Measuring information technology investment among Canadian academic health sciences centres

Many recent studies have attempted to accurately measure the expenditure by hospitals in the area of new information technology (IT), for example see Leonard 1998 and Pink et al. 2001. This is usually done as an exercise to compare the healthcare sector with other industries that have had much more success in implementing and leveraging their IT investment (Willcocks 1992; Chan 2000). It is normally hoped that such investigation would help explain some of the differences among the various industries and provide insight into where (and how much) future IT spending should occur in healthcare (Leonard 2004). Herein, we present the results from a study of eight Canadian academic health sciences centres that contributed data in order to analyze the amount of information technology spending in their organizations. Specifically, we focus on one specific indicator: the IT spend ratio. This ratio is defined as the percentage of total IT net costs to total hospital net operating costs, and aims to provide a "relative (or percentage) measure of spending" so as to make the comparisons meaningful. One such comparison shows that hospitals spend only 55% of the amount the financial services sector spends.     

The effect of information technology investment on firm-level performance in the health care industry

BACKGROUND: The return on investment for information technology (IT) has been the subject of much debate throughout the history of management information systems research. Often referred to as the productivity paradox, increased IT investments have not been consistently associated with increased productivity. Understanding individual IT factors that directly contribute to business value should provide insight into the productivity paradox. PURPOSE: The effects of 3 different firm-level IT characteristics on financial performance in the health care industry are studied. Specifically, the effects of IT budget, IT outsourcing, and the relative number of IT personnel on firm-level financial performance are analyzed. METHODS: Regression analysis of archival survey data for 914 Integrated Healthcare Delivery Systems is performed. RESULTS: IT budgetary expenditures and the number of IT services outsourced are associated with increases in the profitability of Integrated Healthcare Delivery Systems, whereas increases in IT personnel are not significantly associated with increased profitability. Each one tenth of a percentage increase in IT expenditures is associated with approximately $100,000 in increased profit, and each additional IT service outsourced is associated with approximately $950,000 in increased profit for an average-sized Integrated Healthcare Delivery System. IMPLICATIONS: To increase profitability, IT administrators should increase IT budgetary expenditures along with IT outsourcing levels. IT administrators in the health care industry can use such findings during budgeting cycles to justify increased investments in IT personnel as being budget neutral while increasing organizational capacity.     

Antecedents of clinical information technology sophistication in hospitals

Grounded in the resource-based theory and the innovation diffusion theory, this article develops and tests a research model for assessing the antecedents of hospital innovativeness with regard to clinical information technology (IT) applications. A cross-sectional survey was conducted in a sample of U.S. hospitals (n = 74) to assess three dimensions of clinical IT sophistication. Secondary data were used to measure the antecedents, namely, four groups of organizational capacity variables. Bivariate and regression analyses were conducted to identify significant associations. A significant percentage (45-61%) of the variance in clinical IT sophistication was explained, mostly by leadership and knowledge sharing capacities. In particular, IT tenure and technical knowledge resources were significantly related to clinical IT sophistication. Surprisingly, managerial tenure and hospital's belonging to a network showed significant negative associations with two dimensions of the clinical IT sophistication construct. To address the challenges they face, hospitals should consider encouraging career development for current individuals in charge of IT activities, and attracting professionals with an IT background who have the knowledge and ability to trigger new ideas and favor the adoption and use of clinical IT applications in these settings.     

The development and implementation of a strategic and tactical planning framework at Mayo Clinic Arizona

This article describes the Mayo Arizona process for developing an information technology strategic plan. The background of organizational events that gave rise to this strategic planning process is presented. A cross-functional team of key IT stakeholders was convened; the team used a facilitated process to derive a pro forma set of IT strategic objectives from the larger organization's emerging strategic plan. A broad set of leadership interviews was conducted to further identify detailed objectives that would confirm, complement, or conflict with the "strawperson." The IT strategic objectives then were refined and published by the organization. The article also describes the annual process of reviewing the IT strategic plan and translating it to a set of tactical objectives. This includes the committee structure for project prioritization, which is guided by the IT strategic plan. The outcome of the prioritization process is a five-year IT tactical plan, which is used to communicate the IT action plan for achievement of the strategic objectives. The strategic and tactical plans have resulted in stronger ownership and advocacy of IT activities by organizational leadership and a clearer view of the impact of technology on the organization's strategic plan.     

The effect of payer mix on the adoption of information technologies by hospitals

BACKGROUND: Numerous studies have examined the relationship between organization characteristics and hospital adoption of information technology (IT). However, no known study has examined whether patient characteristics of those treated at a given hospital influences the decision to adopt IT. PURPOSE: The present study combines primary and secondary data to examine the effect of payer mix (the combination of payers that make up a given hospital's patient discharges) on IT adoption in hospitals. METHODS: Survey data from Florida hospitals were combined with the state's hospital discharge database. Multiple regression analyses were used to analyze the data. RESULTS: When examining Medicare, Medicaid, traditional commercial insurance, and managed-care plans, only an increase of managed-care patients, as a percentage of hospital discharges, was associated with a significant increased likelihood to adopt clinical and administrative IT applications by hospitals. PRACTICE IMPLICATIONS: Our results suggest that increasing cost pressures associated with managed-care environments are driving hospitals' adoption of clinical and administrative IT systems as such adoption is expected to improve hospital efficiency and lower costs. Given that such cost pressures are also emergent in Medicare, Medicaid, and traditional third-party payment environments, an opportunity exists for these parties to motivate hospital IT adoption as a means for cost reduction.     

Can information technology help hospital employees to reduce costs?

Objectives

The purpose of this study is to examine the association of hospital employees and health IT on Case Mix Index (CMI).

How automated access verification can help organizations demonstrate HIPAA compliance: A case study

This case study of Sharp HealthCare takes an in depth look at how the organization has embedded security policies into its business process and automated workflow to ensure users are granted only the IT access that is necessary for them to perform their jobs and to ensure patient privacy Some of the most pressing audit and compliance concerns in healthcare organizations today revolve around the need to constantly review and give an account for users' IT access. The need for this at Sharp is exacerbated because of the high rate of change within the organization and the large percentage of non-employee staff such as traveling nurses moving throughout hospital departments on their rotations. By implementing a software solution to verify the accuracy of user access rights or automatically initiate appropriate corrective actions, Sharp is now able to extend the responsibility and accountability for compliance to the most appropriate resources.     

Relationship between obesity, total plasma cholesterol and blood pressure in male adults]

I investigated the relationship between the percentage of body fat, Body Mass Index (BMI) and total plasma cholesterol and blood pressure. The percentage of body fat was measured by the bioelectrical impedance method. The subjects investigated were 2,955 men aged from 23 to 59 years, who were working in a company making machinery. They were divided into four groups as follows. The normal group were within the normal BMI range (< 24) and body fat percentage range (< 20%). The seemingly obese group were over the normal BMI (> or = 24) and normal percentage of body fat range. The occult obesity group were within the normal BMI range and over the normal percentage of body fat range (> or = 20%). The obese group were over the BMI and percentage of body fat range. In each group, those who had high total plasma cholesterol and blood pressure were counted. The number of those who had high total plasma cholesterol was significantly larger in the obese group than in the seemingly obese group and the normal group, and larger in the occult obesity group than in the seemingly obese group and normal group and larger in the seemingly obese group than in the normal group. The number of those who had high systolic blood pressure was significantly larger in the obese group than in the occult obesity group, the seemingly obese group and the normal group, larger in the occult obesity group than in the normal group and larger in the seemingly obese group than in the normal group. The number of those who had high diastolic blood pressure was significantly larger in the obese group than in the occult obesity group, and the seemingly obese group and the normal group, larger in the occult obesity group than in the normal group, and larger in the seemingly obese group than in the normal group. These results suggest that measurement of percent body fat is useful in preventing adult diseases in employees with a high percentage of body fat, but who show no sign of abnormality in medical examinations, and those who are considered to be obese according to their BMI or percentage of body fat have a high risk of adult diseases.     

Opening the black box: measuring hospital information technology capability

Recently, health care investment in information technology (IT) has experienced a significant increase. Paralleling this increase has been an increase in IT capabilities. Despite the interest in and promises of IT in the health care setting, there is a paucity of empirical research that has attempted to define an organizational measure of IT capability. The dearth of research has contributed to the traditional belief that IT is perceived as a "black box," whereby organizational resources enter the box as "inputs" and are somehow transformed into positive outcomes for an organization. However, for positive outcomes to be realized, these outcomes must be measurable. This research uses a stakeholder perspective to develop a theoretically specified measure of IT capability. A latent construct, IT munificence, is proposed using tenets from diffusion of innovation theory and strategic contingency theory. The construct is tested using a sample of 1,545 acute care hospitals located in the United States. IT munificence fits the study data well, supporting the hypothesis that IT munificence represents a strategy of hospital IT capability.     

Hospital adoption of information technologies and improved patient safety: a study of 98 hospitals in Florida

Most of the studies linking the use of information technology (IT) to improved patient safety have been conducted in academic medical centers or have focused on a single institution or IT application. Our study explored the relationship between overall IT adoption and patient safety performance across hospitals in Florida. Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between measures of IT adoption and the Patient Safety Indicators (PSIs) of the Agency for Healthcare Research and Quality. We found that eight PSIs were related to at least one measure of IT adoption. Compared with administrative IT adoption, clinical IT adoption was related to more patient safety outcome measures. Hospitals with the most sophisticated and mature IT infrastructures performed significantly better on the largest number of PSIs. Adoption of IT is associated with desirable performance on many important measures of hospital patient safety. Hospital leaders and other decision makers who are examining IT systems should consider the impact of IT on patient safety.     

Hospital quality of care: does information technology matter? The relationship between information technology adoption and quality of care

BACKGROUND: Hospitals have been slow to adopt information technology (IT) largely because of a lack of generalizable evidence of the value associated with such adoption. PURPOSE: To explore the relationship between IT adoption and quality of care in acute-care hospitals. METHODS: Primary data on hospital IT adoption were combined with secondary hospital discharge data. Regression analyses were used to examine the relationship between various measures of IT adoption and several quality indicators after controlling for confounders. Adoption of IT was measured using a previously validated method that considers clinical, administrative, and strategic IT capabilities of acute-care hospitals. Quality measures included the Inpatient Quality Indicators developed by the Agency for Healthcare Research and Quality. RESULTS: Data from 98 hospitals were available for analyses. Hospitals adopted an average of 11.3 (45.2%) clinical IT applications, 15.7 (74.8%) administrative IT applications, and 5 (50%) strategic IT applications. In multivariate regression analyses, hospitals that adopted a greater number of IT applications were significantly more likely to have desirable quality outcomes on seven Inpatient Quality Indicator measures, including risk-adjusted mortality from percutaneous transluminal coronary angioplasty, gastrointestinal hemorrhage, and acute myocardial infarction. An increase in clinical IT applications was also inversely correlated with utilization of incidental appendectomy, and an increase in the adoption of strategic IT applications was inversely correlated with risk-adjusted mortality from craniotomy and laparoscopic cholecystectomy. PRACTICE IMPLICATIONS: Hospital adoption of IT is associated with desirable quality outcomes across hospitals in Florida. These findings will assist hospital leaders interested in understanding better the effect of costly IT adoption on quality of care in their institutions.     

Hospital information technology and positive financial performance: a different approach to finding an ROI

This empirical study examined the relationship between information technology (IT) utilization and hospital financial performance. Using primary and secondary data, we specified and tested a series of regression models that examined this relationship in Florida hospitals. In addition, we employed performance group analysis for a select group of operational performance indicators. Findings suggested a significant and positive relationship between increased levels of IT use and various measures of financial performance, even after controlling for case-mix acuity and bed size. Regardless of the analysis or method employed, the results indicated that IT adoption is consistently related to improved financial outcomes both overall and operationally. This relationship was present when examining IT collectively and for clinical IT, administrative IT, and strategic IT as individual measures. Lastly, although higher IT use was associated with a higher level of revenues, income, or cash flow, higher use was also associated with ratios based on higher expenses. This probably reflects the relatively high acquisition costs associated with obtaining and maintaining sophisticated IT systems. Given that a true return on investment is so difficult to obtain for many individual hospitalwide IT systems, our data can serve as a proxy for hospital leaders and policymakers who want to understand the potential financial effects of investing in IT in the acute care setting.     

Information technology strategy: three misconceptions

The core intent in developing an IT strategy is to ensure that there is a strong and clear relationship between IT investment decisions and the organization's overall strategies, goals, and objectives. In the course of developing an IT strategy, an organization may fall victim to three major misconceptions about IT strategy. Those misconceptions are: The IT strategy should be solely derived from a thorough review of organizational strategies and plans. The IT strategy should be dominated by a focus on defining needed application systems. The IT strategy is better if it is developed by using a rigorous methodology. These misconceptions are dangerous. While they are right, they are not completely right. Hence, a dogmatic approach embracing these misconceptions risks an incomplete IT strategy or a strategy that is not as aligned with the organization as it should be.     

Medicare's cost crisis: solutions are within our grasp

As this collection of papers shows, Medicare faces serious future challenges as the population it serves grows larger and older in the coming decades. Variation in the way health care is provided--also known as process variability--is a major contributor to the rising costs that are threatening Medicare's long-term viability. If existing information technology (IT) and industrial operations tools were applied, process variability could be reduced, efficiency increased, and cost growth reined in. Health professionals trained in geriatrics could form the nucleus of such an organized effort to preserve access to Medicare.     

Building IT capability in health-care organizations.

While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care.     

Action through collaboration: a conversation with David Brailer. Interview by Robert Cunningham

Progress toward widespread adoption of health information technology (HIT) by providers remains uncertain and fraught with obstacles. But since his appointment as national coordinator for HIT in May 2004, David Brailer has observed a flowering of initiatives at the state level and the stirring of grassroots demand for action by providers. Brailer sees the creation of a new leadership group to spur adoption of technical standards as an important step forward. He remains concerned that small provider organizations will fall behind larger ones and that IT adoption will move forward without adequate standardization, compromising opportunities for interoperability in the future.     

Finding value from IT investments: exploring the elusive ROI in healthcare

This article explores the historical IT value research, discusses its applicability to IT investments in healthcare, and highlights how it is challenged by several factors unique to the healthcare industry. The integration of historical IT value research with healthcare industry attributes provides an important context for understanding why the IT value proposition in healthcare has been so elusive. The article also poses a set of guidelines, which, based on the IT value research outside of healthcare, may assist in alleviating some of the current frustration with determining the value of healthcare IT investments.     

Improving America's health care system by investing in information technology

Large-scale investment in health care information technology (IT) infrastructure will not take place without leadership by the federal government. But how the federal government supports the financing of health care IT is critical. Health care IT development has multiple aspects, but it is fundamentally a problem of community infrastructure development. A policy approach that has had consistent success in financing our country's essential physical infrastructure in transportation and environmental protection will be well suited to fostering health care IT infrastructure as well. We propose the creation of a health care IT revolving loan fund program to invest public dollars in health care IT infrastructure projects through community-level nonprofit lending agencies.     

论医学生实习期信息技术能力培养

目前,医学院校的信息技术课程设置存在滞后于现代医院信息化发展的现象。而实习期是提高医学生综合能力的关键期,期间,充分利用医院信息化建设成果,重视对医学生信息技术素质与能力的培养,是弥补医学院校信息技术课程设置不足的有效途径。本文就现代化医院对医学生信息技术基本能力的要求、实习期信息技术能力培养的方法进行了讨论。