Seven years ago, when Hospitals and Health Networks magazine first went looking for the 100 "most wired" hospitals and health systems in the country, the healthcare industry was focused on finding the hard dollars and cents that could be saved with cutting edge information technology. But these days, the emphasis has shifted to a scorecard approach that tries to balance an accountant's calculus on ROI (return on investment) with the improvements in quality and streamlined workflows that deliver important, if harder to measure, returns.
The goal now, according to the magazine's latest take on top tech performers, is delivering "value" with measured improvements in quality, overall satisfaction and patient care. And those hospitals at the top of the tech ladder are able to do more work with paperless medical records, digital imaging, telemedicine and bigger budgets for IT education aimed at dedicated staffers.
"There's been a huge evolution in the thinking of how return is measured," says Alden Solovy, executive editor of HHN magazine, which is published by the American Hospital Association. "The word 'return' is actually slowly being replaced by 'value' — how information technology derives value to the healthcare system. That includes the classic ROI calculation, and it includes process improvements that may have soft returns … things you couldn't put a hard number on. General efficiency improvements are reflected in the overall financial well-being of the organization."
And not everyone is working according to the exact same set of rules.
"There is still some disparity as far as how value is achieved and measured," says Lewis Redd, managing partner, Accenture Health Provider Practice, Atlanta. Some hospitals emphasize financial returns, while others look for quality and process improvements. "The priorities of hospitals vary. It's just a question of which one is more important to you," he says.
Sometimes, priorities can also change after new technology is deployed.
"Having IT changes measurements and it changes the management game," says Solovy, "because incidents, activities, moments of interaction with patients can get captured that didn't get captured before." The technology can illuminate problems that hospitals may have assumed didn't exist. Now, however, errors that may have been caught and corrected unnoticed are being picked up on the tech radar, and hospitals are finding that they have bigger quality challenges than they knew — along with some unexpected potential rewards.
"Take medication management systems," says Solovy. "We know that if we decrease the number of medical errors, it lowers liability risk and improves the hospital's general financial position, because we're not spending resources fixing problems we created." But there's a lot more than money at stake here. "The main purpose is safety and quality. That is what we'll measure, and we'll skip the gymnastics of rationalizing it through financial benefits we know we are going to get.
"In general, hospitals are getting much more sophisticated in their use of IT — and that means both using IT when it should be used and not using IT when it shouldn't be used," says Solovy. "The thought applied to how the use of technology fits into the care process is much more studied than it was. CIOs are more engaged as members of quality improvement teams and as partners in the development of improving care processes and making change, and they're not doing technology for technology's sake. It's not about implementing systems that then everyone has to live with. It's being part of decisions and about improving patient care."
Creating the "most wired" list requires a lot more than a hospital having a big IT budget. The magazine report looks to see how technology is being adopted throughout the system. Are doctors directly entering more orders themselves? Are more clinical transactions being handled digitally?
Healthcare has long been known as a laggard among industries in its adoption of information technology. But even as that reputation changes among hospitals, there are still plenty of big challenges to face.
One of the biggest is wiring up physician offices.
"How can I, as a hospital or pharmacy, provide information to primary care physicians if they're not wired?" asks Solovy. Regional health information networks are helping to change that in some areas, he adds, but much work remains.
Hospitals, meanwhile, are likely to find new ways to hone the edge of their technology programs.
"I see two potential futures," sums up the editor. "One is that as technology becomes more widely adopted, the playing field levels … I think that's less likely than … technology continues to evolve and more and more things can be done with it. A convergence of clinical IT continues so that the investment today that's thought of as cutting edge, becomes the infrastructure of tomorrow to do new things."
