U.S. News Identifies 159 Most Connected Hospitals Based on AHA IT Survey Data

Recently, U.S. News & World Report compiled and released the “2015–2016 Best Connected Hospitals Survey Report” by screening and organizing questionnaire responses from the American Hospital Association (AHA)’s “Information Technology Supplement to the 2013 and 2014 Annual Surveys.” The report lists 159 leading medical centers across the United States in this field, highlighting the future direction of healthcare digitalization.The questions in the “Information Technology Supplement” address three key areas:●●●Clinical InterconnectivityAssess the hospital’s capacity to exchange or share patient-required information with other healthcare providers in electronic format. This capability is not only critical within the hospital itself but also plays a pivotal role across the entire healthcare system and among all medical institutions. Specific examples include: 1) digitally transmitting patients’ laboratory results to independent medical practices; 2) notifying primary care providers outside the hospital that a patient has been admitted to the emergency department. In this domain, the scoring accounted for nearly half of the total points in the 2013 Information Technology Appendix, and approximately three-fifths in 2014 (with a higher response rate in the latter year).Patient SafetyEvaluate hospitals’ capacity to prevent computerized devices from causing patient harm, such as using barcode-enabled wristbands to verify patient identity before medication administration or treatment delivery. This domain accounted for approximately one-third of the total score in 2013, and about one-quarter in 2014.●●●Patient EngagementEvaluate hospitals’ capacity to enhance patient engagement by providing patients with electronic access to their medical information, and even authorizing them to update or modify such information—for example, allowing patients to retrieve their own electronic health records (EHRs) and update weekly blood pressure reports. This domain accounted for approximately one-fifth of the total score in 2013, but declined to about one-tenth in 2014.Regarding scoring, hospitals can receive 2, 1, 0.5, or 0 points for each survey question, depending on their level of electronic interoperability. Generally, higher scores are awarded for electronic communication with healthcare providers outside the hospital than for internal communications within the hospital; similarly, achieving computerized security across different clinical units yields higher scores than doing so within a single unit.However, because the survey’s methodology reflects only U.S. News & World Report’s best judgment, it has certain limitations, most notably the following:

• Responses to the “Information Technology Appendix” of the AHA Annual Survey are provided to the AHA by hospital administrators. Self-reported data may not reflect assessments of hospitals’ interoperability status by independent observers.

• Similar responses from different hospitals may obscure substantial real-world distinctions.

• This survey did not include all data from the AHA’s Information Technology Appendix. If more questions were included in the scoring, or if the scoring criteria for existing questions differed, some hospitals’ scores could be higher or lower than those listed.

• Many hospitals did not respond to the questionnaire in the AHA’s Information Technology Appendix. Some of them, had they responded, might have qualified for inclusion among the Best Connected Hospitals.

• Data are relatively lagging. Part of the reason is that hospitals across the United States have been accelerating the deployment of new healthcare IT equipment in response to government mandates. Therefore, survey responses from 2013 and 2014 may, to some extent, underestimate the development of hospital interoperability levels in 2015; on the other hand, using 2013 data can demonstrate how rapidly and decisively hospitals adopted new technologies to improve healthcare quality.

The selection results were unexpected, with a relatively small number of institutions named among the Best Connected Hospitals for 2015–2016. Electronic Medical Records/Electronic Health Records (EMR/EHR) were first developed in the 1960s; it was only seven years ago that the federal government began allocating dedicated funds to help healthcare organizations adopt information technology.In practice, the federal government’s “Meaningful Use” requirements and the timeline for implementing EMR/EHR technologies across healthcare providers have posed significant challenges for healthcare organizations.Both the 2013 and 2014 editions of the AHA’s Information Technology Supplement included a question (Q16 in 2013 and Q19 in 2014) asking hospital leaders what they considered the greatest obstacle to complying with federal requirements in order to secure funding and avoid penalties:What are the main challenges in implementing EMR/EHR systems that comply with the federal government’s “Meaningful Use” requirements? (Select all that apply)To address this issue, the 2013 questionnaire provided 11 options, including 10 specific items and one “Other” option; the 2014 questionnaire offered 10 options (the removed option was “Complexity of coordinating decision-making with system-level leadership,” which was selected by slightly more than one-fifth of respondents in the 2013 survey).In both years’ surveys, a substantial number of hospitals selected multiple options for this question, suggesting that they face significant challenges in this area. Additionally, this may reflect hospital leaders’ frustration with the complexity and substantial costs associated with implementing the “Meaningful Use” requirements.More than half of the respondents listed one or more of the following factors as the “top challenges” to meeting the “Meaningful Use” criteria in their responses to Q16/Q19 in 2013 and 2014:Options with a selection rate exceeding 50%:

Securing the necessary IT systems and maintaining adequate IT human resources is also a source of anxiety: 45% of respondents in 2013 and 40% in 2014 cited “insufficient IT staff in hospitals to support the implementation/maintenance of information systems” as their primary challenge.In contrast, privacy and security concerns (22%/25%) and uncertainty regarding specific federal government requirements (16%/18%) ranked lower among the factors hindering the progress of healthcare digitalization.

Survey Content for the Best Connected Hospital

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Given that the content in each domain is extensively sampled from the AHA’s “Information Technology Appendix” annually, resulting in a high degree of alignment, we will primarily examine the questionnaire items and scoring criteria from the 2014 AHA “Information Technology Appendix.”

2014 Survey Questions and Answers

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Clinical Interconnectivity Domain (47 points)

Q4. What types of patient data exchange/sharing does your hospital conduct electronically with various healthcare service providers? (Multiple selections allowed. Maximum 24 points.)b. Laboratory Results (Maximum 6 Points)In-system Hospital (1 Point)Out-of-system Hospital (2 Points)In-system Outpatient Provider (1 Point)Out-of-system Outpatient Provider (2 Points)Unknown (0 Points)c. Medication History (Maximum 6 Points)In-system Hospital (1 Point)Out-of-system Hospital (2 Points)In-system Outpatient Provider (1 Point)Out-of-system Outpatient Provider (2 Points)Unknown (0 Points)d. Radiology Reports (Maximum 6 Points)In-system Hospital (1 Point)Out-of-system Hospital (2 Points)In-system Outpatient Provider (1 Point)Out-of-system Outpatient Provider (2 Points)Unknown (0 Points)e. Clinical/Summary Care Records in Any Format (Maximum 6 Points)In-system Hospital (1 Point)Out-of-system Hospital (2 Points)In-system Outpatient Provider (1 Point)Out-of-system Outpatient Provider (2 Points)Unknown (0 Points)Q5 When a patient is transferred to another healthcare institution or organization outside your hospital’s system, how does your hospital routinely send and/or receive care summary records? (Multiple choices allowed. Maximum 8 points.)b. Use EHR for electronic faxingSend (1 point)Receive (1 point)Don’t know (0 points)c. Use EHR for secure messaging (via Direct messaging or other secure protocols)Send (1 point)Receive (1 point)Don’t know (0 points)d. Provider portalSend (1 point)Receive (1 point)Don’t know (0 points)e. Via HIEO or other third partiesSend (1 point)Receive (1 point)Don’t know (0 points)Q6. When patients are transferred to other medical institutions or organizations, does your hospital routinely send and/or receive summaries of care records in structured formats (e.g., CCDA) electronically (not via electronic fax) with the following other healthcare providers? Multiple selections allowed. (Maximum 8 points)a. Other hospitals outside your hospital’s systemSend (1 point)Receive (1 point)Don’t know (0 points)b. Outpatient service providers outside your hospital’s systemSend (1 point)Receive (1 point)Don’t know (0 points)c. Long-term care service providers (within or outside the system)Send (1 point)Receive (1 point)Don’t know (0 points)d. Behavioral health service providers (within or outside the system)Send (1 point)Receive (1 point)Don’t know (0 points)Q7. Does your EHR integrate clinical information received electronically (excluding electronic fax) from healthcare providers or information sources outside the hospital system/organization, without requiring manual entry? Software can be used to convert scanned documents into indexed and discrete data that can be integrated into the EHR. (Maximum 1 point)Yes, and it is routine (1 point)Yes, but it is not routine (0.5 points)No (0 points)Unknown (0 points)No data (0 points)Q8 If “Yes” is selected, does your EHR contain care summary records received electronically (excluding electronic faxes) that do not require manual entry? Software can be used to convert scanned documents into indexed and discrete data that can be integrated into the EHR. (Maximum 1 point)Yes, and it is routine (1 point)Yes, but not routine (0.5 points)No (0 points)Unknown (0 points)No data (0 points)Q9a Can your hospital’s healthcare providers routinely obtain, in electronic format, the necessary information on patients previously treated by other healthcare providers/institutions from external healthcare providers or information sources? (Maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)Q9b Can your hospital’s healthcare providers electronically access patients’ medical information (e.g., medication records, out-of-hospital care history, etc.) through other data sources? (Maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)Not applicable (0 points)Q10a When a patient visits your emergency department, do you routinely provide electronic notification to that patient’s primary care physician? (0 points)Yes (please select the notification type in Q10b)NoDon't knowNo emergency departmentQ10b [If “Yes” is selected in Q10a] What electronic notifications are provided to the initial consulting physician? (Multiple choices allowed) (Maximum 2 points)In-system (1 point)Out-of-system (1 point)Unknown (0 points)Q11 Please indicate your level of participation in the Health Information Exchange (HIE) or Health Information Organization (HIO) in your country, region, or locality. (Maximum 1 point)Our hospital is located in a region with HIE/HIO, and our hospital participates in and actively exchanges data in at least one HIE/RHIO (1 point)Our hospital is located in a region with HIE/HIO, but our hospital does not participate (0 points)There is no HIE/HIO in the region where our hospital is located (0 points)Unknown (0 points)

Patient Safety Domain (20 points)

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Q1 Does your hospital currently possess computerized systems that permit the following scenarios (maximum 16 points):Computerized entry of service provider orders with electronic transmission (Maximum 2 points)Q1c3 Medications (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Clinical Decision Support (Maximum 10 points)Q1b4 Clinical reminders (e.g., pneumococcal vaccine) (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q1c4 Drug allergy alerts (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q1d4 Drug-drug interaction alerts (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q1e4 Drug-lab interaction alerts (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q1f4 Drug dosage support (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Closed-loop medication tracking using barcodes or Radio Frequency Identification (RFID) (Maximum 4 points)Q1a5 Medication administration management (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q1b5 Patient verification (Maximum 2 points)Fully implemented in all units (2 points)Fully implemented in at least one unit (1 point)Initiated in at least one unit (0.5 points)Resources available, to be implemented next year (0 points)No resources, but considering implementation (0 points)Resources unavailable, not considering implementation (0 points)Q2. Does your hospital currently have an electronic system that enables you to perform [medication management] tasks (maximum 4 points):Q2a3 Compare the medication list at admission with the pre-admission list (maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)Q2b3 Provide an updated medication list at discharge (maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)Q2c3 Verify inpatient prescriptions according to internal protocols (maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)Q2d3 Automatically track medication administration via electronic Medication Administration Record (eMAR) (maximum 1 point)Yes (1 point)No (0 points)Unknown (0 points)

Patient Engagement Domain (8 points)

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Q3. Can patients at your hospital do the following regarding their health/medical records? (Multiple choices allowed)Q3a3 View your own health/medical records online (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3b3 Download information from their health/medical records (eMAR) (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3d3 Request changes/updates to their health/medical records (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3e3 Request online prescription refills (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3f3 Schedule medical consultations online (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3g3 Pay bills online (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3h3 Submit patient-generated data (e.g., blood glucose, weight, etc.) (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)Q3i3 Send and receive secure messages with providers (max 1 point)Yes (1 point)No (0 points)Don't know (0 points)List of the Best Connected Hospitals in 2015-2016The table below lists 159 of the most connected healthcare organizations across 37 U.S. states in 2015–2016, arranged alphabetically by state. The information was updated on October 23, 2015, with corrections to some data originally provided by the American Hospital Association (AHA) in 2014. Hospitals marked with an asterisk (*) indicate that the hospital or its system was also included in the HealthCare’s Most Wired survey list.Detailed survey results are presented in the table below.

According to statistics,In 2013, a total of five hospitals achieved the full score of 61 points., namely Greenwich Hospital* and Yale-New Haven Hospital* in Connecticut; Carolinas Medical Center* in North Carolina; West Virginia University Hospitals* in West Virginia; and the University of Toledo Medical Center in Ohio.In 2014, a total of 10 hospitals achieved the full score of 75 points.including five in Colorado: Medical Center of the Rockies, Memorial Hospital, Penrose-St. Francis Health Services, Poudre Valley Hospital, and University of Colorado Hospital*; two in Connecticut: Greenwich Hospital* and Yale-New Haven Hospital*; as well as Stormont-Vail HealthCare in Kansas, Oakwood Hospital and Medical Center* in Michigan, and Appleton Medical Center* in Wisconsin.In 2014, a total of 13 hospitals received a perfect score of 47 points in the field of clinical connectivity.including five in Colorado: Medical Center of the Rockies, Memorial Hospital, Penrose-St. Francis Health Services, Poudre Valley Hospital, and University of Colorado Hospital*; two in Connecticut: Greenwich Hospital* and Yale-New Haven Hospital*; two in Michigan: Beaumont Hospital* and Oakwood Hospital and Medical Center*; as well as Stormont-Vail HealthCare in Kansas, Appleton Medical Center* in Wisconsin, St. Peter's University Hospital* in New Jersey, and Medical University of South Carolina* in South Carolina.AndIn 2014, in the areas of patient safety and patient engagement, 116 and 88 hospitals respectively achieved perfect scores, accounting for 73% and 55% of the total number of hospitals on the list.。

Compiled by Chen XinEditor: Mo Renying