health information technology adoption & use john k. iglehart founding editor

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Health Information Technology Adoption & Use John K. Iglehart Founding Editor

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Page 1: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Health Information Technology Adoption & Use

John K. IglehartFounding Editor

Page 2: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Health Affairs thanks

for its ongoing support of the journal as well as today’s briefing

Page 3: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Keynote

Farzad Mostashari, M.D., Sc.M.

National Coordinator for Health IT, US Department of Health And Human Services

Page 4: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Meaningful Use: Where Are We Now?

Michael W. Painter, J.D., M.D.

Senior Program OfficerRobert Wood Johnson Foundation

Page 5: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Adoption of Electronic Health Records Grows RapidlyBut Fewer Than Half of US Hospitals Had At Least a Basic System in 2012

Catherine M. DesRoches, Ph.D.

Senior Survey Researcher Mathematica Policy Research

Page 6: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Methodology• 2012 health IT supplement to the AHA’s

annual survey.• Field period: October 2012 – January 2013.• Analytic sample: 2,796 general, acute care

hospitals.• Measures: basic and comprehensive EHR,

stage 1 MU and stage 2 MU proxies.• All results are weighted to adjust for non-

response bias.

Page 7: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Changes In Adoption Of Basic And Comprehensive EHR

DesRoches CM, Charles D, Furukawa MF, et al. (2013) Adoption of Electronic Health Records Grows Rapidly, But Fewer Than Half of US Hospitals Had At Least A Basic System in 2012. Health Aff (Millwood). 2013;32(8)

Page 8: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Meaningful Use• 42.2% of hospital met our proxy

measure of stage 1 meaningful use • Hospitals meeting stage 1

– Larger hospitals– Major teaching hospitals– Private non-profit status– Located in urban areas

• 5.1% of hospitals met our proxy measure for meaningful use stage 2.

Page 9: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Conclusions And Policy Implications• Substantial increases in adoption over

prior years.– Tremendous amount of activity across all

subgroups, although some still lag behind.

• Challenges remain.– Fewer than half of hospitals met stage 1

proxy.– Small proportion could meet core criteria

for stage 2.

Page 10: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Continued Effort Is Needed In The Following Areas:• Small and rural hospitals

– Both revenue and workforce challenges

• Patient access to records• Electronic data exchange

– Among hospitals and providers– Public health functions

• Hospitals that appear to be moving more slowly

Page 11: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Office-based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health RecordsChun-Ju Hsiao, Ph.D., M.H.S. Ashish K. Jha, M.D., M.P.HJennifer King, Ph.D.Vaishali Patel, Ph.D.Michael F. Furukawa, Ph.D.Farzad Mostashari, M.D., Sc.M.

We would like to thank the Office of the National Coordinator for Health Information Technology for funding the National Ambulatory Medical Care Survey - Electronic Health Records Survey. Dr. Jha was funded by RWJF. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, or the Office of the National Coordinator.

Page 12: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Policy Context And Purpose

• Substantial resources made available through HITECH have been devoted to helping providers achieve meaningful use of EHR systems.

• To assess who is using the systems and how their adoption has evolved

• To examine adoption and routine use of specific capabilities related to a Basic EHR system and meaningful-use criteria

Page 13: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Data And Methods• 2010-12 National Ambulatory Medical Care

Survey (NAMCS) - Electronic Health Records Survey of office-based physicians

• Measuring EHR adoption

• Measuring routine use

Page 14: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Analysis• Descriptive analysis examining the change in the use

of any type of EHR system and the adoption of a Basic system between 2010 and 2012– Multivariate analysis assessing characteristics

associated with the adoption of a Basic EHR system

• Descriptive analysis examining trends in adoption of capabilities required for a Basic EHR system and selected stage 1 core criteria for meaningful use

• Descriptive analysis examining whether physicians routinely used capabilities related to stage 1 core criteria for meaningful use and a Basic EHR system– Multivariate analysis assessing characteristics

associated with routine use

Page 15: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Office-based Physician’s Adoption Of EHR Systems, 2010-12

Page 16: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012

 Basic EHR adoption rate 

(adjusted percent)Change in Basic EHR

adoption rate

  2010   2012  Absolute change (percentage point)

Relative change(percent)

Age              <45 29.5  40.0  10.5 35.6  45-54 years 26.4  41.3  14.9 56.4  55-64 years 25.1  35.4  10.3 41.1  ≥65 years  16.5** 33.3  16.8 101.8

Practice size (number of physicians)              1 11.3  25.6  14.3 127.2  2-5 26.0** 36.6** 10.6 40.6  6-10 29.7** 44.0** 14.3 48.1  ≥11 45.0** 57.7** 12.6 28.1

**p<0.01

Page 17: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012

**p<0.01

 Basic EHR adoption rate 

(adjusted percent)Change in Basic EHR

adoption rate

  2010   2012  Absolute change (percentage point)

Relative change(percent)

Practice ownership              Physician/physician group 23.5  34.3  10.8 45.9  Hospital/academic medical center 28.4  47.5** 19.1 67.3  HMO/other health care    organization 39.8** 58.4** 18.6 46.8  Community health center 13.5** 32.3  18.8 139.6  Other/unknown 28.6  31.2  2.7 9.4

Metropolitan status              Large central metropolitan 23.4  36.0  12.6 54.0  Large fringe metropolitan 26.0  35.8  9.8 37.8  Medium metropolitan 25.0  39.7  14.7 58.8  Small metropolitan or non-  metropolitan 30.8** 43.5** 12.7 41.1

Page 18: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Adoption Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2010 And 2012

MU

Sta

ge 1

Cor

e

2010 Change 2010-20122012

Bas

ic E

HR

Page 19: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Adoption And Routine Use Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2012

Page 20: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Conclusions

• Findings are consistent with the proposed positive effect of incentives and technical assistance on physicians’ adoption and use of health information technology (IT)

• Key areas for continued policy focus include monitoring trends in physicians’ use of IT and whether gaps between physicians persist

• Rapid growth in the IT infrastructure may create a platform for delivery of high-quality, efficient care

Page 21: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Operational Health InformationExchanges Show Substantial Growth, But Long-Term Funding Remains

Julia Adler-Milstein, PhDDavid W. Bates, MD MScAshish K. Jha, MD MPH

Page 22: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Policy Context

• Health information exchange is critical to a well-functioning health care system.

• Electronic sharing of data between providers can lead to better care coordination, greater efficiency

• Prior to HITECH, growth in HIE was slow

• HITECH provided funding as well as non-financial incentives to increase HIE

Page 23: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Current Study• National census of HIE efforts to

answer:

1. How many HIE efforts are there? Has it changed over time?

2. Who is participating? What are they sharing?

A. Can they support key elements of stage 1 Meaningful Use?

3. What are the primary barriers to long term viability of these entities?

Page 24: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Key Findings• Substantial growth in the number of

operational HIEs

– 119 efforts in 2012 (up from 75 in 2010)

• Substantial growth in the number of participating hospitals and ambulatory practices

– Hospitals: 14% 30%

– Ambulatory Practices: 3% 10%

• Broad geographic coverage

– 67% of hospitals service areas had an HIE effort that enabled providers to meet stage 1 meaningful use

Page 25: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

• Broad Array Of Barriers Continue To Be Reported

– Financial barriers are the most pressing

Page 26: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

HITECH @3: Strong Start On A Long Path

Ashish K. Jha, M.D., M.P.H.

Harvard School of Public HealthJuly 2013

Page 27: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Why HITECH? • U.S. Healthcare “system” still a

mess– High cost, disappointing quality

• Paper-based records a contributor– Lead to lots of errors, waste

• EHR adoption was low, moving slow

• The largest payer intervened

Page 28: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

What Happened?• Well-crafted, strong incentives

work• EHR adoption slow moving• Incentives kicked in 2011

– Adoption has taken off – Doctors, hospitals embracing

technology– Nearly half way there

• With a lot of progress in the pipeline

Page 29: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Health Information Exchange• Progress slower• Exchange remains in its infancy

– Lots of challenges– Mostly not about technology

• Business model for HIE a challenge

Page 30: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Intermission: Unfinished Business

• What happens in the second half of the play?– Will things continue to move quickly?– Will some providers just not make it?

• How do we bring others on board?– Nursing homes, rehab facilities, etc.?– Major problem if they remain left out

Page 31: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Unfinished Business• How do we use technology more

effectively?– What can we do to improve quality,

efficiency?– How do we ensure safe implementation?

• Integration with health reform efforts– ACOs, Bundled Payments, etc.– Quality measurement

Page 32: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Getting Health IT Right Is Essential

• Infrastructure for payment, delivery reform

• HITECH is having a big effect• Our work is just getting started

Page 33: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Acknowledgements• RWJF• NCHS, AHA, ONC as great partners• Health Affairs

Page 34: Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Health Affairs thanks

for its ongoing support of the journal as well as today’s briefing