Struggling to cope with a tough economy means that many hospitals have had to slow their efforts to improve information technology (IT). But at the same time, healthcare reform and regulatory changes are demanding more digitized and wired hospital environments. It's a conundrum illustrated in this year's just-released 100 Most Wired hospitals survey.

"From last year, we've seen a decrease in capital spending on IT," Alden Solovy, executive editor of the survey sponsor, Hospitals & Health Networks magazine, told Medical Device Daily. "Anecdotally we're hearing that they are maintaining investments in those things that are critical to the organization such as current IT commitments and those things that will position them to have meaningful electronic health records (EHR) and to qualify for stimulus funding."

Just a handful (12) of the 100 hospitals that made the list did so for the first time. The majority have made the list multiple times with quite a few landing on the top 100 list every year since the survey started 11 years ago. Avera Health System (Sioux Falls, South Dakota), which counts 27 hospitals in its group, is the largest to make the top 100 for 11 years straight.

"About a third of the list changes every year, in part because some hospitals choose not to take the survey every year and some new ones decide to do it," Solovy said.

With all the effort to install multiple IT systems, EHRs and computerized physician order entry (CPOE) systems, can industry observers connect the dots between wiring an institution and greater efficiency or even better patient outcomes?

"Do we have a preponderance of evidence to accept the notion that IT is a contributor to quality?" Solovy said. "The answer is it is nearly impossible to tease out the singular contribution of IT from good management, process change, staff training, leadership and other managerial processes that affect care. We have done analyses that show that the most wired have better quality outcomes and higher patient satisfaction. That's not the entire story.

"What we can't say is that IT caused those differences, but they are present in these organizations. But it's a chicken and egg question," he said. "Perhaps, yes if done well, or no if not done well. So we go back to the preponderance of evidence that suggests that IT contributes to quality, safety and satisfaction in organizations that are dedicated to improvement."

The 50-question survey found that hospitals are continuing to invest in IT that supports quality and safety initiatives. As part of that, investment in electronic medication management is considered one of the fundamentals of using IT to improve care. There was an overall increase in use of both CPOE and electronic bedside matching at the time medications are administered.

"We do see some difference and emphasis based on the type of hospital – children's versus academic or military hospitals," Solovy said. "For example, both children's hospitals and academic hospitals, year over year, put emphasis on increasing electronic ordering of medications by physicians and that grew among both groups. Rural and critical access hospitals put more of an emphasis on bedside medication matching. "

Overall, however, there is increased use of these technologies. At the typical hospital responding to the survey, 26% of medications are entered electronically by physicians, compared with 19% in 2008. The typical respondent has 40% of medications matched at the bedside, compared with 30% in 2008.

Of the organizations that completed the survey, 38 hospitals and health systems (6.8% of the sample) have effectively deployed IT at both ends of the medication administration process. This compares with 23 hospitals and health systems in 2008, or 4.1% of the sample.

While most hospitals are just striving to get wired, 25 more advanced facilities made the Most Wireless list, the majority being located in the Eastern U.S.

"We are seeing a number of the most wired hospitals investing in medical-grade wireless infrastructure," Solovy said. "Forty-two percent of most wired have invested in that. It's a way of making sure the wireless capability offers clinical capabilities to physicians, nurses and other caregivers at a Six Sigma-level of reliability. We're seeing that as a trend."

What surprised Solovy the most about survey results is that more and more hospitals are publishing quality results.

"It appears that transparency of quality data has hit a tipping point," he said. "A lot of organizations are using websites and communicating quality results to their communities. They're showing it all."

As hospitals forge ahead in eliminating paper and digitizing everything possible, there's always the threat that grows and looms: systems go down and leave facilities helpless. The good news, Solovy said, is that "More organizations are able to get their critical systems up in 24 hours after core systems are brought down. To bring up these critical systems, have the back-up, support, technology and wherewithal takes a commitment and investment."

IT will continue to play a key role at healthcare institutions as the healthcare system is reformed. And with a 2013 deadline approaching for the U.S. to switch to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), IT will play a critical role too. ICD-10 is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (Geneva). This kind of a regulatory change will demand IT support.