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Clinical is King

June 1, 2007
by Mark Hagland
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This year's HIMSS CIO Survey found that using clinical IT to improve patient safety was top-of-mind

H. stephen lieber

Stephen Lieber

More than ever before, the results of this year's HIMSS Leadership Survey are clear: right now, the focus is on clinical information systems.

And with IT executives finding that improving quality of care and patient satisfaction are the top issues driving healthcare IT spending, it's not surprising that respondents to the annual survey (60 percent of whom were CIOs this year) cited implementing technology to reduce medical errors and promote patient safety as the top IT priority both for now and the next two years.

Specifically, nine of the top 10 healthcare applications identified as being important for the future were clinical systems, with computerized provider order entry (CPOE) and electronic medical records (EMRs), tied at 47 percent, as the most important applications.
HIMSS leadership survey respondents are putting clinical it priorities above others, with improvement of patient safety, replacement/upgrade of clinical systems, and emr implementation, at the top, in the next year

In fact, the top eight "most important applications" or the next two years cited by respondents were all clinical in nature. Following CPOE and the EMR, respondents named clinical information systems in general (46 percent), bar-coded medication management (43 percent), the clinical data repository (37 percent), enterprise-wide clinical information-sharing (35 percent), evidence-based medicine at the point of care (29 percent), and point-of-care data collection (29 percent) as the most important applications going forward.

Given the centrality of the EMR to clinical information systems development in general, the significant progress in EMR implementation that seems to be taking place is a positive sign, HIMSS leaders noted. This year, 32 percent of respondents reported that they had a "fully operational system," versus 24 percent last year and 18 percent two years ago. "There could be some debate about the definitions and numbers; but the trend is very clear," said H. Stephen Lieber, the association's president and CEO.

And George "Buddy" Hickman, CIO of Albany (N.Y.) Medical Center and HIMSS' chairman, added, "I would say that EMR adoption is the most discussed topic out there today" in terms of IS implementation.

Hickman added that hospital organizations are going for real benefit from EMR implementation in terms of improving patient care quality and optimizing processes and clinical operations. "Adoption does take a while," he added, with regard to the relatively slow uptake of EMR implementation until recently, "because we are talking about remarkable cultural changes" required along with technology implementation.

"The rate of change has picked up dramatically" on EMR adoption, Lieber added. "Seven years ago, during the 2001-2003 period, the rate of increase of EMR adoption was about 1 percent a year; now we're jumping 17 percent or more a year."

Meanwhile, along with the pace of EMR adoption have come heightened security concerns. Asked what their top concerns were over security of computerized medical information, respondents cited internal breaches of security (57 percent), HIPAA compliance (30 percent), the limits of existing technology (26 percent), connecting IT at hospital and remote facilities (25 percent), external breaches of security (23 percent) and unauthorized use of data by third parties (19 percent) as their top concerns
All the applications cited as most important are clinical, including cpoe, emr, and bar-coded medical management

And they named disaster recovery, firewalls, user access controls, audit logs, single sign-on technologies, data encryption, electronic signaturing, and offsite storage as top technologies to protect their data and information systems generally.

Meanwhile, respondents cited lack of financial support, a perpetual issue, as the most significant barrier to implementation (at 20 percent), followed by lack of staffing resources (16 percent), and vendor inability to effectively deliver product (15 percent). The 360 respondents to this year's leadership survey represent 306 organizations and nearly 700 hospitals nationwide. A summary of the survey's results can be found on the HIMSS Web site, at

Mark Hagland is a contributing writer based in Chicago.