Becker's Hospital Review

32 Health Information Technology Doing More With Less: Forgoing and Simplifying in Health IT By Helen Gregg A ccording to a HIMSS survey, the average hospital's IT budget is increasing. However, this increase is most often due to the overall growth of IT systems in the organizations and the costs of meeting regulatory requirements, leaving little room for hospital CIOs to invest in every technology that may be beneficial to their organization. "Everyone is facing this sort of thing, with budgets getting tighter," says Ste- phen Stewart, CIO of Henry County Health Center in Mt. Pleasant, Iowa. The 25-bed acute-care hospital, like hospitals and health systems across the country, has had to make some difficult decisions when it comes to new IT investments, he says, examining the cost and benefits for the specific orga- nization. For HCHC, one of the technologies that was ultimately skipped was desktop virtualization infrastructure. The benefits of VDI are widely known among CIOs — VDI helped Kootenai Health in Coeur d'Alene, Idaho, achieve sig- nificant efficiency and security gains through faster load times and easier backend maintenance, and Seattle Children's CIO Wes Wright calls the im- plementation of VDI his biggest accomplishment. However, for the small and rural HCHC, the benefits of VDI just weren't worth the cost. "We took a hard look at it, and what we would gain and what it would cost at the end of the day, and there just wasn't a payback," says Mr. Stewart. "Even though some clinicians wanted it, we took it off the radar… it's what you have to do when times get tough." As an organization, HCHC has decided the most worthy investment is the hospital's best-of-breed electronic health record, and any investments out- side of the EHR needs to meet "higher standards of justification," says Mr. Stewart. "We've started to really ask the question, 'Is this a business need or is it a convenience?'" he says. "We've come to conclude we can't be all things to all people." The approach has proven successful, and the hospital was on schedule to complete its 90-day attestation period for meaningful use stage 2 at the end of June. "We've funded the technology we needed to," says Mr. Stewart. HCHC is not the only organization evaluating which software and IT sys- tems are needed, and which are not. For Boston-based Partners HealthCare, the unnecessary technology was the disparate IT systems being run across its many sites. "For many years, we had a thousand flowers blooming," says Scott MacLean, the system's deputy CIO, of the variety of specialized software and apps that were being used across the system. The variety extended to EHRs — Partners had various vendor-delivered and homegrown EHRs at its two academic medical centers and its community hospitals. "We concluded it was very expensive to maintain all that and hard to keep up with all the vendors that were [handling EHRs] for many custom- ers," says Mr. MacLean. So about three years ago, Partners made the decision to transition all exist- ing EHRs to a single vendor, and begin to standardize the software and apps used at the different care sites. Despite the expenses of changing systems and reworking staff and clinician workflows, Mr. MacLean expects the process to reduce costs and simplify IT costs across the system. At Milwaukee-based Aurora Health Care, the IT department has avoided un- necessary complexity and disappointing results by waiting to invest in what CIO Philip Loftus, PhD, sees as still-immature technology: mHealth systems and solutions. "While mobile devices have a very important role to play [with] healthcare providers, in many cases they need to be able to integrate with the core clini- cal and revenue cycle systems, such as the EHR and picture archiving and communications systems, to deliver their full value," he says. "At this point in their development, many of them are part of stand-alone systems that often limit their level of use." Dr. Loftus sees a prudent investment in mobile health systems and other new technologies as dependent on EHR and other health IT vendors updating their systems to accommodate the advent of mHealth. "The legacy system vendors also need to provide more open and standard interfaces that sup- port a broader range of front end devices, both mobile and fixed," he says. n NewYork- Presbyterian, Columbia Pay Largest-Ever HIPAA Fine By Helen Gregg N ewYork-Presbyterian Hospital and Columbia University, both in New York City, paid a combined $4.8 million to settle charges of a HIPAA violation following a 2010 data breach, the largest HIPAA settlement to date. HHS announced the settlement payment in May. NewYork-Presbyte- rian and Columbia University are separate entities, but have an affilia- tion under which Columbia professors work as attending physicians at NewYork-Presbyterian, and through the affiliation the two organiza- tions share a data network and firewall that links to NewYork-Presby- terian's patient records database. According to an investigation by HHS' Office for Civil Rights, the 2010 breach occurred when a Columbia physician attempted to deactivate a personal computer that was connected to the NewYork-Presbyterian network and contained patient information. A lack of technical barri- ers then led to patients' health information being accessible through search engines. The OCR alleged neither organization had conducted an adequate risk analysis of all of its IT systems and neither had an appropriate risk management plan. Additionally, NewYork-Presbyterian did not adequately secure its database or follow its own information access policies. NewYork-Presbyterian paid $3.3 million and Columbia paid $1.5 mil- lion in the settlement, and both organizations have agreed to a correc- tive action plan. n

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