that have invested significantly in health information technology
have lower mortality rates than other hospitals.
are three key differences in how hospitals apply and use information
technology to improve care," said Alden Solovy, executive editor
of Hospitals & Health Networks, the journal
of the American Hospital Association. "The 'Most Wired'
use a wider array of IT tools to address quality and safety, they
have a significantly larger percentage of physicians who enter
orders themselves and they conduct a larger percentage of clinical
activities via information technology."
they are safer environments for patients. According to Hospitals
& Health Networks' annual "100 Most Wired" survey, the top
wired hospitals have, on average, risk-adjusted mortality rates
that are 7.2% lower than other hospitals.
relationship between improved outcomes and information technology
has been previously documented in both academic and practitioner
research, but those studies usually dealt with specific projects
and targeted safety improvements. According to H&HN, this
is the first analysis showing that hospitals with broad use of
information technology across a variety of projects also have
called the differences between "Most Wired" and "Least Wired"
hospitals "staggering." The analysis does not establish an explicit
causal relationship between IT and outcomes. But it points hospitals
and health care organizations in a positive direction.
association is strongly suggestive, not causal, but it's an important
piece of the research," said Carolyn Clancy, M.D., the director
of the Agency for Healthcare Research and Quality, according to
the mortality analysis, the "2005 Most Wired" data found three
significant differences in how hospitals apply and use information
technology to improve care:
Most Wired use a wider array of IT tools to address quality
and safety, including Computerized Physician Order Entry (CPOE),
bedside electronic medication matching, automated alerts and
reminders, physician portals and electronic patient surveillance.
the Most Wired, significantly larger percentages of physicians
enter orders themselves.
Most Wired conduct a larger percentage of clinical transactions
— the number of doses ordered and the number of medications
matched to the patient — via information technology.
the Most Wired, 41% said they have achieved full adoption of pharmaceutical
order entry by physicians, compared with the 8% adoption rate
among the Least Wired. The survey also broke out results for "IT
Quality Leaders," the 50 hospitals that scored highest on the
survey's safety and quality section, and "Tech Leaders," which
are the hospitals on the 100 Most Wired list that are not among
the IT Quality Leaders.
availability of order entry is also important. The Most Wired
hospitals provide clinicians with access to CPOE functions from
more locations — 30% provide access from physician offices,
ambulatory settings or other remote locations, compared with only
5% among the Least Wired.
survey also found that the Most Wired were more proficient at
medication delivery. Among the 100 Most Wired, 28% of medication
orders are entered electronically by physicians. Among the Least
Wired, less than 2% of medication orders are entered electronically
use of electronic alerts by physicians, nurses and pharmacists
among the Most Wired hospitals was high, with full adoption rates
ranging 48% to 100%. Full adoption rates in the Least Wired group
ranged from zero to 67%, with duplicate order, drug-drug interaction,
dose checking and allergy alerts being the most common.
advanced hospitals have linked clinical alerting with electronic
surveillance to monitor patient vital signs, lab test results
and other clinical information in order to notify caregivers in
advance of any deterioration in a patient's condition.
technology is not the end-all solution. As the article states:
"Most chief information officers and chief medical officers say
that, to be effective, adoption of information technology must
be combined with clinical process improvements and a culture of
we know from the studies we're supporting is that technology is
only part of the drive to improve quality," Dr. Clancy said. "It
clearly has to be linked with process improvement."
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