The Health Information and Management Systems Society's 25th annual HIMSS Leadership Survey, released at the HIMSS14 conference, offers much insight into the top concerns and challenges of healthcare CIOs and other IT executives.What follows is an in-depth look at the survey results as well as occasional comments from Jennifer Horowitz, the senior director of research for HIMSS Analytics, the division of HIMSS that conducted the survey in December 2013.Who Took the HIMSS Leadership Survey?Image by HIMSS Leadership SurveyMost of the survey's 298 respondents (65 percent) are CIOs. Of the rest, 16 percent are directors of IT or IS, 9 percent are chief medical information officers (CMIOs), 4 percent are chief nursing informatics officers and the remaining 6 percent are IT managers and informatics personnel.Nine in 10 respondents work in a hospital environment, with 37 percent at a standalone hospital, 32 percent in a healthcare system and 21 in a multi-hospital system. Together, they represent 650 U.S. hospitals, with an average bed size of 600. Four percent of respondents work in an outpatient setting, with the others at mental or behavioral health facilities, long-term care facilities and home care agencies.What Responsibilities Do HIMSS Leadership Survey Takers Have?Image by HIMSS Leadership SurveySixty-five percent of respondents sit on organization's executive committee, which HIMSS describes as "the leadership team that drives overall organization strategy and direction." Those who identify themselves as senior IT executives have a range of responsibilities, from contributing to overall business strategy (87 percent) to driving value from IT investments (85 percent) to managing IT department operations (75 percent).In addition, nearly all respondents oversee at least one area outside IT. For most, it's telecommunications (67 percent) or informatics (57 percent), though health information management (22 percent) and biomedical or clinical engineering (16 percent) are also common.What Are Healthcare CIOs' Key Business Objectives?Image by HIMSS Leadership SurveyFor one in four healthcare IT leaders, sustaining financial viability ranks as the top business objective. (Respondents were asked to choose one option from a list of several.) The transition to ICD-10 is a big part of that, Horowitz notes. Organizations that can't file claims using ICD-10 codes won't get reimbursed, which dramatically impacts the bottom line.Other main objectives include improving operational efficiencies (16 percent), improving patient care and meeting meaningful use requirements (both at 14 percent). Least important: Improving physician satisfaction, attracting quality staff and participating in a health information exchange (HIE) organization, all cited by fewer than 1 percent of respondents.What Business Issues Drive Healthcare IT Decisions?Image by HIMSS Leadership SurveyThe biggest factor is healthcare's changing payment models (23 percent), though this is down from 37 percent in 2013's survey. Right behind it, at 22 percent, are policy mandates such as the ICD-10 conversion, which much be completed by Oct. 1, 2015. (Note: At the time of the survey, the ICD-10 deadline was Oct. 1, 2014; March's Congressional votes pushed it back one year. Again.) Demand for capital and creating new revenue sources checks in at 17 percent. Non-IT infrastructure needs such as facility upgrades aren't important; neither are outside threats such as terrorism or natural disasters.What Are Healthcare's Overall IT Priorities?Image by HIMSS Leadership SurveyFor 25 percent of respondents, it's meaningful use. This is down from 28 percent in 2013 and 50 percent in 2011 \u2014 not surprising, given that meaningful use enters Stage 2 in 2014 and given that the Government Accountability Office reports that hospitals and physicians are dropping out of meaningful use.Additional priorities include more efficient use of existing IT systems (19 percent) and big data analytics using what's in BI systems and clinical data warehouses. Several initiatives are of little concern: Personal health information (PHI) security, identity management, medical device integration, consumer-focused solutions, revenue cycle management and supply chain management.What Is Healthcare's Clinical IT Focus?Image by HIMSS Leadership SurveyHIMSS asked specifics questions about healthcare CIOs' clinical, financial and infrastructure challenges. On the clinical side, myriad physician systems are a top priority (21 percent); these include computerized physician order entry (CPOE), clinical decision support (CDS) and physician documentation. Implementing a fully functional EHR, which is critical to achieving meaningful use Stage 2, and linking clinical systems to quality measures both check in at 13 percent. Low priorities include clinical data repositories, nursing documentation, picture archiving and communication systems (PACS), evidence-based guidelines for CDS, clinical documentation flow charts and implementing sub-acute and post-acute care solutions.What Is Healthcare's Financial IT Focus?Image by HIMSS Leadership SurveyBy a landslide, and to no one's surprise, it's ICD-10 (69 percent). Also worth noting: 92 percent of respondents say they will be ready for the (at the time of the survey) Oct. 1 deadline for making the transition to ICD-10. Other issues include upgrading patient billing systems (6 percent) and upgrading financial analytics to support the accountable care organization model (5 percent).Interestingly, natural language processing, seen as a way to reduce the ICD-10 coding burden, wasn't deemed important. Neither was reducing the reliance on payment clearinghouses by sending claims transactions directly to insurers.What Is Healthcare IT's Infrastructure Focus?Image by HIMSS Leadership SurveyResults here represent a mixed bag. Given that IT budgets are limited \u2014 and often constrained by EHR implementations and other initiatives \u2014 Horowitz says organizations have to make choices about where they invest.Security topped the list of concerns (20 percent). One in five respondents also say they experienced a data breach in 2013, which suggests continued challenges in preventing healthcare data breaches. Close behind security, though, were desktops and laptops (15 percent), virtual desktops and laptops (also 15 percent) and servers and virtual servers (11 percent). Implementing a vendor neutral archive, sometimes seen as a "must" for healthcare big data, mattered most to only 3 percent of respondents.What Are Healthcare IT's Biggest Barriers?Image by HIMSS Leadership SurveyNot surprisingly, inadequate budget and staffing represent the biggest barriers hindering healthcare IT, at 19 and 18 percent, respectively (more on these two issues later). Coming in third, to quote the survey: "Vendors' inability to effectively deliver products or services to respondents' satisfaction." Data security, effective project management and government regulations that prevent technology sharing with referring providers ranked among the least important barriers.Horowitz suggests that security ranked low here, despite topping the list of IT infrastructure concerns, for a simple reason: Without investments and skills, organizations can't get under the covers and address their most pressing security needs.What's Happening to Healthcare IT Budgets?Image by HIMSS Leadership SurveyAccording to HIMSS Analytics, the average IT operating expense in U.S. hospitals is 3.08 percent of total expense. Among survey respondents, 65 percent say their IT budget would increase in 2014, 19 percent expect an unchanged budget and 12 percent expect a decrease.Several factors drive budget increases: Growing systems and technology adoption (58 percent), compliance (49 percent), overall budget increase (46 percent), infrastructure upgrades (41 percent) and additional staffing or consulting needs (39 percent).Lower IT budgets, meanwhile, are easier to explain: 65 percent of respondents expecting smaller budgets attribute it to overall budget decreases, while 35 percent blame it on reductions in revenue.What's Happening to Healthcare IT Staff?Image by HIMSS Leadership SurveyThe average hospital IT staff, according to HIMSS Analytics, is 39 full-time equivalents. Half of survey respondents expect IT staffing levels to stay the same in 2014, while 39 percent plan to add IT staff in 2014 \u2014 though 57 percent expect to add fewer than five FTEs and 9 percent say their would-be new hires aren't in the budget. For comparison's sake, half of 2013's respondents planned to add staff, and 61 percent did in 2012.Top staffing needs include clinical application support (36 percent), network and architecture support (29 percent) and clinical informatics (21 percent). IT planning and mobile device management, meanwhile, ranked among low priorities.How Can Healthcare IT Improve Patient Care?Image by HIMSS Leadership SurveyBetter patient care (and patient engagement) ranks with improving efficiency and lowering costs as key goals for most hospitals. Healthcare IT leaders aim to boost patient care by improving clinical and quality outcomes (37 percent), reducing medical errors and improving patient safety (18 percent) and using evidence-based medicine to standardize clinical care (13 percent). Obtaining data from remote locations, such as patient homes, didn't register \u2014 though as mobile health demands rise, and as wearable technology catches on, hospitals may have no choice but to respond.