- 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)
- 2 -September 2007AHRQ Annual Meeting
Prologue
Widespread (universal?) EHR adoption by 2014
Has adoption reached tipping point?
Do EHRs improve quality of care?
How are physicians using EHRs?
- 3 -September 2007AHRQ Annual Meeting
Outline
Massachusetts e-Health Collaborative
Statewide survey of physicians, 2007
- 4 -September 2007AHRQ Annual Meeting
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
- 5 -September 2007AHRQ Annual Meeting
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
- 6 -September 2007AHRQ Annual Meeting
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
- 7 -September 2007AHRQ Annual Meeting
HEALTH INFORMATION EXCHANGENorthern Berkshire Example
Patient recruitment Health data exchange Referrals mgmt Patient portal
- 8 -September 2007AHRQ Annual Meeting
State of the State: Physician Survey
- 9 -September 2007AHRQ Annual Meeting
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.
- 10 -September 2007AHRQ Annual Meeting
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***
- 11 -September 2007AHRQ Annual Meeting
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%
- 12 -September 2007AHRQ Annual Meeting
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)
- 13 -September 2007AHRQ Annual Meeting
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%
- 14 -September 2007AHRQ Annual Meeting
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
- 15 -September 2007AHRQ Annual Meeting
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)
- 16 -September 2007AHRQ Annual Meeting
Questions?
- 17 -September 2007AHRQ Annual Meeting
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
- 18 -September 2007AHRQ Annual Meeting
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