Meaningful use – a concept introduced only a year ago – appears to be spurring an increase in healthcare information-technology (IT) spending, along with a brightening economy, suggests results of the 21st annual Healthcare Information and Management Systems Society (HIMSS) leadership survey. The American Reinvestment and Recovery Act (ARRA) promises financial incentives to providers and hospitals for the "meaningful use" of certified healthcare IT products. Although criteria for meaningful use will not be established until later this year, 59 percent of the 398 respondents to this year’s survey said they plan to make additional investments to position themselves to qualify for the incentives.

Nearly three quarters (72 percent) of respondents said they expect their IT operating budgets to increase, bringing that response back to the levels of two years ago. Last year, only 55 percent of respondents expected an increase in their budgets. Forty-nine percent of those who said their budgets would increase this year reported that meaningful use would be a driver. Another 45 percent reported the increase would be due to an overall growth in the number of systems and technologies at their organization.

Asked to identify their single IT priority during the next two years, 42 percent of respondents identified meeting meaningful-use criteria. When asked to identify their organization’s primary clinical IT focus, 35 percent said it would be ensuring their organization has a fully functional electronic medical record (EMR) in place, and 27 percent said it would focus on installing a computerized provider order-entry (CPOE) system.

Meaningful use was reflected in other answers throughout the survey. More than one-third (38 percent), for example, said government issues would have the biggest impact on healthcare in the next two years; whereas last year, only 6 percent thought that was the case. Financial considerations were identified as the top business issue last year, chosen by 54 percent of respondents. This year, 23 percent identified it as the top business issue.

Security concerns continue to remain consistent. One third of respondents (34 percent) said an internal breach of security was their top security concern, and nearly one-quarter (23 percent) said their organization had a security breach in the past year. Thirty percent said their major security concern was compliance with Health Insurance Portability and Accountability Act security regulations and Centers for Medicare & Medicaid security audits.

Nearly half (48 percent) of the healthcare organizations surveyed said they have a fully operational EMR in at least one facility, compared to 41 percent last year. Nearly a quarter (22 percent) said they have a fully operational EMR throughout their entire organization, up from 17 percent last year. Almost a third (32 percent) have begun to install an EMR in at least one facility.

Asked about what area of patient care on which IT could have the most impact, more than a third (37 percent) said it could improve clinical and quality outcomes. Another quarter (28 percent) felt the biggest impact would be in reducing medical errors and improving patient safety. The 2009 survey identified the same top two items, with the order reversed. Additionally, nearly all (95 percent) said clinicians play a role in the IT process at their organizations.

HIMSS: Embrace technology

Excerpts from the keynote address given by Barry Chaiken, M.D., chairman of the board of directors, HIMSS.

"Our great country is on an unsustainable healthcare cost curve that threatens our ability to bounce back from the severe economic challenges we now face. Healthcare information technology is the instrument that will transform healthcare and it is we – the informaticists, clinicians, management engineers, senior IT executives, IT specialists and the diverse talents of so many others – who will create the applications, processes and work flows that will improve quality, safety, access and cost efficiency.

"In many respects, our healthcare system still operates like the typical business of 1969 – it is still largely paper based, it ignores information tools that can facilitate evidence-based best practices, and it functions without analytics to qualify and quantify the care we provide. Medical decisions are made according to implicit criteria – hidden internal knowledge – rather than explicit criteria – external knowledge that can be checked, evaluated and updated. Too many providers are not taking advantage of 21st-century technologies to access 21st-century information, choosing instead to provide care the same way it was done 40 years ago.

"Today, we must begin to change healthcare by creating healthcare IT solutions that are so compelling, so irresistible, that people just want to use them. We cannot rely on incentive programs or executive orders. We must create demand.

"We must create electronic systems so appealing that they make physicians want to leave their paper medical records behind. We must create clinical decision-support systems that make it routine for physicians to check their internal knowledge with data and evidence. We must offer work-flow solutions that improve the efficiency of using health IT. We must make physicians want, yes, demand the enormous power that IT brings to ... medicine.

"We have to change a paper-based system in which most clinical decisions are made primarily by intuitive judgment – based on the ability to recall disparate facts – into an electronic system enabling decisions to be made according to data and evidence.

"We must provide clinical decision-support tools that reduce the burden of recalling facts and help to assess patients, form diagnoses and choose therapeutic paths. Healthcare IT opens the door to this higher level of medical practice, one where both physicians and nurses can concentrate on examining, interacting and motivating patients, while technology handles the burdens of collecting, storing and accessing data. The knowledge of best practices and evidence-based care must be delivered to every single clinician at every point of care so that every patient everywhere receives care according to this latest knowledge, rather than according to the habits of a clinician disconnected from this knowledge.

"It’s up to healthcare IT to make knowledge more readily available and its discovery and use more intuitive. This work will require the design of clinical decision-support systems and other tools that merge seamlessly with patient-care activities. This work will not just distribute best practices, but embed them into the work flow of medical practice. This work requires a unique multidisciplinary effort involving not only work-flow experts but also virtually any person connected with clinical care.

"Bringing this level of sophistication and beyond to American healthcare will signify true transformation and will require all of the diverse talents represented within HIMSS. No matter who you are – whether you are a senior IT executive, a clinician or an engineer; whether you come from a hospital, a community or public health organization, a clinical practice, a payer or a pharmaceutical company; or whether your primary interest is patient safety, quality, research, privacy, or return on investment – we need you to contribute to the cause of transforming healthcare through IT."