david w. bates, md, msc medical director of clinical and quality analysis, partners healthcare

- 1 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.

Electronic Health Record Adoption and Implementation: A Report from the Massachusetts

eHealth Collaborative

David W. Bates, MD, MSc

Medical Director of Clinical and Quality Analysis, Partners Healthcare

Chief, Division of General Medicine, Brigham and Women’s Hospital


Overview

•Formation of the MaEHC

•Adoption of EHRs in the collaborative

•Statewide adoption data

•Conclusions


MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE

• Universal adoption of electronic health records

• MA-SAFE

• $50M commitment to heath information infrastructure

• Recognition of “systems” problem

• Company launched September 2004

– Non-profit registered in the State of Massachusetts

• CEO on board January 2005

• Backed by broad array of 34 MA health care stakeholders


THREE COMMUNITIES SELECTED FROM 35 APPLICANTS

Newburyport

Brockton

North Adams


PHYSICIAN EHR SELECTIONS

Newburyport North Adams

Community down-select

Physician choice

• Most decentralized approach

• Individual physicians chose from down-selected vendors

• Chose single vendor for entire community

• “Enterprise EMR” model

Brockton

• Physician choice was further narrowed by community orgs

• Brockton NHC

• BGPMA

• CGMC IPA

• Brockton Hospital PHO

More centralizedLess centralized


SCOPE OF PILOT PROJECTS

Offices

0

100

200

300

400

500

600

350

Patient population (000)

95

43 488

0

20

40

60

80

100

120

140

160

180

200

111

41

25177

Small

Med

Large

111

37

27

175

184

48

38

270

0

50

100

150

200

250

300

350

400

450

500

295

85

65 445

PCPs

Specialists

Physicians

Almost 450 physicians……who care for ~500K

patients……in almost 200 offices.

BrocktonNewburyport

N. AdamsAll

BrocktonNewburyport

N. AdamsAll

BrocktonNewburyport

N. AdamsAll


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


2005 Physician Survey

Sampled 1829 practices (30% of state) within strata:

• Primary care vs. specialty

• Urban vs. rural

• Large vs. small practices

Only physicians w/ambulatory practices

8-page mail survey with $20 incentive

Overall Response Rate: 71%


EHR Adoption

Percent of Office Practices Using EHRsOverall 23%Specialty

Primary Care 25%Single Specialty 20%Multi-Specialty 23%

Number of physicians1 14%2-3 15%4-6 33%7+ 52%


EHR Adoption

52%

20%

24%

21%

40%

14%

0% 10% 20% 30% 40% 50% 60%

Hospital-based

Non-hospital based

Urban

Non-urban

Teaching

Non-teaching

% of office practices using EHRs


Additional Adoption Statistics

On a physician level, a total of 45 percent of physicians in Massachusetts had EHRs.

Among practices with EHRs, more than half (53 percent) reported having EHRs in their practice for more than 3 years.


Lack of time to acquire knowledge about systems

69% 80% 0.66 0.56 – 0.93

Physician skepticism 49% 60% 0.53 0.39 – 0.73Lack of computer skills 57% 60% 1.04 0.76 – 1.41Lack of technical support 59% 68% 0.78 0.57 – 1.07Lack of uniform standards 68% 81% 0.57 0.40 – 0.80Technical limitations of systems 78% 79% 1.02 0.70 – 1.49Start-up financial costs 64% 90% 0.26 0.18 – 0.38Ongoing financial costs 63% 88% 0.35 0.24 – 0.50Loss of productivity 65% 86% 0.41 0.29 – 0.59Privacy or security concerns 47% 58% 0.83 0.61 – 1.13

Adjusted Odds Ratio

95% CIEHR Adopters

(%)

EHR Non-Adopters

(%)

Barriers to HIT Adoption or Expansion


Implementation – Future Plans

Not in the foreseeable future (52%)

Within the next 12 months (13%)

Within 3-5 years (11%)

Within the next 1-2 years (24%)


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


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


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 and decision support)


Conclusions

•Adoption is increasing, and adoption rate in Massachusetts are much higher than in rest of nation

•Use of key functions often lags behind

• Probably need to use features to get many of desired benefits

•Need to target both adoption and then use of key functions

• Easy to get stuck

david w. bates, md, msc medical director of clinical and quality analysis, partners healthcare

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