Hospitals find it tougher to be "Most Wired"
■ The American Hospital Assn.'s annual survey of hospitals' use of technology is revised to emphasize how well facilities used it.
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Changes in criteria for the American Hospital Assn.'s "Most Wired" hospital list made it more difficult for many institutions to make the cut this year, reflecting a growing emphasis on hospitals not just having technology, but maximizing its use in their operations and patient care.
The AHA's two-year push to revamp the survey and its methodologies and analytics was started before the Center for Medicare & Medicaid Services issued its final "meaningful use" standards, announced at about the same time as the list's release in July. However, standards of meaningful use ultimately had a role both in how the survey was redesigned and in how well hospitals performed.
To make the AHA list, hospitals must hit at least some of the requirements in four focus areas: infrastructure; business and administrative management; clinical quality and safety; and care continuum, which provides measures for the health systems' ambulatory and physician community.
Before 2010, the list had consisted of the top 100 wired hospitals. While the organization decided not to limit the new list to 100, it turned out that only 99 of the 1,280 hospitals that took the survey -- 7.7% -- made the cut under the list's new standards. Additionally, 30% of the 100 hospitals that made the list last year were not on the list this year, according to the co-author of the survey report, Matthew Weinstock, senior editor of Hospitals and Health Networks, which published the AHA report.
While the AHA did not suggest that a spot on the list indicated that a hospital is positioned to meet meaningful use standards, some involved with the process of revamping the list say meaningful use did play a role in helping hospitals focus on the right things.
Hospitals that made the list showed progress that indicates the stimulus is doing what it was intended to do -- stimulate, said David Muntz, senior vice president and CIO of Baylor Health Care System in Dallas. Developing meaningful use standards was part of the economic stimulus package enacted in 2009. Hospitals must meet the standards to qualify for Medicare and Medicaid financial incentives.
Implementation of computerized physician order entry systems, for example, is part of meaningful use, and the "Most Wired" hospitals are further along in CPOE than are others. The survey found that 79% of "Most Wired" hospitals had evidenced-based order sets, compared with 42% of all hospitals that took the survey. Evidenced-based order sets exist within CPOE systems to help ensure patient safety and quality of care.
But an area of struggle for even the "Most Wired" hospitals is electronic medical record use in affiliated physicians' practices. The survey found that 43% of physician practices affiliated with a "Most Wired" hospital use an EMR, compared with 69% of practices owned by "Most Wired" hospitals.
Weinstock said he knows from speaking to some hospitals that took the survey that many plan to start discussions with those practices as they look to meet meaningful use requirements.
There is a focus on interoperability and data exchange in the meaningful use criteria that hospitals must meet to qualify for incentive pay.
Muntz, who served on the AHA survey's advisory committee as a representative of the College of Healthcare Information Management Executives, said that despite his own hospital's inability to make it back on the list for five years, he thinks the criteria should grow tougher each year, as they have done. And, he said, the criteria go well beyond areas that meaningful use doesn't touch, such as administrative functions.
Allana Cummings, chief information officer of the Northeast Georgia Health System, who also served on the Most Wired committee, said her organization did not make the list either. But she said her participation has helped the system prioritize its implementation plans as it moves toward meaningful use.