Who Leads The Online Race In Health Care?
 

Who Leads the Online Race

Chicago's big Northwestern Memorial Hospital, which has invested an average of $10 million annually on technology since 1995 and will invest $30 million over the next two years, makes the grade. But so do rural Good Hope Hospital in Erwin, N.C., and Kootenai Medical Center in Coeur d'Alene, Idaho, which have a fraction of that money to spend.

Over the past four years, the American Hospital Association has been identifying the "Most Wired" hospitals in all size categories, trying to get its arms around what kind of progress hospitals are making in using Internet technologies to connect with patients, doctors, nurses, employees, payers and suppliers. It has been giving out innovator awards to hospitals large and small that have embraced such technologies, and has offered up case studies on best practices in information technology.

The group's 2002 Most Wired Survey will be published next month. The group's analysis of the data it has collected already shows that more hospitals are providing clinicians with access to patient information via the Web. However, "there are hospitals that are much further ahead in this endeavor," says Alden Solovy, executive editor of the AHA's Hospitals & Health Networks magazine. "The gap is fairly wide." About 800 hospitals and health-care groups responded to the 2002 survey, or about 16% of the field.

The winners in past surveys (available at hhnmostwiredsurvey.com¹) range from such well-known innovators as Boston's Harvard-affiliated Partners HealthCare and the University of Pittsburgh Medical Center health system to lesser-known names like the Cape Fear Valley Health system in Fayetteville, N.C., and the Altru Health System in Grand Forks, N.D. There are a number of Veterans Administration and other military hospitals on the list, as the VA and the Pentagon have moved to more-aggressive use of information systems to manage their vast patient populations. As for smaller hospitals, many have made the Most Wired list by linking up with larger health-care groups; Kootenai, for example, got tagged as one of the survey's "Most Wired on a Budget" winners last year by joining forces with Inland Northwest Health Services, a Spokane, Wash., health-care network that delivers information-technology services and expertise to hospitals in Washington and Idaho.

DOWN TO THE WIRE   Hospitals have made significant gains in the past three years in providing Web-enabled access to clinical records, but there are still large differences among them. Hospitals providing physicians and nurses Web access to the following:     2002   2000 2001 2002 Most Wired (1) Less Wired (2) Current medical record 24% 42% 53% 81% 40% Medical history 25 40 51 78 38 Nurses' notes 18 24 30 54 18 Patient demographics 28 47 57 81 45 (1) Percentage of a benchmark group of hospitals on the 100 most-wired list that had the given technology.   (2) Percentage of a benchmark group of those hospitals that completed the survey but did not get named to the most-wired list that had the technology.   Source: Hospitals & Health Networks' Most Wired Survey 2000, 2001, 2002

Some hospitals make the grade, Mr. Solovy says, because they are ahead in connecting doctors and patients via the Web, and others because they have strong back-office and financial-information systems that save money and improve efficiency. Others have an emphasis in some particular aspect of technology that puts them ahead of the curve, such as computerized fetal-monitoring systems that allow an obstetrician to look at the readings from a home computer and decide whether to make a trip to the hospital at 3 a.m.

Though new systems have won the Most Wired awards each year, hospitals have also fallen off the survey because they didn't continue to invest in technology, Mr. Solovy says.

So far, it isn't clear whether the Most Wired hospitals do better when it comes to the quality of their clinical care. Last year, Hospitals & Health Networks asked Health Grades Inc., which ranks hospitals by various quality measures, to compare the clinical effectiveness of the Most Wired hospitals in its survey with the rest of the nation in six service areas: cardiovascular, stroke, vascular, orthopedics, pulmonary and obstetrics. (HHN notes that the comparison probably included other hospitals that might have made its Most Wired list but didn't participate in the survey.) Comparing actual deaths with predicted mortality and complication rates, Health Grades found that in cardiovascular care and obstetrics, the Most Wired earned higher ratings than the average for the rest of the nation. But in the other four services, the results were even.

Even among the most wired hospitals, obstacles to progress remain. Notably, few systems yet "talk" to different doctors and hospitals outside their own network, or to competitors who might have treated the same patient. There are a number of initiatives under way to change that, such as the new Patient Safety Institute's pilot project to collect medical records from different providers, but it's not here yet. "I still can't go from doctor to doctor and have my patient record move across town with me," says Mr. Solovy. "That needs to happen."

Interestingly, the process of conducting the survey itself has provided insight into just how complicated it will be to get the health-care system up to speed on information technology. Mr. Solovy says that one hospital that consistently ranks as the most wired has several staff members fill out the survey, but when the chief information officer compares their answers, he often finds his own staffers have different perceptions about the scope of services available to them through their own hospital's information technology. "Do we have a handle on the scope of the problem or how well wired health care is?" Mr. Solovy asks. "We have measures that are powerful enough to know that significant advances are being made, that greater investment is needed and that the rate of adoption -- relative to other industries -- is slow."

Not surprisingly, the hospitals that consistently rank high on the surveys tend to be the biggest and strongest, with the best credit ratings and greater access to capital. They tend to have strong cost-control and productivity measures. The 100 Most Wired hospitals and health systems also lead the nation in the use of online technologies for disease management, such as health-status assessment, submission of self-test results and online medication management, Hospitals & Health Networks notes.

But many hospitals are accomplishing a lot with slimmed-down versions of fancy information systems, and using the Internet, combined with security technology, "to make various pieces available for better patient care," Mr. Solovy says. "If you've got a commitment to getting wired and are frugal, you can accomplish a lot."

--Ms. Landro is an assistant managing editor of The Wall Street Journal in New York.

Write to Laura Landro at laura.landro@wsj.com⁶

Updated June 10, 2002