Part 1 of 2. While the American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act make headlines, many hospital IT departments are battling to improve patient care and hospital employee productivity while simultaneously cutting costs and increasing access to secure data.
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The soaring number of uninsured and under-insured, the battle to keep well-qualified staff from moving to another organization, the always-on nature of the hospital IT world, and the ever-increasing number of software applications within a medical facility create a plague of challenges for frazzled IT professionals at small and medium-sized hospitals. But it all comes down to one key issue.
"I think every hospital will tell you their number one challenge is finance," said Gary Weiner, a senior manager and consultant at Affiliated Computer Services Inc. (ACS), a Dallas-based provider of business process and IT services.
Funding fears for hospital IT departments
Finding the money to pursue, implement and support new applications or expand existing systems is an ongoing effort for hospitals. As health care organizations seek tools to improve patient care, enhance productivity, shave costs and compete against larger groups, the pressure is on the usually small hospital IT department.
"When you have a lack of funding, you're also trying to do more with less people as well. Most hospitals, especially small and midsize, don't have large CTO[chief technology officer] roles or infrastructure executives," said Jeff Laurinaitis, a sales director at RKON Technologies, which provides IT services to Children's Memorial Hospital in Chicago, among other medical clients.
Already, some organizations have funneled money from their hospital IT budgets to new HITECH and ARRA projects, such as electronic medical records (EMRs), forcing delays on other projects.
"[One] hospital's planning to move into a large EMR that's going to need a lot of support and there isn't any more funding," Weiner said about one ACS client. "This hospital's going to spend over $30 million over the next three years. Over a 10-year-period, it could be $75 million to $100 million."
Projects related to the HITECH Act involve more than just software and hardware. Small hospital IT departments need the personnel to implement them, the high-speed networks to transport their data, and the patience to ensure that the system meets not just the HITECH Act's fine print but also the needs of the doctors, nurses and administrators who use it daily.
Filling jobs in the hospital IT department
High unemployment may translate into more job seekers, but it has not simplified small and medium-sized hospitals' ability to attract and retain quality IT personnel, some executives said.
"Staffing is a huge issue, and we're trying to look at what programs, software, initiatives can we delay or automate through different means to try to take the burden off folks," said Mike Ward, director of information services at Anderson Hospital, a 130-bed, not-for-profit facility in Maryville, Ill.
Those in more rural areas are hard pressed to find the people they need, executives said. "Most rural facilities have limited or no availability to high-quality technical professionals and consulting or contract personnel, which is cost-prohibitive," said Roger Neal, vice president and chief information officer (CIO) at Duncan Regional Hospital in Oklahoma. "Yet, to maximize the opportunity available using technology, the opportunity to receive stimulus reimbursement, and to provide the safest care, you need high-quality resources."
We help save lives by making sure [clinicians] have the tools to do so.
George Curtis, director of information systems, Upson Regional Medical Center
There are two schools of thought on how to fill IT jobs at hospitals.
Chuck Wiley, CIO at Harrison County Hospital in Corydon, Ind., said medical professionals trust their invaluable technology in the hands of someone with an IT background. "What I find is, from [the user's] standpoint, they don't care how much we [in IT] know about what they're doing. They want to know that we can fix their computer," he said.
This approach could backfire, though. Right now, there aren't enough IT employees for health care, just as there weren't enough IT pros for banks and other organizations threatened by the Y2K problem, Anderson Hospital's Ward said. "Over the next few years, we're going to be bringing a ton of people into health care IT," he continued. "Once 2015 comes around and we have to have it all in place, we'll have a group of consultants who are not going to have enough work."
Ward thus prefers to teach IT skills to medical professionals. "It's easier to teach nurses about technology than computer people about health care….Health care is discombobulated. It's this monstrosity that's very difficult to get your arms around," he said. "The time spent teaching [nurses] patient care -- where they see people move through the system -- is the most important aspect. I know they have a good foundation of what needs to be changed and what needs to be the same, when implementing a new technology." (Harrison County Hospital's Wiley noted that his department has hired medical professionals in some cases, and will continue to do so "in an ideal situation.")
Keeping hospital IT departments constantly connected
Meanwhile, Internet access, taken for granted in metropolitan and suburban regions of the nation, is a pressing need at rural medical facilities.
Government agencies are investing funds to expand rural practitioners' access to the Internet, while telecommunications and cable providers are speeding up their initiatives. Last year, for example, the Federal Communications Commission donated $9.9 million to the Iowa Rural Health Telecommunications Program (IRHTP). The funds were allocated to install a fiber optic connection to Iowa's communications network. (This particular initiative was highlighted in a case study on the Rural Assistance Center website.)
Before the fiber optic installation, participating hospitals used limited Internet connections to research health issues or communicate with people outside the area. After the anticipated three-year rollout, hospitals will be able to send bandwidth-hungry EMR files and share video, pictures and data with colleagues across the country, according to the IRHTP.
Harrison County Hospital's Wiley said his hospital IT department doesn't have a lot of options for high-speed connectivity -- "we purchased a T1 from the phone company; it's a good solution, but it's a little pricey for us" -- though he is seeing a push from Verizon to make DSL available in the area. "Unfortunately, the more rural you get, the worse it's going to get," he added. (Harrison County's population is about 35,000.)
Assuring customer, user satisfaction with hospital IT services
Hospital IT spending, staffing and connectivity notwithstanding, a small or medium-sized hospital's IT department also must be exceptionally talented at communicating with a diverse user base to determine which technologies are best suited to meet users' needs and allocate resources, executives said.
A straightforward mission statement can affect communication and a hospital's IT strategic plan positively, said George Curtis, director of information systems at Upson Regional Medical Center in Thomaston, Ga., and a member of the state's Healthcare Information and Management Systems Society, or HIMSS, board.
"Years ago, we were a normal hospital, very employee-focused, [but t]he past and present CEO took us through a cultural change," Curtis said. "Everything is about the patient. We make all our decisions, including in our IT, based on how is this going to help the patient. If it doesn't fit into that category, it gets back-pocketed."
Some may think patient satisfaction matters little to a hospital IT department. Not so, Curtis said. “We have to make sure our clinicians have everything they need to take care of our patients. In that proxy manner, we consider ourselves quasi-clinicians. We help save lives by making sure [clinicians] have the tools to do so."
The future of the hospital IT department: Facing forward
Information technology continues to reshape the way small and medium-sized hospitals treat patients, from imaging and EMR software to e-prescription systems and remote data access. These technologies promise improvements to productivity and patient care, but they challenge IT professionals on a regular basis. And now, with the passage of the stimulus package and the HITECH Act, additional requirements await.
Part 2 of this series examines the mandates of the stimulus package and provides strategies for complying with them.