Analyzing the HIMSS Leadership Survey of Healthcare CIOs

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.

Most 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.

Sixty-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.

For 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.

The 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.

For 25 percent of respondents, it’s meaningful use. This is down from 28 percent in 2013 and 50 percent in 2011 — 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.

HIMSS 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.

By 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.

Results here represent a mixed bag. Given that IT budgets are limited — and often constrained by EHR implementations and other initiatives — 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.

Not 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.

According 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.

The 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 — 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.

Better 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 — though as mobile health demands rise, and as wearable technology catches on, hospitals may have no choice but to respond.

To improve coordination, a hospital pursuing a new business model such as the accountable care organization needs data analytics — and that only happens when everyone on the care team has “secure, online access to patient information.” Nearly all physicians (96 percent) enjoy such access, compared to 70 percent or nurses, 63 percent of other clinical professionals such as therapists and 61 percent of non-clinical staff such as transcriptionists. Only 36 percent of institutions give patients secure, online access to their own data — though this is up from 12 percent in 2010.

As noted, 20 percent of respondents experienced a data breach in 2013. Their top healthcare IT security concerns include CMS security audits and the HIPAA Security Rule (38 percent), suffering an internal data breach (29 percent) and securing data on mobile devices (24 percent).

Issues of lesser importance include the ability of business associates to comply with BAAs — not surprising, given that healthcare is warming to cloud technology— as well as EHR security. Both checked in at only 3 percent.

Sixty-four percent of respondents are part of a health information exchange, which HIMSS defines as “an organization which brings together healthcare stakeholders to oversee and govern the exchange of health-related information according to nationally recognized standards.” Such organizations can be private or state-run — and 12 percent of respondents take part in a state-run HIE. (These received funding under the HITECH Act, but this money runs out this year.)

The number of organizations participating in HIE represents an increase from 51 percent in 2013. Among the remainder, 16 percent of organizations have chosen not to participate, 14 percent have yet to start planning and 3 percent participated in a failed HIE organization.

For 49 percent of healthcare organizations, IT’s strategic plan is part of the larger operating, clinical and capital strategic plans. Among the remainder, 37 percent say the IT plan is integrated with, but separate from, the organizational strategic plan, 7 percent have unintegrated IT and organizational plans and 6 percent startlingly don’t have an IT strategic plan at all.

Horowitz says, overall, this reflects a “very high degree of cohesion and interconnectedness,” since 86 percent of strategic and IT operating plans are in fact integrated. She adds that the numbers haven’t moved much in the last few years. Organizations that haven’t changed, then, aren’t likely to do so.

Ninety percent of respondents qualified for meaningful use Stage 1; an additional 6 percent plan to. As for Stage 2, 71 percent expect to qualify this year, 19 percent next year and 2 percent in 2016. (Four percent aren’t sure.)

Forty-three percent of organizations spent less than $4 million to meet Stage 1 requirements, 24 percent spent between $4 million and $10 million, and 9 percent spent more than $10 million. Stage 2 should be less expensive, though 19 percent aren’t sure what it will cost.

As for overall ROI, 51 percent expect less than $4 million, 9 percent expect between $4 million and $10 million, and only 3 percent expect more than $10 million. The rest don’t know or declined to share.

As stated, 92 percent of respondents expect to meet the government-mandated deadline for making the transition to ICD-10. (Remember, that date has been pushed back to Oct. 1, 2015.) Most haven’t had to spend a lot to get there — for 46 percent, the cost falls below $1 million, while only 4 percent of respondents are spending more than $5 million to prepare clinical, financial and administrative systems for the ICD-10 code set. Tellingly, though, one in four don’t know what the ICD-10 conversion will cost.

At this point, Horowitz says, it’s “almost a foregone conclusion” that IT can be instrumental in impacting patient care. This impacts the bottom line, too: Organization that aren’t financially viable can’t provide high quality patient care and vice versa.

Horowitz plans to keep an eye on a few things this year:

* Will even more organizations appoint a chief nursing informatics officer? * Will clinicians’ increasing role as “project champions” — 74 percent evaluate technology before an organization buys — lead to better IT investments? * As healthcare’s reimbursement model changes, and sustained business viability remains a key business objective, will financial resources continue to outpace staffing as the top barrier to implementing IT?