BENCHMARKING HIT ADOPTIONS AND CROSS COUNTRY LEARNING

Agenda

1)Introduction- What does adoption of HIT mean2)HIT as a global endeavour3)Cross country comparison4) Insights from country specific approaches5) Conclusion

What does HIT adoption meana)Computerized systems and secured exchanges

between consumers, providers, insurers.b) Adoption of EHR and EMRc) mHealthd)eRx

HIT Adoption in the US

1)Since 2010, the proportion of hospitals having a basic electronic health record (EHR) has tripled.

2)More than 38 percent of physicians report having adopted basic EHRs in 2012.

3) Hospitals were more likely to implement EHR functions to record patient demographics, vital signs, and smoking status than they were functions for electronically submitted lab reports, health surveillance data, summary records for patient transitions between care settings, and functionalities for patient use.

4) U.S. providers could do more using HIT to engage patients with educational materials tailored to an individual’s diagnosis and health literacy level.

HIT as a global endevourAn OECD survey identified four common core

objectives for HIT implementation across countries

a)To increase the quality and efficiency of careb)To reduce the operating costs of clinical

servicesc)To reduce the administrative costs of running

the health care systemd)To enable entirely new models of health care

delivery

Cross country comparison

WHOa) Focused on implementation of ehealth,

telemedicine, mobile health, patient information management.

b) Total of 114 member states chose to participate in the 2009 survey.

WHO GOe Telemedicine Survey

WHO mhealth survey

Member states reporting at least one mhealth initiative, by WHO region.

Elearning in health sciences

European Commissiona) Survey in late 2010 to access the use of e-

health in hospitals.b) Found that 65% European hospitals have a

common EHR system, only 45 percent of acute hospitals can exchange clinical information electronically with other settings, and telemonitoring remains rare (8%).

Commonwealth Funda) In 2012, released findings of a survey of primary care

physicians in 10 countries.b) Found notable increase in the use of EHRs but

differences across countries existed.c) Reported the use of specific HIT capabilities—such as

order entry management; generating patient information; generating panel information; or routine clinical decision support—and found lower rates of adoption.

OECDa) Survey uses functionality based approach to measure

availability and use of electronic systems to perform specific clinical tasks, rather than relying on vague terms that may mean different things in different settings.

b) OECD approach uses a “model survey” framework, which is composed of separate, self-contained modules that afford flexibility and adaptability to a rapidly changing environment.

Country Specific ApproachesSweden• 100 % of prescriptions are ordered and renewed

elect100 % of prescriptions are ordered and renewed electronically

• All laboratories in the nation are fully computerized• Shared technical infrastructure• Challenges faced

• More than 50% of the counties choose different platform

• EHR adoption and interconnectivity within counties

• Regional EHRs do not connect to the 60 national condition-specific quality registries

• Center for eHealth – introduced national wide use of IT in the decentralized health and social care systems.

• Focus was made on improving national information structures and creating national terminology standards.

• U.S. health care has also taken the national approach with MU standards and a common set of EHRs.

• Adoptions U.S can make from Sweden approach

Germany• 64% adoption of EHRs among acute-care

hospitals and 90% adoption in primary care.• Like Sweden, Germany has struggled to

achieve broad connectivity • Patients at the center of the process for

electronic clinical data sharing• U.S. solution relies almost exclusively on

health care providers sending and receiving information.

• efforts are heavily subsidized by the government

• uncertain return-on-investment for providers who choose to participate.

Advantages of following the adopting the German approach • MU criteria that patients should have

information over their health records.• Enables direct access to health information

of patients.• patient- centered care

Canada• (EHR) is defined as a complete health record that holds

all relevant health information about a person over their lifetime from all sources.

• Acts in place of a series of connections between providers to exchange specific pieces of clinical data

• Canadian approach offers a middle ground between the provider centric approach of U.S. and the patient-centric approach of Germany.

• Patient-centric, lifelong record, and require that providers report the key pieces of data.

Conclusions

From all that we have seen we know that1. There has been a huge paradigm shift in the adoption

and the use of HIT in the US2. However this is not just a US wide shift but a global one.3. WHO, the European and the OECD have made real

efforts to facilitate this movement.4. The US has a lot to learn from countries whose EHR

adoption is at a much advanced level.

References

http://www.who.int/goe/survey/2009/figures/en/index1.htmlhttp://www.ehr-impact.eu/downloads/documents/ehr_impact_study_final.pdf

http://www.ehr-impact.eu/downloads/documents/ehr_impact_study_final.pdf