AG: What were your impressions of the HIMSS conference? I know you’re connected to the show, but what did you notice?
DG: I work there too, but I’ve been going to the HIMSS conference since, I think, ’91. It seemed to flow smoother than any one I’ve been to in the past, and maybe that’s because I was paying attention to that. And I was really paying attention to that because I wanted to make sure that it was a good experience for everybody. We have had issues in the past, from what I understand, with things not working right. This year, I thought the exhibit floor was heavily populated. I think there were considerably more CIOs there this year and they stayed longer. We had more representatives from critical access hospitals there than we’ve ever had in the past, which is a good thing because those people are in the market for application software that haven't been before because they haven't had the money and they haven't had the impetus to do it. There was some special attention paid to that.
AG: What about major trends — anything that you heard people talking about that indicated certain directions the industry was moving in?
DG: I think there is still a bunch of confusion about what interoperability means. I’m seeing more rubber hitting the road on that kind of stuff. In the standards arena, people were pleased and were starting to actually codify some of the great ideas that people have had, especially the continuity of care document stuff. So I saw and heard some very positive stuff about that. I think the industry is in a stage … there are multiple stages and it depends on how far down the road you are and which stage you're in, but there are a lot of organizations out there that have spent a lot of money implementing technology and haven't gotten commensurate value for it. I think there is a recognition on the part of the organizations who haven't gone down that road yet, ‘Wait a minute, we need to factor that into the equipment right at the beginning rather than think about it after the fact.’ So I saw quite a bit of that kind of conversation going on. I don’t think there was any real breaking news.
AG: Did your organization conduct the HIMSS Leadership survey? There seemed to be some major questions about the results in the press luncheon we were both at.
DG: Yes, we did the Leadership Survey, but HIMSS Analytics also did surveying of its own. We’ve been doing the leadership survey for years for HIMSS. In the comparisons that we’ve done in Analytics, we’re showing that about 43 percent of the healthcare organizations increasing their spending, 22 percent are decreasing their spending, and there is not much change in the remainder (35 percent). Most healthcare organizations are increasing their spending; they have to. And it depends on what stage you're in. If you haven't spent the money yet on an enterprise vendor coming in with a bunch of clinical apps — which is the situation for a lot of critical access hospitals and the hospitals under 150 beds — they're going to spending a lot more going forward because they’ve got to spend, not only capital to buy the systems, but they’ve also got to spend in operations to be able to support it. So their budgets are going to go up.
If you’ve already spent the money and you’re already starting down the road, your operating budget is going to go up because you have to have more people to support the more advanced clinical apps, and you're starting to depreciate the capital you spent. That hits your operating budget as well. If you have already got everything implemented and you're not done, but you're way down the road, your operating budgets are still higher because you need a large IS staff and the support of IT to your organization is going to be greater.
It may not be the IS organization. Your organization may have a whole bunch of nurse informaticists that report into the nursing organization, but the total spend on IT in an organization from an operating perspective is going to be greater because you have to support the apps, they don’t support themselves, and you're going to be depreciating the capital.
So I don’t see any way that spending isn't going to go up. I just don’t. The stuff that we have projected through the next five years is showing them going up on the operating side, as well as the capital side. It won’t go up at the same level on the capital side in our view because we’re heading into a recession. We think people will be a bit more careful about their spending on the capital side, but the operating side, I don’t know how that number doesn’t do anything but continue to go up.
AG: Let’s talk about your EMR adoption model with its eight stages. How can our readers use that model to help them?