Gone are the large white boards at the emergency room of Inova Fair Oaks Hospital in Fairfax, Va. Two large flat-screen computer monitors have taken their place. The patient information displayed on the screens is constantly updated through small tablets cradled in the arms of physicians and nurses.

If you ask the emergency department staff, they will tell you they can't imagine having to go back to paper.

Going from paper to the electronic system wasn't an overnight process. It took time. It took training. And it cost money. But it has paid off by improving efficiency, quality, and throughput, say officials at Inova Health System, of which Inova Fair Oaks is a part.

The health system was named as one of the most wired hospitals in the nation by Hospitals & Health Networks' annual most wired survey.

The 99 hospitals and health systems that made the unranked list were recognized in the categories of most improved, most wired, most wireless, and most wired in small and rural settings.

The list is the result of 555 submitted surveys, which were filled out voluntarily by the institutions and represent 1,280 hospitals (22% of U.S. hospitals). The survey, conducted since 1999, aims to benchmark hospitals' progress in information technology. The hospitals were recognized for achievement of IT applications in the areas of clinical quality and safety, care continuum, infrastructure, and business and administrative management.

The 2010 survey shows, for example, that the most wired hospitals are further along (82%) than other hospitals (51%) in deploying computerized provider order entry (CPOE) systems.

Under the Health Information Technology for Economic and Clinical Health Act, hospitals are incentivized to use electronic health record (EHR) systems in a meaningful way with financial bonuses through 2016. Yet, experts say that much more work needs to be done before the majority of hospitals will achieve the HITECH goal by then.

When hospitals do comply, however, the benefits are great on the practice side, according to Geoff Brown, Inova Health System's chief information officer. Implementing the right electronic systems can help improve quality of care and efficiency at the hospitals, he said.

This is especially true for hospitalists, who tend to care for a variety of patients. Having to view the patients' information and status quickly can be laborious on paper. An electronic system that displays the patient history, allergies, and medications can be a lot more helpful, he said.

So what does it mean to be an ideal wired hospital?

Dr. Franklin Michota, director of academic affairs in the hospital medicine department of the Cleveland Clinic, said that it starts from a patient-focused perspective: electronic medical records that are available to everyone who sees the patient, information that a patient can access, patients' ability to log their diet and exercise in a system, and patients' ability to communicate with their health care provider.

In other words, “all information, all vital signs, all notes, and all orders are paperless,” Dr. Michota said. And for a truly efficient hospital, that system is integrated with billing, supply chain, and other systems such as the regulatory requirements.

But the nation's health care systems and providers—big and small—have a long way to go before achieving that ideal, said Dr. Michota.

While the financial sector has long had online banking and national and international access to ATMs, hospitals in the same city are still unable to connect with each other, much less connect to hospitals and doctors' offices elsewhere in their state or across the nation.

That's mostly due to lack of standardization, according to Dr. Michota. Hospitals tend to tailor their electronic tools to meet the needs of their specific system of care. As a result, there isn't a standard EHR system that hospitals can buy and implement.

Dr. Michota expressed doubt about the incentives in HITECH for hospitals to get wired. “They say you've got to figure out a way to do it, and if you do it, you might get a few carrots. They haven't made a good business case for hospitals to do this.”

Others are more hopeful. Mr. Brown of Inova said that there is the incentive to boost physician recruitment. Many graduating residents won't join a health system or practice that's not wired, he said.

Dr. Michota said he wasn't convinced that being a wired hospital is a major selling point. Some doctors may prefer to work with a wired hospital, and “some physicians who like paper may run away from wired hospital.” Yet, he added, being a wired hospital “may be a marker for a well-organized and well-managed system.”

To see the list, visit www.hhnmag.com/hhmag_app/gateFold/pages/JULY10.jsp

Survey IDs Most Wired, Wireless Hospitals