use of Bar Coding in Hospitals, california, 2007

in Hospitals


Pharmacy benefit managers

Payers

Other hospitals

School clinics

Public health department

Long term care facilities

Retail pharmacies

Free-standing imaging centers

Labs

Physicians in private practice 76% 24%

74% 26%

18% 82%

9% 91%

46% 54%

32% 68%

4% 96%

22% 78%

65% 35%

6% 94%

Yes No



sHARe WITH…Three-quarters of


they share electronic,

patient-specific health

care information with

physicians in private

practice and with labs.

Hospital Sharing of Electronic Patient Information with MDs/Labs, california, 2007

in Hospitals


Plan to implement within 3 years50%

Not implemented38%

Testing7%

Partially implemented5%



no hospitals reported

having a fully

implemented RFID

system, but half plan

to implement one

within three years.

Radio Frequency Identification Systems (RFID) in Hospitals, california, 2007

in Hospitals


Loans

Bonds

Grants

Operational budget

Capital budget 83%

69%

23%

10%

5%

n=122

n=102

n=34

n=14

n=8



The great majority of


they finance their HIT

systems in part through

their capital budget.

nearly one-quarter rely in

part on grants.

How Hospitals Fund HIT Systems, california, 2007

Financing in Hospitals


41–60% —81–100% —

HIT as a Percent of Total Capital Investmentin Prior Year

(n=147)

Total HIT Expendituresin Prior Year

(n=117)

0–20%

21–40%

Unknown/No response

$0–100K

$101–500K

$501K–$1M

$1.1–5M

$5.1–10M

$10.1–25M

No response

— 61– 80%

$25.1–50M —



most hospitals reported

spending up to

20 percent of all their

capital investment on

HIT in the last fiscal

or calendar year. most

hospitals spent $1.1 to

$5 million on HIT in the

last year.

Capital Investment and Spending for HIT in Hospitals, california, 2007


©2008 California HealtHCare foundation 12

41–60% —81–100% —

HIT as a Percent of Total Expected Capital Investmentin the Next 3 Years

(n=147)

Total Expected HIT Expendituresin the Next 3 Years

(n=118)

0–20%

21–40%

NA/No response

$0–100K

$101–500K

$501K–$1M

$1.1–5M

$5.1–10M

$10.1–25M

$25.1–50M$50.1–75M

Unknown/No response

— 61–80%

$75.1–100M —


Source: American Hospital Association and California Hospital Association. Health Information Technology Surveys. 2006/2007.

Most hospitals expect to

spend up to 20 percent

of their total capital

investment on HIT in the

next three years. Most

hospitals expect to spend

$10.1 to $25 million on

HIT during that period.

Projected Capital Investment and Spending for HIT in Hospitals, California, 2007



3.1–5.0% —10.1+% —

Percent of Total Expendituresfor HIT Operations

(n=147)

Total Expendituresfor HIT Operations

(n=116)

0–1.0%

1.1–2.0%

2.1–3.0%

Unknown/No response

$0–100K$101–500K$501K–$1M

$1.1–5M

$5.1–10M

$10.1–25M

$25.1–50M

Confidential/No response

— 5.1–10.0%$50.1–75M —



most hospitals reported

that they spent 2.1 to

3.0 percent of their total

expenditures on HIT

operations (noncapital

costs) in the last fiscal

or calendar year. most

hospitals spent $1.1 to

$5 million on operational

HIT costs in the last year.

Hospital Investment in HIT Operations, california, 2007



10.1+% —

Percent of Total Expected Expendituresfor HIT Operations in the Next 3 Years

(n=146)

Total Expected Expendituresfor HIT Operations in the Next 3 Years

(n=115)

0–1.0%

1.1–2.0%

2.1–3.0%

3.1–5.0%5.1–10.0%

Unknown/No response

$0–100K$101–500K$501K–$1M

$1.1–5M

$5.1–10M

$10.1–25M

$50.1–75M$75.1–100M

$125.1–150M

Confidential/No response

$25.1–50M —

$100.1–125M —

$150.1–200M — — $200.1+M


Source: American Hospital Association and California Hospital Association. Health Information Technology Surveys. 2006/2007.

Most hospitals expect to

spend 2.1 to 3.0 percent

of total expenditures on

HIT operations in the

next three years. Most

hospitals expect to spend

$1.1 to $5 million on HIT

operations in that period.

Projected Spending on HIT Operations in Hospitals, California, 2007



Inability to comply effectively with HIPAA costs

Fear that technology will become obsolete too quickly

Availability of well-trained HIT staff

Inability of technologies to meet needs

Interoperability of hardware/software with current systems

Ability to support ongoing costs of hardware/software with current systems

Availability of well-trained clinical staff for process design

Acceptance of technology by clinical staff

Initial cost of HIT investment 49% 45% 6%

40% 51% 9%

25% 67% 8%

19% 71% 10%

17% 60% 23%

12% 53% 35%

11% 42% 47%

5% 30% 65%

5% 36% 59%

Significant barrier Somewhat of a barrier Not a barrier



The largest number


that the initial cost of

HIT investment was

a significant barrier to

adoption, followed by

clinical staff’s acceptance

of the technology.

Barriers to HIT Adoption in Hospitals, california, 2007



Have not started

Gathering information (no timeline established)

In planning stage (timeline established)

In system selection stage

System being developed

Full/partial implementation or in process

46%

25%

44%

0%

11%

0%

5%

7%

6%

14%

7%

0%

35%

32%

39%

0%

18%

11%

SNFs (multifacility)

SNFs (free-standing)

RCFEs (more than 75 beds)


*Health information technology (HIT) is defined as technology used to collect, store, retrieve, and transfer clinical, administrative, and financial health information electronically. Notes: SNF is a skilled nursing facility; RCFE is a residential care facility for the elderly.

Source: Health Information Technology: Are Long Term Care Providers Ready? California HealthCare Foundation. April 2007.

Nearly half of skilled

nursing facilities (SNFs)

with more than one

facility reported they

have implemented or

are implementing some

form of HIT. Far fewer

free-standing SNFs

reported such progress.

Implementation of HIT* in Long Term Care Facilities, California, 2007

in Long Term Care Facilities


Business/AdministrativePurposes

Medication AdministrationCharting

21%18%

97%

17%

22%

83%

SNFs*RCFEs (more than 75 beds)

Clinical Purposes


*Includes hospital-affiliated, multifacility, and free-standing skilled nursing facilities . Notes: SNF is a skilled nursing facility; RCFE is a residential care facility for the elderly .

Source: Health Information Technology: Are Long Term Care Providers Ready? California HealthCare Foundation . April 2007 .

About one-fifth of all

long term care facilities

reported that they use

some form of HIT for

clinical purposes. nearly

all nursing homes and

83 percent of residential

care facilities for the

elderly (RCFes) indicated

they use such technology

for business or

administrative purposes.

Use of HIT in Long Term Care Facilities, california, 2007

in long term care Facilities


Lack of reimbursement for using HIT

Staff lack computer skills

HIT product not integrated with other systems

Lack of professional HIT staff

Lack of capital resources

44%

78%

54%

31%

44%

62%

56%

44%

85%

53%

48%

85%

17%

60%

29%

SNFs (multifacility, n=32)

SNFs (free-standing, n=27)

RCFEs (more than 75 beds, n=13)


Fifty-six percent of

skilled nursing facilities

with more than one

facility, and 85 percent of

residential care facilities

for the elderly cited lack

of integration with other

systems as a significant

barrier to HIT adoption.

Notes: SNF is a skilled nursing facility; RCFE is a residential care facility for the elderly .


Barriers to HIT Adoption in Long Term Care Facilities, california, 2007



Electronic prescribing

Monitoring and messaging systems‡

Care planning

Medication administration

Clinical data exchange†

Clinical documentation*93%

66%

60%

50%

60%

33%

40%

33%

27%

33%

27%

33%

SNFsRCFEs


*Activities of daily living, daily notes, physician orders, and results . †Electronic communications of resident information with physicians, hospitals, and providers in the community, and insurance eligibility information available on one system for

Medicare, Medi-Cal, and HMOs . ‡Blood pressure, blood glucose, weight scales, and electronic thermometers . Notes: SNF is a skilled nursing facility; RCFE is a residential care facility for the elderly .


After administrative and

financial functions,

clinical documentation is

the top HIT priority for

long term care facilities.

Top Clinical IT Priorities in Long Term Care Facilities, california, 2007


Give Us YoUr Feedback

Was the information provided in this report of value? Are there additional kinds of information or data you would like to see included in future reports of this type? Is there other research in this subject area you would like to see? We would like to know.

Please click here

to give us your feedback.

Thank you.

For more inFormaTion

California HealthCare Foundation

1438 Webster Street, Suite 400

Oakland, CA 94612

510.238.1040

www.chcf.org

CAL I FORNIAHEALTHCAREFOUNDATION


health information Technologysources and MethodologiesThe american hospital association surveyed about 4,000 hospitals in the fall of 2006. More than

1,500 — about 31 percent of all community hospitals in the United States — responded. The AHA sent its

survey form via email and fax to chief executive officers, who could complete it on paper or on a secure

Web site. Seventy-one California hospitals participated, a state-level response rate of about 20 percent.

To supplement these data, between July and September of 2007, the california hospital association

contacted 414 hospitals in the state that did not respond to the AHA survey. CHA received 76 additional

responses, increasing the total response rate among California hospitals that participated in both the

AHA and CHA surveys to 30 percent.

In 2006, the california healthcare Foundation supported research to better understand the health

information technology (HIT) readiness of skilled nursing facilities (SNFs), residential care facilities for the

elderly (RCFEs), and other providers in the state. This research included a literature review, nonrandom

surveys, and focus groups. The survey of long term care providers was conducted in collaboration with

the California Association of Health Facilities and Aging Services of California, which distributed the

survey form to a select list of HIT decision-makers at facilities with an interest in HIT. Forms went to

150 SNFs of any size and to 50 RCFEs with more than 75 beds. The SNF and RCFE response rates

were 47 percent and 24 percent, respectively. Participants completed 82 of 103 forms electronically; the

other 21 were completed on paper at the end of five focus groups. The focus groups, which included

administrators, nursing directors, and care managers, were convened in Los Angeles, Sacramento, and

Fremont in October 2006.

http://survey.chcf.org/TakeSurvey.aspx?SurveyID=n4KJ8nm

http://www.chcf.org

the state of health information technology in california ......health information technology source:...

Documents