Taking stock
Each month, we speak to John Hoyt and HIMSS Analytics Senior Director of Research Jennifer Horowitz about a different species of health information technology. For this issue, we asked Hoyt to take part in a lightning round, offering a quick assessment of where the industry is – and where it should be – with regard to each one.

Ambulatory EHRs. "We still have a long way to go. We are just at the very beginning. And that's where there's some world leadership that the U.S. needs to listen to. Especially to the small countries that have wealth, such as Singapore.

"We all know that some 80 percent of the volume of healthcare consumption takes place on the ambulatory side. What they've done – and this is part of their culture; they've got less entrepreneurialism in medical care delivery, and more of a government or corporate influence; frankly we're moving in that direction as hospitals buy practices, and we're positioning ourselves to be more like them and take advantage of economies of scale. But ambulatory EHRs need to get out there more ubiquitously. We're low on that."

Inpatient EHRs. "I think the most prominent change in 10 years is that medical staff has become – or is about to become – highly active users."

HIE. "Continuing struggles. We recognize the importance of it, and frankly I'm very happy that the stimulus program includes HIE. But we continue to struggle and we cannot take our foot off the pedal of that."

Interoperability. Same thing. And the federal government's role, I think, has been appropriate: Stimulate the industry to develop and implement standards."

Analytics. "We're at the beginning. We have now gotten to the point where the early adopters and the advanced organizations are collecting huge sums of data, and we're just beginning to become skilled at using the data to improve quality safety and efficiency. And there are some excellent examples of early adopters in Stage 6 and Stage 7. Generally I would say they're large, and it somewhat correlates – necessity is the mother of invention – the big organizations that have risk contracts clearly have better analytics.

"Jennifer and I were at a community hospital a couple weeks ago on a Stage 7 visit. One or 2 or 3 percent of their contracts were at risk, and their analytics were immature. Two weeks earlier, I was at an organization and 65 percent of its revenue is at risk. And they have MDs and MPHs running their analytics program. Plural. Multiples of them. As opposed to an evening nurse who got tired of running evenings and decided to go into analytics."

Clinical decision support. That subset of the industry has had some interesting changes going on.  I've noticed when I do these Stage 7 visits over the past two years, I ask them, do you use – and I mention a couple brand names – and more than two out of three times, the big places, notably Epic clients, say, 'Nope, we don't use them anymore. We used to, but we've got the skills in-house. We don't need to pay $50,000 a year for order sets, we can build them ourselves. We all expect the systems to give us clinical advice. But other than pharmacy, which is a necessity, I'm getting a sense that the bigger organizations, for order sets and protocols, are saying, I don't need to pay that kind of money. Which was not always the case. When I was a CIO, I remember buying all that stuff and putting it on PCs."

Mobile. "It's exploding. And it's a challenge for the CIOs, on bring your own device and security. But clearly it has a public health benefit, and clearly it has Third World implications that we aren't even thinking of; when you hear these people who have been to Africa, which has sort of skipped the landline phenomenon and gone straight to mobile, I think it's very very helpful for underdeveloped nations.

PACS. "We're at the saturation point, and clearly at the expectation point. Making film is just ludicrous."

Privacy & security. "We're treading water, but mobility is adding a new layer of stress. One new phenomenon that we weren't even talking about 10 years ago is patient involvement in chronic disease management, enabled by technology. Patient portals, etc. That's a whole new subject that wasn't even on the agenda 10 years ago."

[See also: Benchmarks: Changes are afoot for clinical and business intelligence]