- 0 - september 2007 ahrq annual meeting opportunities and challenges for implementing hit steven r....

- 1 -September 2007AHRQ Annual Meeting

Opportunities and Challenges for

Implementing HIT

Steven R. Simon, MD, MPH

August 2007

Supported by a grant from the US Agency for Healthcare Research and Quality (AHRQ)


Prologue

Widespread (universal?) EHR adoption by 2014

Has adoption reached tipping point?

Do EHRs improve quality of care?

How are physicians using EHRs?


Outline

Massachusetts e-Health Collaborative

Statewide survey of physicians, 2007


Massachusetts e-Health Collaborative (MAeHC)

Formed in 2004

Major health care stakeholders

$50 million from Blue Cross Blue Shield of MA

Statewide EHR adoption

Demonstration project:

• Universal EHR adoption in 3 communities

• Intra-community (and, ultimately, inter-community) data exchange


Pilot Timeline Overview

Activities 2004 2005 2006 2007 2008

ACP-MA summit

MAeHC launch

Community RFA launch

Pilot communities announced

EHR vendor RFP

EHR vendor finalization

Community EHR implementation

Intra-community connectivity

Evaluation

Formal Pilot completion


PHYSICIANS “GOING LIVE”, BY COMMUNITY

0

50

100

150

200

250

300

350

400

450

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total

# MDs

2006 2007

North Adams(55)

Newburyport(81)

Brockton(305)

9 7 5 19 21 33 25 24 27 43 51 9 88 1 77 1 441


HEALTH INFORMATION EXCHANGENorthern Berkshire Example

Patient recruitment Health data exchange Referrals mgmt Patient portal


State of the State: Physician Survey


Massachusetts Physician Survey

Stratified random sample of practices (N=1884)

Randomly sampled one physician per practice.

2005: 1345 respondents (71%)

EHR Adoption: 23% of practices, 45% of physicians

EHR Usage: wide variability in available functions and reported usage.


2007 Follow Up Survey (N=1345)

May – July, 2007

Multiple mailings to all 1345 respondents from 2005

Excluded: moved, retired, deceased (N=200)

902 completed surveys (response rate 79%)

***Preliminary Analysis***


Characteristics of Respondentswith EHRs (N=562, >60% of sample)

Female 37%

20+ Years Since Med School 39%

10+ Years with Practice 22%

Primary Care 16%

7+ Physicians in Office 44%

Practice Ownership 32%

Teaching (Students/Residents) 65%

Number of Patients/Week (median) 60

Incentives for HIT Adoption 35%

Incentives for HIT Usage 28%


Please indicate all features of the EHR that you have available in your practice. For those features that you have, indicate the extent to which you use them.

Laboratory test results

Laboratory order entry

Radiology test results

Radiology order entry

Electronic visit notes

Reminders for care activities (e.g. overdue health maintenance)

Electronic medication lists of what each patient takes

Electronic problem list

Can transmit prescriptions to pharmacy electronically or via electronic faxing

Electronic referrals or clinical messaging (secure e-mailing between providers)


Available EHR Functions, 2005 - 20072005 2007

Function (N=387) (N=562)

Laboratory test results 85% 86%

Laboratory order entry 47% 51%

Radiology test results 76% 78%

Radiology order entry 54% 54%

Electronic visit notes 84% 87%

Alerts and reminders 53% 56%

Electronic medication lists 75% 81%

Electronic problem list 71% 76%

Electronic transcription of Rx 45% 70%

Electronic referrals 62% 63%


Usage* of EHR Functions, 2005 - 2007Function 2005 2007

Laboratory test results 72% 77%

Laboratory order entry 52% 64% ▲

Radiology test results 74% 81%

Radiology order entry 48% 69% ▲

Electronic visit notes 71% 89% ▲

Alerts and reminders 31% 40%

Electronic medication lists 67% 79% ▲

Electronic problem list 58% 72% ▲

Electronic transcription of Rx 45% 67% ▲

Electronic referrals 43% 50%

*Most or all the time


2007 Massachusetts SurveySummary

EHR adoption continues to increase Majority of Massachusetts’ physicians use EHRs

Large segments of the physician population have “light” models of EHRs

Just over half of physicians with EHRs have Lab and radiology order entry Clinical decision support

Use of available EHR functions is increasingSubstantial proportions of EHR users do not use key functions that may improve quality and safety (order entry, e-Rx, and decision support)


Questions?


0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Lab test results

Visit notes

Radiology test results

Medication lists

Problem lists

Clinical messaging

Radiology order entry

Alerts, warnings, reminders

Lab order entry

E-prescribing transmittal

% of practices with EHRs that have each functionality

Most or all of the time Some of the time None of the time


EHR SELECTION

Preferred VendorsSelection

Community down-select

• EHR RFP distributed in May, 2005

• Over 30 responses received

• Vendor Selection Committee validated 7 vendors to go forward

• Community Steering Committees down-select to smaller number for individual physician choice in each community

• 3 or 4 in each community

• Initial vendor fairs completed in each community and down-select complete

Physician choice

• Individual physician vendor fairs

• Each community developing different model of physician choice

- 0 - september 2007 ahrq annual meeting opportunities and challenges for implementing hit steven r....

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