Headline
Continued Progress
Hospital Use of
Information Technology
2007
Summary of Findings
H
ospitals realize the promise of health information
technology (IT) to improve quality of care. Despite
the financial and implementation challenges of health
IT adoption, hospitals continue to accelerate their use
of health IT, with 68 percent reporting fully or partially
implemented electronic health records (EHRs) in 2006.
interactions. In 2006, 51 percent of hospitals were
using real-time drug interaction alerts, up from 23
percent in 2005.
•Certain kinds of hospitals are further ahead in
adoption of health IT. Larger hospitals, those in urban
areas, teaching hospitals, and hospitals with positive
margins used more health IT. In addition, large and
urban hospitals also showed greater rates of growth
in IT use than their smaller and rural counterparts.
To gauge the extent of health IT use among U.S. hospitals
and better understand the barriers to further adoption, the
American Hospital Association (AHA) surveyed hospitals
in fall 2006. The results provide the most complete
picture of hospital IT use currently available. The survey
asked about use of EHRs and other specific kinds of
health IT, financing of health IT systems, barriers to
greater use, and involvement in arrangements to share
clinical information. More than 1,500 community hospitals
— about 31 percent of all U.S. community hospitals —
responded to the survey. This sample fairly represents
all community hospitals by size, location, and teaching
status. This is the AHA’s second survey of hospital health
IT use; the first was conducted in spring 2005.
•Hospital spending on health IT is high and increasing.
Not surprisingly, therefore, the most commonly cited
barrier to further IT adoption continued to be cost.
•About one-half of hospitals shared electronic patient
data with others in both 2005 (53 percent) and 2006
(49 percent). Their most common partners included
private-practice physician offices, laboratories,
payers, and other hospitals.
The data show continued progress in health IT adoption
in hospitals, but we remain far from the goal of universal
adoption. The patterns displayed in the survey data
suggest that certain kinds of hospitals — generally
those with greater financial resources — are gaining
ground faster than others. Accelerating adoption among
all kinds of hospitals will require a shared investment
between providers, payers, and purchasers. Hospitals
currently bear almost all the costs of IT investment,
with no increase in payment for the use of these new
technologies. However, many of the financial benefits of
IT — such as decreased need for repeat tests, lower
readmission rates, and shorter lengths of stay — accrue
to those who pay for care.
Key findings include:
•Over two-thirds of hospitals (68 percent) had either
fully or partially implemented EHRs in 2006.1 The
11 percent with fully implemented EHRs were more
likely to be large, urban, and/or teaching hospitals.
•Health IT use is growing. In 2006, 46 percent of
community hospitals reported moderate or high use
of health IT, compared to 37 percent in 2005. Health
IT use was determined by the number of clinical IT
functions — such as medication order-entry, test
results review, or clinical alerts — a hospital had fully
implemented.
When looking at how to finance health IT adoption,
policymakers should give special attention to hospitals
with less stable finances, smaller hospitals and rural
hospitals. Other barriers to IT use, such as lack of systems
that share data easily, challenges in managing work
process changes, and lack of trained IT staff also must
be addressed by policymakers and the hospital field.
•Computerized physician order-entry (CPOE) is
gaining traction. In 10 percent of hospitals, physicians
routinely ordered medications electronically at least
half of the time in 2006. For laboratory and other
tests, physicians routinely placed orders electronically
at least half of the time in 16 percent of hospitals.
•Hospitals reported dramatic increases in the use
of computerized alerts to prevent negative drug
Introduction
he potential of health information technology (IT) to
improve the care patients receive and the overall
efficiency of the health care system has become a central
part of the national health care debate. Many hospitals
and health systems have embarked on the challenging
journey of IT adoption. However, use of health IT is not
yet universal due to financial, technical, implementation,
and policy barriers.
T
The AHA surveyed all U.S. community hospitals — both
members and non-members — to ensure as complete
a picture as possible. More than 1,500 community
hospitals — about 31 percent of all U.S. community
hospitals — responded to the survey. This sample fairly
represents all hospitals by size, location, and teaching
status. The technical appendix contains more details on
the survey methodology.
To further develop our understanding of the level of
health IT use by hospitals and the barriers to further
adoption, the AHA conducted a second survey of
hospitals in the fall of 2006 (a previous survey was
fielded in the spring of 2005). The survey asked about
the use of specific technologies, such as electronic
health records (EHRs) and computerized physician
order-entry (CPOE), as well as other clinical and
non-clinical applications, such as administrative
and department-specific information systems. The
survey also asked about financing for IT, barriers to
use, and efforts to exchange clinical information with
others.
This report provides a comprehensive picture of hospital IT
use. It first discusses adoption of the most comprehensive
clinical IT tools – EHRs and CPOE. It then explores the
evolutionary nature of clinical IT adoption, which often
involves implementation over time of separate systems
in different departments of the hospital, such as the
pharmacy or laboratory, that provide data to the EHR. The
report places hospitals along a spectrum of IT adoption
and considers the factors that drive greater IT use. It then
looks at the use of other supportive technologies, such as
bar-coding and telemedicine. The final sections examine
the barriers to adoption and increasing efforts to share
clinical data with others.
Hospitals are adopting
electronic health records
A
mong other technologies, the survey asked hospitals
about their use of EHRs, defined as systems that
integrate electronically originated and maintained
patient-level clinical health information, derived from
multiple sources, into one point of access. An EHR
replaces the paper medical record as the primary source
of patient information.
More than two-thirds of
hospitals had fully or partially
implemented EHRs
Percent of hospitals reporting EHRs*, 2006
Fully
implemented
11%
Sixty-nine percent of hospitals reported having either
fully or partially implemented an EHR. Larger hospitals,
those in urban areas, and teaching hospitals were more
likely to be among the 11 percent with fully implemented
EHRs.
Hospital size bears a systematic relationship to progress
on EHR implementation; as bed size increases, so does
use of EHRs. While 23 percent of responding hospitals
with 500 or more beds have a fully implemented EHR
— and 92 percent have a fully or partially implemented
EHR — only 3 percent of hospitals with fewer than 50
beds have fully implemented EHRs. Among the smallest
hospitals, 55 percent have no EHR.
Given that larger organizations are more likely to have
EHRs, and a larger share of all hospitalizations occur in
large hospitals, more than 11 percent of patients with a
hospital stay in 2006 likely had an EHR as their primary
medical record. For example, in 2005, 23 percent of
hospital admissions occurred in hospitals with 500 or
more beds, compared to 4 percent in hospitals with
fewer than 50 beds.
EHR implementation also varies by hospital location.
Urban hospitals are three times more likely to have a
fully implemented EHR than their rural counterparts
(16 percent versus 5 percent). Among rural hospitals,
43 percent have no EHR. The advantage held by
urban hospitals remains, but is lessened, when partial
implementation is also considered (77 percent versus
58 percent).
No EHR
32%
Partially
implemented
57%
*NOTE: This question was first asked in 2006.
Larger hospitals more likely
to have EHRs than smaller
hospitals
Percent of hospitals reporting EHRs by bed size, 2006
92%
87%
79%
63%
46%
66%
64%
69%
56%
43%
3%
7%
<50
beds
50-99
beds
13%
100-299
beds
Fully implemented
23%
23%
300-499
beds
500+
beds
Partially implemented
Teaching hospitals are almost twice as likely to have
fully implemented EHRs as non-teaching facilities
(17 percent versus 9 percent). When both fully and
partially implemented systems are considered, the
gap remains, but narrows (81 percent versus 65
percent).
Urban hospitals more likely
to have EHRs than their
rural counterparts
Percent of hospitals reporting EHRs by location, 2006
77%
Hospitals without an EHR were primarily small, rural,
non-teaching, and did not belong to a health system:
58%
•71 percent had fewer than 100 beds (compared to
48 percent of all community hospitals);
61%
53%
•61 percent were rural (compared to 41 percent of
all community hospitals);
5%
Rural
•88 percent were non-teaching (compared to 78
percent of all hospitals); and
Fully implemented
16%
Urban
Partially implemented
•63 percent were not system members (compared
to 45 percent of all hospitals).
While these hospitals are certainly committed to EHR
adoption, they face considerable financial and other
barriers.
Teaching hospitals more likely to
have EHRs than their
non-teaching counterparts
Percent of hospitals reporting EHRs by teaching status,
2006
81%
65%
64%
56%
9%
Non-teaching
Fully implemented
17%
Teaching
Partially implemented
Hospitals are moving toward
computerized physician order-entry
However, successful CPOE implementation can be
difficult to achieve, since it requires significant changes
to work processes and the active support of busy
clinicians. Hospitals often phase-in CPOE systems,
starting with physician technology champions in one or
two departments. Consequently, not all physicians in a
hospital may be entering orders electronically.
To gauge CPOE use across hospitals, the survey asked
about the share of treating physicians placing orders
electronically. In 10 percent of hospitals, more than
half of the physicians routinely ordered medications
electronically in 2006, while at least some physicians
were doing so in 27 percent of hospitals. Use of
CPOE was more common among hospitals with fully
implemented EHRs. In about 25 percent of those
facilities, at least half of the physicians routinely ordered
medications electronically. In about half of the hospitals
with fully implemented EHRs, some physicians were
routinely ordering medications electronically.2
As with adoption of EHRs, CPOE use was more common
in larger, urban, and teaching hospitals. In 27 percent
of hospitals with 500 or more beds, almost all physicians
(75-100 percent) routinely ordered medications
electronically. In 32 percent of those hospitals, almost all
physicians (75-100 percent) routinely ordered laboratory
and other tests electronically.
In 10 percent of hospitals,
more than half of treating
physicians routinely ordered
medications electronically
Share of physicians ordering medications
electronically, 2006
73%
Percent of hospitals
C
omputerized physician order-entry systems allow
physicians to electronically order medications,
tests, and consultations. They also provide advice
on best practices and alerts to the possible adverse
consequences of a therapy, such as an allergy or a
harmful combination of drugs. Numerous studies have
shown that CPOE can lead to fewer adverse drug events
and other quality improvements, leading organizations
such as the Leapfrog Group to call for universal CPOE
adoption.
14%
None
1-24
percent
3%
2%
25-49
percent
50-74
percent
8%
75-100
percent
In 16 percent of hospitals,
more than half of treating
physicians routinely ordered
tests electronically
Share of physicians ordering tests
electronically, 2006
Physician order-entry was slightly more common for
laboratory and other tests than for medications. Among
survey hospitals, 16 percent reported that treating
physicians routinely ordered tests electronically at least
half of the time. In another 37 percent of hospitals,
electronic ordering was done by at least some physicians.
Among hospitals with fully implemented EHRs, almost
60 percent had at least some physicians ordering
laboratory tests electronically, with 28 percent reporting
that 50 percent or more of the physicians did so.
Percent of hospitals
63%
17%
None
1-24
percent
12%
4%
4%
25-49
percent
50-74
percent
75-100
percent
Use of health IT
is evolutionary
I
mplementing EHRs with CPOE systems requires
significant changes to hospital workflow. Beyond
the technological changes, physicians, nurses, and
other hospital staff must incorporate new ways of
processing, storing, and retrieving the information they
use every minute of every day. Not all implementations
are successful, and failure is very expensive. Given
the large-scale changes — and large-scale costs — of
these kinds of systems, many hospitals are taking an
incremental approach. For example, they may implement
IT systems in individual departments, working over time
to connect them. Hospitals also may prioritize their
implementation of health IT systems according to their
quality improvement goals.
• Order-entry of laboratory tests.
• Results review for laboratory tests.
• Order-entry of radiology procedures.
•Results review for radiology images, including
picture archiving and communications systems
(PACS).
• Results review of radiology reports.
• Order-entry of medications.
• Real-time drug interaction alerts.
• Back-end drug interaction alerts.
• Clinical guidelines and pathways.
•Patient support through home monitoring, selftesting, and interactive patient education.
In 2006, the survey also included two additional functions
— use of other clinical alerts and patient access to
electronic records — in order to complete the picture of
decision-support functions and capture the new trend
toward consumer access to EHRs.
To capture the diversity and incremental nature of health
IT use among hospitals, the survey asked about distinct
clinical IT functions. In both 2005 and 2006, the survey
asked about implementation of:
• Access to current medical records.
• Access to medical history.
• Access to patient flow sheets.
• Access to patient demographics.
Laboratory, radiology, and pharmacy functions
Much of the care provided in the hospital involves
ordering and receiving tests and medications from
Hospitals used many electronic laboratory,
radiology, and pharmacy functions
Percent of hospitals reporting that they have fully or partially implemented various clinical IT functions
Results review, Lab
66%
66%
66%
64%
64%
64%
2006
2005
Order-entry, Lab
2006
2005
Order-entry, Radiology
2006
2005
60%
60%
62%60%
12%
12%
11%
62%
59%
59%
62%
62%
59%
65% 65%62%
Results review,
Radiology report
2006
2005
Results review,
Radiology images
2006
2005
65%
47%
47%
60%
41%
41%
2006
2005
47%
46%
46%
66%48%
48%
Order-entry, Pharmacy
12%
12%
78%
11%
75%
11%
11%
11%
9%
9%
60%60%
12%
12%
17%
19%
19%
70%
71%
77%
12%
72%
64%
60%
15%
15%
14%
14%
61%
62%
Fully implemented
72%
73%
Partially implemented
ancillary departments such as the laboratory, radiology,
and pharmacy. Physicians typically generate these
orders, which are communicated to the relevant
department on paper or electronically. The results
of tests must be communicated back to treating
physicians, and medications must be delivered to the
bedside. Therefore, information systems in these areas
are a focus for many hospitals. Indeed, the Centers
for Disease Control and Prevention estimate that
laboratory results produce 70 percent of the information
in a patient’s medical record.
electronically in 77 percent of hospitals, while the actual
images were computerized in 64 percent of hospitals. In
70 percent of hospitals, orders for radiology procedures
were entered electronically (either by the physician or
within the radiology department).
Sixty–one percent of hospitals had fully or partially
implemented electronic order-entry for the pharmacy
(either by the physician or pharmacist) in 2006, about
the same number as in 2005.
Decision-support systems
Within the pharmacy, 2006 witnessed a remarkable
increase in use of drug interaction alerts. In more
than half of hospitals, either real-time or back-end drug
interaction alerts were being used. These systems are
key elements of improving medication safety. Thirty-six
percent of hospitals had fully or partially implemented
electronic clinical guidelines and pathways that support
physicians in making clinical decisions, such as which
Laboratory information systems are widely used, with
78 percent of hospitals having electronic results review
either fully or partially implemented in 2006 (an increase
over 2005), and 72 percent having electronic order-entry
systems (either by the physician or within the lab).
Reports summarizing the results of X-rays, CT scans,
and other radiology procedures were available
Hospitals increased use of decision-support functions
Percent of hospitals reporting that they have fully or partially implemented
various decision-support functions
31%
Real-time
drug alerts
2006
Back-end
drug alerts
2006
Clinical guidelines
and pathways
2006
10%
2005
9%
Other clinical alerts
2006
2005
2005
10%
13%
23%
37%
14%
51%
20%
19%
13%
27%
36%
26%
26%
17%
35%
26%
43%
Fully implemented
56%
Partially implemented
diagnostic tests or medications may be appropriate
for a given condition. Other types of electronic clinical
alerts were fully or partially implemented in 43 percent
of hospitals.
patient demographic information (79 percent in 2006).
However, electronic access to current and historic
medical records was less common, but still available in
more than 60 percent of hospitals, a small improvement
over 2005. Functions that allow patients to access
their own EHRs and support patients through home
monitoring were much less common.
Medical record and other functions
Hospitals reported high use of IT systems for maintaining
Hospitals increased use of electronic record
management functions
Percent of hospitals reporting that they had fully or partially implemented
various EHR functions
68%
62%
11% 79%
12% 74%
Access to patient demographics
2006
2005
Access to current medical records
2006
2005
32%
30%
32%
30%
Access to medical history
2006
2005
34%
29%
30%
30%
Access to patient flow sheets
2006
2005
27%
21%
Results review - Consultant report
2006
2005
Patient support through
home-monitoring, etc.
Patient access to EHRs*
24%
24%
43%
45%
64%
60%
64%
59%
51%
45%
19%
16%
62%
61%
2006 2% 9% 11%
2005 2% 11% 13%
2006 1%4% 5%
Fully implemented
*NOTE: This question was first asked in 2006.
Partially implemented
Hospitals fall along a
spectrum of health IT use
T
he evolutionary nature of health IT adoption means that hospitals fall at different places along the adoption curve.
To assess differences in the level of IT use among hospitals, the AHA created four usage groups based on the
number of clinical IT functions that were reported to be fully implemented at each surveyed hospital, ranging from just
getting started to having almost all of the functions in place.3
Spectrum of IT use
Level of
Use
Functions
Getting
Started
Low
Moderate
High
0-3 Functions
4-7 Functions
8-11 Functions
12-15 Functions
(0-25%)
(26-50%)
(51-75%)
(76-100%)
Fully implemented
Fully implemented
Fully implemented
Fully implemented
• A
ccess to current medical
records
• Access to medical history
• Access to patient flow sheets
• Access to patient
demographics
• O
rder-entry - lab
• R
esults review - lab
• O
rder-entry - radiology
• Results review - radiology
images (incl. PACS)
• Results review - radiology
report
• Results review - consultant
report
• Order-entry - pharmacy
• Real-time drug interaction
alerts
• B
ack-end drug interaction
alerts
• Clinical guidelines and
pathways
• Patient support through
home monitoring,
self-testing, and interactive
patient education
Hospitals used more health IT
in 2006
Hospitals continue to progress in the use of
health IT. In 2006, 46 percent of hospitals
reported moderate to high clinical IT use,
a considerable increase over 2005 when
just 37 percent of hospitals fell into these
groups. Sixteen percent of hospitals had
implemented almost all of the functions in
2006, up from 10 percent in 2005.
Distribution of hospitals by level of health IT use
Despite this growth in the upper end of the
spectrum, more than half of hospitals were
still in the getting started or low use groups
in 2006.
2006
32%
2005
36%
Getting started
22%
30%
27%
Low
16%
27%
Moderate
10%
High
The extent of health IT use varied with many different
hospital characteristics, including number of beds,
location, teaching mission, and membership in a
hospital system. The patterns displayed in the survey
data suggest that certain kinds of hospitals — generally
those with greater financial and technical resources
— are gaining ground faster than others.
Fifty-six percent of hospitals in urban areas reported
moderate or high health IT use in 2006 compared to
33 percent of rural hospitals. Both groups experienced
increases from 2005. Among rural hospitals, 46 percent
reported just getting started with adoption of health IT in
2006, down from 50 percent in 2005.
Teaching hospitals used more health IT than their nonteaching counterparts in 2006, with 59 percent reporting
moderate or high use compared to 42 percent of nonteaching hospitals. However, both groups saw increased
use from 2005 to 2006.
Of all the characteristics considered, the size of the
hospital bore the strongest relationship to health IT use.
Of the largest hospitals — those with 500 or more beds
— 74 percent reported moderate or high health IT use
in 2006. In contrast, only 23 percent of hospitals with
50 or fewer beds were in the top two levels of IT use. In
between these extremes, health IT use increased with
hospital size.
Being part of a hospital or health system can mean that
hospitals have access to greater financial and technical
resources for health IT adoption. Among system
hospitals, 51 percent reported moderate or high health
IT use, compared to 42 percent of non-system hospitals
in 2006. Both groups reported increases across years.
In addition to having greater health IT use, larger
hospitals saw a much greater increase in use from
2005 to 2006 than did smaller hospitals. In general,
larger hospitals have greater revenues, greater access
to capital, and more staff resources to support IT
adoption.
Implementing and maintaining health IT systems
requires significant financial resources. Not
surprisingly, financial status also helps determine a
Larger hospitals used more health IT and saw greater
growth from 2005 to 2006
Distribution of hospitals across levels of health IT use by bed size
6%
10%
5%
7%
18%
18%
18%
19%
66%
2005
58%
2006
< 50 beds
27%
11%
21%
12%
21%
31%
37%
26%
2005
23%
42%
2006
50-99 beds
23%
19%
2005
2006
100-299 beds
Getting started
24%
45%
47%
34%
48%
13%
Low
10
31%
18%
34%
61%
40%
19%
20%
11%
11%
7%
6%
2005
2006
2005
2006
300-499 beds
Moderate
13%
High
500+ beds
hospital’s health IT use: hospitals with better financial
standing generally have greater IT use. Having positive
margins gives hospitals the funds needed to make the
large capital investments necessary to implement
health IT and covers the increased operating costs
Urban hospitals used more health
IT than rural hospitals, but both
groups increased use
that come along with investment in health IT systems.
Among those with negative margins, 43 percent
of hospitals are just getting started with health IT
investments, compared to 29 percent of those with
positive margins.
Teaching hospitals used more health
IT than non-teaching hospitals, but
both groups increased use
Levels of health IT use by location
7%
11%
18%
12%
Levels of health IT use by teaching status
13%
20%
9%
19%
22%
24%
36%
25%
21%
22%
29%
46%
2005
2006
22%
22%
2005
2006
Urban
Rural
Getting started
Low
Moderate
7%
19%
14%
28%
32%
28%
26%
18%
28%
31%
2005
2006
24%
42%
2005
Getting started
34%
2006
Non-system
System
Low
Moderate
2005
2006
37%
2005
2006
Non-teaching
Low
Moderate
High
Level of use of fully implemented IT systems
by margin level
6%
11%
11%
17%
22%
24%
29%
32%
26%
22%
28%
22%
23%
32%
18%
41%
Hospitals with positive margins
used more health IT
in both 2005 and 2006
Levels of health IT use by system status
14%
15%
Getting started
Hospitals that were members of
systems used more health IT than
those that were not, but both
groups increased use
21%
23%
Teaching
High
27%
40%
26%
30%
50%
43%
36%
15%
32%
29%
2005
2006
Getting started
11
43%
2005
2006
Negative Margin
Positive Margin
High
46%
Low
Moderate
High
Other supportive
IT applications
H
ospitals use IT systems for clinical and nonclinical purposes. The survey asked about use
of a select group of applications that support the care
process, but are not a direct part of the EHR. These
technologies included bar-coding, which has multiple
clinical and administrative functions, telemedicine, and
administrative systems.
use of bar-coding for labeling lab specimens, identifying
patients, and tracking pharmaceuticals throughout the
facility.
The survey also found that some hospitals are beginning
to use radio frequency identification (RFID), a new
technology for identifying and tracking items. This
technology is at an early stage, with almost 10 percent
of hospitals having fully or partially implemented it in
both 2005 and 2006.
The survey revealed that more than half of all hospitals
have adopted bar-coding technologies for at least
one purpose. Bar-coding technologies have created
significant safety benefits by matching patients and their
drugs before they are administered to ensure that the
right medication is given to the right patient, in the right
dose, and at the right time. Twenty-six percent of those
surveyed had fully or partially implemented bar-coding
for pharmaceutical administration in 2006, a small
increase over 2005. Hospitals also reported increased
Telemedicine technology allows remote health care
facilities to consult with physicians and medical
personnel at other hospitals or central facilities, such
as regional medical centers, through the use of highresolution cameras, digital-imaging equipment, and
high-speed connectivity. This technology can reduce
the need to transfer patients and possibly save lives.
Hospitals increased use of bar-coding
Percent of hospitals with fully or partially implemented bar-code systems
Lab specimens
Patient ID
35%
2005
2005
2006
Tracking pharmaceuticals
2006
Pharmaceutical administration
2006
2005
2005
2005
18%
25%
20%
2006
Supply chain management
19%
38%
2006
17%
17%
16%
16%
14%
40%
40%
19%
33%
18%
14%
12%
30%
26%
12%
11%
42%
37%
24%
24%
12%
23%
Fully implemented
12
57%
53%
Partially implemented
More than half of hospitals in both urban and rural areas
used telemedicine in both 2005 and 2006.
Some physicians have found that using hand-held
electronic devices — such as personal digital assistants
(PDAs) — to access patient information and medical
references, and enter orders, can improve their workflow.
According to survey results, about 30 percent of hospitals
had fully or partially implemented this technology in both
2005 and 2006.
Administrative tasks also are becoming increasingly
electronic, with almost all hospitals using IT systems for24%
patient accounts, about three-fourths using electronic
patient scheduling systems, and about 70 percent using 24%
IT systems to manage their pharmaceutical and medicalsurgical supply chains in 2006.
Hospitals adopting telemedicine
and other technologies
Percent of hospitals with fully or partially
implemented systems
Telemedicine
2006
24%
2005
24%
34%
58%
37%
Physician use of personal 2006 8% 23%
digital assistance (PDAs) 2005 9% 21%
31%
30%
Radio frequency 2006 3% 9% 12%
identification (RFID) 2005 2% 8% 10%
Fully implemented
Partially implemented
Hospitals using
administrative systems
Percent of hospitals with administrative systems, 2006
Patient accounts
13
61%
97%
Patient scheduling
75%
Pharmaceutical supply
chain management
71%
Medical-surgical supply
chain management
70%
Health IT is expensive
H
ospitals spend large sums on health IT. The level
of health IT spending will depend on both hospital
size and the technologies deployed. Hospitals use many
sources to finance IT, but rely primarily on capital and
operating budgets. Capital budgets cover investments
in buildings and medical equipment, as well as health IT
systems, while operating budgets cover staff, supplies,
and other daily expenses of running a hospital. Operating
costs are generally higher than capital spending in
a given year and represent ongoing costs, such as
upgrades, maintenance, and interfaces to ensure that
various applications work together.
number of beds in the hospital, reporting spending per
bed. Among the hospitals surveyed in 2006, the median
capital spending per bed for health IT was $5,556. This
is a one-year snapshot of capital spending, and does
not reflect the full spending for multi-year IT installations.
For operating costs, the median amount per bed was
$12,060. Thus, a 200-bed hospital at the median
spending level for health IT would have invested $1.1
million in capital for health IT and spent $2.4 million on
related operating costs in 2006.
On average, hospitals spent more on health IT in 2006
than in 2005. Notably, the median operating cost per
bed was 4.5 percent higher in 2006. The median capital
spending per bed was 1 percent higher.
To ensure a common comparison across large and
small hospitals, health IT spending was scaled by the
Spending on health IT is high
and increasing
Median one-year spending per bed
$11,538
$12,060
$5,500 $5,556
2005
2005
2006
Capital spending
2006
Operating costs
14
Cost is the greatest barrier
to greater adoption
H
ospitals are showing progress in health IT use, but
adoption is still not as widespread as it should be.
The survey asked hospitals about the many different
barriers to use, including the initial costs of deploying
IT, personnel needs, and the need to devote resources
to other priorities, such as meeting federal privacy and
security requirements. Respondents identified the initial
and ongoing costs of deploying and maintaining IT
systems as the greatest barriers to IT use. In 2006, 94
percent of hospitals saw the initial costs of adoption as
a significant barrier or somewhat of a barrier, compared
to 95 percent in 2005. In both years, 87 percent of
hospitals saw ongoing costs as a barrier.
In general, smaller hospitals were more likely to see
the initial and ongoing costs of IT implementation as a
significant barrier, but the largest hospitals (those with
500 or more beds) also struggle to afford health IT.
The availability of well-trained staff to implement
technology — both technical and clinical — is also an issue.
Hospitals also struggle with the lack of interoperability
among systems and finding technology that really meets
their needs. There were some changes in the percent
of hospitals identifying each barrier between 2005 and
2006, but the ordering of barriers remained consistent,
with cost being of greatest concern.
Hospitals continued to report cost as greatest barrier to IT adoption
Percent of hospitals indicating barrier is a “significant barrier” or “somewhat of a barrier”
54%
59%
Initial costs
2006
2005
Ongoing costs
2006
2005
Interoperability with current systems
2006
2005
27%
25%
Acceptance by clinical staff
2006
2005
23%
24%
Availability of well-trained IT staff
2006
2005
Inability of technology to meet needs
2006
2005
32%
33%
55%
54%
87%
87%
52%
52%
79%
77%
82%
82%
59%
58%
51%
49%
16%
15%
11%
12%
51%
48%
67%
54%
62%
60%
Significant barrier
15
94%
95%
40%
36%
Somewhat of a barrier
While a barrier for all, smaller
hospitals were most likely to see
ongoing costs as significant barrier
Percent of hospitals indicating ongoing costs are
a “significant barrier” or “somewhat of a barrier”
by bed size, 2006
<50 beds
50-99 beds
100-299 beds
300-499 beds
500+ beds
42%
49%
36%
91%
55%
28%
91%
59%
25%
87%
61%
38%
86%
45%
Significant barrier
83%
Somewhat of a barrier
Rural hospitals more likely to see
ongoing costs as significant barrier
Percent of hospitals indicating ongoing costs are
a “significant barrier” or “somewhat of a barrier”
by location, 2006
Initial
Costs
Urban
Ongoing
Costs
60%
Rural
Rural
Urban
36%
51%
42%
38%
52%
30%
56%
Significant barrier
16
96%
93%
90%
86%
Somewhat of a barrier
Hospitals are sharing
clinical data
A
mong survey hospitals, about half reported sharing
electronic patient-specific health information with
local or regional partners. This information exchange
can take many forms. Examples include:
•Web portals giving physicians access to hospital
information systems;
•Sharing electronic data with other hospitals or
facilities within a system;
• Sharing data with a laboratory;
•Electronic reporting to public health departments;
and
•Planned or nascent projects to share information
through a regional health information network.
Hospitals reported that they most commonly share
electronic patient information with private-practice
physician offices and laboratories. The percent of
hospitals sharing data with various partners changed
slightly from 2005 to 2006, but the general order
remained consistent.
Hospitals most commonly shared electronic patient
information with physician offices
Most commonly reported organizations for sharing of electronic patient health care information
among hospitals that shared data
Private-practice
physician office
2006
2005
Laboratories
2006
2005
Payers
2006
2005
Other hospitals
2006
2005
Public health
department
2006
2005
Long-term
care facilities
2006
2005
67%
66%
40%
46%
42%
39%
39%
38%
31%
28%
23%
27%
17
Policy implications
F
rom 2005 to 2006, hospitals showed progress
in health IT adoption. However, use varied, with
some hospitals just getting started while others had
fully implemented EHRs and routinely used CPOE. The
survey results indicate that hospitals are committed to
moving forward. However, adoption will be evolutionary,
as hospitals implement systems that meet their needs.
Acceleration of the adoption process will require
addressing the barriers identified in the survey, beginning
with the high cost of implementing and maintaining IT
systems. Hospitals are making investments in health IT
because they see the quality and safety gains that can
be realized. However, others who share in the benefits of
a wired health system, such as payers and purchasers,
must share in that investment. Certain types of hospitals
— such as those that are struggling financially, smaller
facilities, and those in rural areas — may need more
help than others.
18
End notes
1 An
EHR was defined as a system that integrates electronically originated and maintained patient-level clinical health information,
derived from multiple sources, into one point of access. An EHR replaces the paper medical record as the primary source of patient
information. This question was not asked in 2005.
2
AHA first asked this question in 2006. No trend data are available.
3
To compare data across years, only those functions that were included in both surveys were used in creating the groups.
19
Technical appendix
he survey instrument was designed with the
assistance of the AHA Member Advisory Group on
Information Technology, a group of about 20 hospital
chief executive officers and chief information officers.
AHA fielded the survey from October to November
2006. All community hospitals — not just AHA members
— were asked to respond.
T
from all parts of the country responded. Hospital CEOs
received multiple reminders about the survey through
e-mail, fax, and newsletters. We are thankful to the many
state, metropolitan, and regional hospital associations that
helped recruit respondents, and to the College of Healthcare
Information Management Executives for assistance with
survey review and recruitment of respondents.
Survey instruments were sent to hospital CEOs by both
e-mail and fax. Respondents could either respond via an
on-line Web portal or fax back a paper copy. We made
special efforts to ensure that hospitals of all types and
The following table compares the survey hospitals to
U.S. hospitals by bed size, location, teaching status,
and other variables. The comparison statistics come
from the 2005 AHA Annual Survey.
Comparison of sample to universe
Characteristic
Bed size
< 50 beds
50 - 99 beds
100 - 299 beds
300 - 499 beds
500+ beds
Universe (%)
Sample (%)
28.4
20.3
35.4
11.0
4.9
29.1
18.6
33.0
12.6
6.7
Location
Urban
Rural
59.3
40.7
53.5
46.5
Teaching status
Non-teaching
Teaching
78.3
21.7
80.4
19.6
Region
New England
Mid-Atlantic
South Atlantic
East North Central
East South Central
West North Central
West South Central
Mountain
Pacific
4.2
9.6
15.1
15.1
8.9
13.7
15.0
7.4
11.1
5.0
11.6
13.2
14.5
7.7
18.7
12.8
7.6
8.6
Ownership
Non-profit
Investor owned
State/local government
59.9
17.6
22.5
62.5
9.7
27.7
System Membership
Member
Non-member
55.0
45.0
41.7
58.3
Note: Universe includes all 4,936 community hospitals in the 2005 AHA Annual
Survey. Sample includes 1,543 community hospitals responding to the
2006 AHA Health IT Survey.
20
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02/07