A Survey of Over 750 Physicians Conducted by Harris Interactive Inc. Data collected: October 14, 1999 - December 31, 1999 Revised presentation of findings March 13, 2000 Computing in the Physician’s Practice “ 40% of physicians use Internet for clinical or medical business use”

Aims of the Study CPP is the most comprehensive study ever of physicians and information technology--more than 750 physician respondents making it 2 to 3 times the size of a typical physician survey. Study focuses on four major issues Physicians’ (and their administrative and clinical staff’s) use of the Internet Physicians’ and their practices staff’s use of computing, the Internet and private networks for administrative tasks Physicians’ and their practices staffs’ use of computing, the Internet and private networks for “administrative clinical” tasks Physicians use of computers and the Internet for clinical tasks, and their use of the “Electronic Medical Record Subsequent study of “power-users” in field February 2000. Where applicable, trended data from previous Harris surveys are noted.

CPP is the most comprehensive study ever of physicians and information technology--more than 750 physician respondents making it 2 to 3 times the size of a typical physician survey.

Study focuses on four major issues

Physicians’ (and their administrative and clinical staff’s) use of the Internet

Physicians’ and their practices staff’s use of computing, the Internet and private networks for administrative tasks

Physicians’ and their practices staffs’ use of computing, the Internet and private networks for “administrative clinical” tasks

Physicians use of computers and the Internet for clinical tasks, and their use of the “Electronic Medical Record

Subsequent study of “power-users” in field February 2000.

Where applicable, trended data from previous Harris surveys are noted.

Survey Methods A random sample of 5,000 physicians was selected from the American Medical Association database including specialists and generalists. Mail surveys were sent to physicians along with letters describing the survey and offering an incentive in October and November. A reminder postcard was sent in December. Physicians were given the option of either completing the survey on paper and mailing or faxing it back to Harris, or choosing to do it online. A URL address was included in the invitation that allowed them to access the survey on the Internet. To ensure confidentiality, interviewing was conducted on Harris’ password protected website. Over 750 physicians responded (769 in data set presented here).

A random sample of 5,000 physicians was selected from the American Medical Association database including specialists and generalists.

Mail surveys were sent to physicians along with letters describing the survey and offering an incentive in October and November. A reminder postcard was sent in December.

Physicians were given the option of either completing the survey on paper and mailing or faxing it back to Harris, or choosing to do it online. A URL address was included in the invitation that allowed them to access the survey on the Internet. To ensure confidentiality, interviewing was conducted on Harris’ password protected website.

Over 750 physicians responded (769 in data set presented here).

Overview of Results Physicians are very encouraged by the actualities as well as the possibilities of computers--most believe that computers have had a positive impact on medicine already. The Internet is a big deal for physicians, and it’s not all stock trading and golf tips. They are using it for clinical and business purposes too. Practice administration is more computerized than is commonly realized, although there is significant room for more automation. Clinical use of computing is still lagging behind, particularly in the core of the “Electronic Medical Record” but most physicians are optimistic about big changes in the next five years. Overall, the physician market looks ripe for take off.

Physicians are very encouraged by the actualities as well as the possibilities of computers--most believe that computers have had a positive impact on medicine already.

The Internet is a big deal for physicians, and it’s not all stock trading and golf tips. They are using it for clinical and business purposes too.

Practice administration is more computerized than is commonly realized, although there is significant room for more automation.

Clinical use of computing is still lagging behind, particularly in the core of the “Electronic Medical Record” but most physicians are optimistic about big changes in the next five years.

Overall, the physician market looks ripe for take off.

Preface: Practice Issues and Experience with Patient Care “ Utilization review, patient relationship continuity, and time pressure on patient care are all concerns”

Overview of practice issues and experience with patient care The study starts with some basic metrics about physicians in practice. Physicians are seeing many more managed care patients than they did just two years ago. Their biggest problems are lower revenues and more hassle from managed care BUT communications and transactions problems, especially around patient eligibility, formularies, and reporting to third parties, are the next most significant issues. Utilization review, patient relationship continuity, and time pressure on patient care are all concerns but less severe. This survey sample has typical physician income characteristics (similar to previous Harris surveys in 1997 and mid-1999).

The study starts with some basic metrics about physicians in practice.

Physicians are seeing many more managed care patients than they did just two years ago.

Their biggest problems are lower revenues and more hassle from managed care BUT communications and transactions problems, especially around patient eligibility, formularies, and reporting to third parties, are the next most significant issues.

Utilization review, patient relationship continuity, and time pressure on patient care are all concerns but less severe.

This survey sample has typical physician income characteristics (similar to previous Harris surveys in 1997 and mid-1999).

Since 1997: A big jump in the number of managed care patients Q.A2 What percentage of your patients are in each of the following insurance categories? Mean percent of patients in each category Asked of all physicians (n = 769)

Besides managed care, physicians are concerned about administrative costs and systems hassles Q.A1 Please indicate how much of a problem the following has been for you in your practice. Percentage of physicians who experienced serious problems with: Asked of all physicians (n = 769)

Practice income: 1997 - 1999 Q.F1 Which of the following income categories best describes your last year’s pre-tax income from your medical practice? Asked of all physicians (n = 769)

Geographic setting of practice Q.F4 How would you describe the geographic setting of your practice? Is it an urban center, a suburb, a small town or a rural location? Asked of all physicians (n = 769)

Part One: Attitudes about Computing and Internet Use “ Over one-third of physicians have access to the Internet in their clinical work area”

Overview of attitudes about computing, and physicians use of the Internet Physicians are surprisingly positive about the impact of computers on medicine, although they are more conscious of the problems hindering information technology than they were two years ago. 89% of physicians use the Internet (including email), with the average online physician using it over 6 hours per week. Most physician Internet use is at home, and most is for personal use BUT 40% is for clinical or medical business use, and the majority of that happens in the practice setting, mostly in their personal office. Over one third of physicians (and slightly more of their staff) have access to the Internet in their clinical work area. As with other Internet users, email is the docs’ killer app--50% use it with professional colleagues, but many fewer use it with patients.

Physicians are surprisingly positive about the impact of computers on medicine, although they are more conscious of the problems hindering information technology than they were two years ago.

89% of physicians use the Internet (including email), with the average online physician using it over 6 hours per week.

Most physician Internet use is at home, and most is for personal use BUT 40% is for clinical or medical business use, and the majority of that happens in the practice setting, mostly in their personal office.

Over one third of physicians (and slightly more of their staff) have access to the Internet in their clinical work area.

As with other Internet users, email is the docs’ killer app--50% use it with professional colleagues, but many fewer use it with patients.

Physicians have a positive attitude towards computing Q.A7 Which one of the following statements best reflects how you feel about the use of computers in medicine? Asked of all physicians (n = 769)

Hindrances to information technology use Q.A8 To what extent is your current use of information technology hindered by each of the following - to a great extent, some extent, or hardly at all? % Responding “Great/Some Extent” Asked of all physicians (n = 769)

Nine in ten physicians are online % currently accessing Internet in following places: Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

The vast majority of physicians now have access to the Internet at home . . . most of the rest will soon Will have access within 18 months Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access at home

Will have access within 18 months Half of physicians’ offices have Internet access in their administrative areas . . . Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying their office staff has Internet access in their administrative areas

. . . and half of physicians have access to the Internet in their personal office area Will have access within 18 months Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access in their personal office area

Will have access within 18 months But only one-third of physicians have Internet access in their clinical work area . . . Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access in their clinical work area

Will have access within 18 months . . .although slightly more of their clinical staff have Internet access in their clinical work area Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying their clinical staff has Internet access in their clinical work areas

The average online physician uses the Internet 6 hours per week Q.B3 In the past week, how many hours did you personally spend using the Internet (or other online services) for all purposes, including business, personal, email, etc.? Hours spent online in past week by physicians with Internet access Mean = 6 hours Median = 5 hours Asked of all physicians with Internet access (n = 687)

Why are physicians accessing the Internet? It’s mostly personal Average number of hours on Internet in past week = 6 % of physicians’ Internet use for different functions Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Asked of all physicians who used Internet in past week (n = 612)

Physicians’ use of the Internet: “What” depends on “Where” Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time where physicians used the Internet for the following: Asked of all physicians who used Internet in past week (n = 612)

Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: Physicians are on E*trade, ESPN and Match.com, especially at home Calculated from physicians who used Internet for personal use in the past week (n = 573) Personal use = 61% of all Internet use % of time physicians spend on Internet for personal use in the following locations:

Specific clinical work relating to individual patients = 8% of all Internet use The little Internet clinical work about individual patients that is done, happens mostly in physicians’ personal office area Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physicians spend on Internet for specific clinical work relating to individual patients in the following locations:

Both at home and at work, doctors are using the Internet for the business of medicine . . . Business, administrative and organizational issues relating to practice = 16% of all Internet use Calculated from physicians who used Internet for business, administrative and organizational issues relating to practice in the past week (n = 335) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physician spends on Internet for business administrative and organizational issues relating to practice in the following locations:

. . .and it’s also used for to look for general clinical information Specific clinical work relating to individual patients = 16% of all Internet use Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physician spends on Internet for specific clinical work relating to individual patients in the following locations:

Websites: Not all physicians have them . . . Q.B5 Does your practice have a website? Asked of physicians who have Internet access somewhere in their practice (n = 706) % of physicians with a website

Practice will have web site within 18 months . . . but many more will get them Q.B5 Does your practice have a website? Q.B5A If your practice does not currently have a website, do you anticipate getting one within the next 18 months? Asked of physicians who have Internet access somewhere in their practice (n = 706)

Email is common with colleagues, but is rare with patients; both are more frequent in big group practices Q.D1 Please indicate if you use email to communicate with any of the following: Asked of all physicians (n = 769) % of physicians using email with community

Q.D1 Please indicate if you use email to communicate with any of the following:

Reasons physicians may not use email with patients QD2. Please indicate which of the following is a reason why you might NOT use email for communications between your patients and your office? Asked of all physicians (n = 769)

QD2. Please indicate which of the following is a reason why you might NOT use email for communications between your patients and your office?

Part Two: Computers and Networks in Office “ 95% of physicians have computers in their practice”

Overview of computers and networks in the office Only 5% of physicians don’t have computers in their practice, but only larger practices tend to have dedicated network connections. Internet access is mostly provided by regular ISPs (not WebMD or POL). Most practices (67%) have internal networks, but less than half have an Intranet, and those are mostly large practices. Physicians are huge users of cell phones (87%), but only 15% have a handheld device (like a Palm Pilot)--there’s a strong correlation between high Internet use and handheld device use. Practice management software vendors may be regarded as being the “path to the physician’s desktop” BUT the vast majority of physicians don’t know who their practice’s vendor is!

Only 5% of physicians don’t have computers in their practice, but only larger practices tend to have dedicated network connections.

Internet access is mostly provided by regular ISPs (not WebMD or POL).

Most practices (67%) have internal networks, but less than half have an Intranet, and those are mostly large practices.

Physicians are huge users of cell phones (87%), but only 15% have a handheld device (like a Palm Pilot)--there’s a strong correlation between high Internet use and handheld device use.

Practice management software vendors may be regarded as being the “path to the physician’s desktop” BUT the vast majority of physicians don’t know who their practice’s vendor is!

The average physician has 15 computers in their office or practice setting Q.C1 How many computers are there in your office or practice setting? Include all computers used by administrative and clinical staff. Number of computers in physicians’ office Mean # of computers = 15 Median # of computers = 5 Asked of all physicians (n = 769)

Physicians’ use of different information appliances: The cell phone is stuck to their ear Q.B6 Please indicate which choice best describes the degree to which you use each of the following devices or technologies: Asked of all physicians (n = 769) Physicians using different information appliances

Q.B6 Please indicate which choice best describes the degree to which you use each of the following devices or technologies:

Handheld devices: Despite the Palm Pilot revolution, they are only used by a small minority so far Asked of all physicians (n = 769) Q.B6 Please indicate which choice best describes the degree to which you use a handheld device such as a Palm Pilot: Percentage of physicians using handheld personal device either in practice or personal use 15% 9% 20% 15% 15% 11% 19%

Q.B6 Please indicate which choice best describes the degree to which you use a handheld device such as a Palm Pilot:

Network connections in the office: They’re more hooked into private networks than the Internet Q.C3 What type of network connection does your office staff use to connect with the outside world? Types of network connections Asked of physicians have computers in office or practice settings (n=708)

Q.C3 What type of network connection does your office staff use to connect with the outside world?

Type of connection physicians have for ISPs Q.C3a Please specify the type of connection your organization has: Asked of physicians who have dedicated line to network connecting to an ISP (n=171)

Q.C3a Please specify the type of connection your organization has:

Like the rest of us, physicians’ offices get their Net access through ISPs Q.B2 Who provides Internet access at your office or clinical workplace? Asked of physicians who have Internet service somewhere in their practice (n = 534)

Internal networks are common . . . Q.C6 Does your practice have an internal network, that is, a system that connects the PCs to each other and/or a central server? Asked of physicians who have computer(s) in their office or practice (n = 708)

Q.C6 Does your practice have an internal network, that is, a system that connects the PCs to each other and/or a central server?

. . . . but only big groups have Intranets Q.C6a If your office has an internal network, does your practice have an Intranet, that is, a system that allows you to view the contents of the internal network via a web browser such as Internet Explorer or Netscape Navigator? Asked of physicians whose practice has internal network (n = 474)

Q.C6a If your office has an internal network, does your practice have an Intranet, that is, a system that allows you to view the contents of the internal network via a web browser such as Internet Explorer or Netscape Navigator?

Practice management system software vendors: not the way to the physician’s mind-share? Q.C5 If you know the name of the vendor who supplies your office’s main practice management system software, please write it below: Asked of physicians who have computer(s) in their office or practice (n = 708)

Q.C5 If you know the name of the vendor who supplies your office’s main practice management system software, please write it below:

Decisions about technology purchases: in smaller practices physicians call the shots Q.C8 If you currently have a computer (or anticipate getting one in the near future), who makes (or will make) the majority of decisions concerning the purchase of hardware, software and networking systems for your practice? Asked of physicians whose practice has internal network (n = 769)

Q.C8 If you currently have a computer (or anticipate getting one in the near future), who makes (or will make) the majority of decisions concerning the purchase of hardware, software and networking systems for your practice?

Part Three: Administrative Use of Computing “ Physicians’ practices use computers for billing information, claims submission and scheduling ”

Overview of administrative computer use Physicians’ practices use computers extensively for a few functions--including billing information, claims submission and scheduling. Many other available transactions, including several that health plans and vendors have been marketing for some time, are used by less than a third of physicians’ practices. Even those practices which do use some of the less common functions (such as eligibility or referral authorization) tend to use them for a lower proportion of their patients. Note: This section uses a complex chart layout. On the left it has a pie chart showing the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone, mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

Physicians’ practices use computers extensively for a few functions--including billing information, claims submission and scheduling.

Many other available transactions, including several that health plans and vendors have been marketing for some time, are used by less than a third of physicians’ practices.

Even those practices which do use some of the less common functions (such as eligibility or referral authorization) tend to use them for a lower proportion of their patients.

Note: This section uses a complex chart layout. On the left it has a pie chart showing the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone, mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

Physicians on their practice’s use of computing for administration: Only billing, claims, and scheduling are ubiquitous Q.C4 Does your practice use a computer for the following activities? Asked of all physicians who have computer in their office or practice setting (n = 708) Percent physicians responding uses a computer in their practice

Plan to use within 18 months Physicians on their practice’s use of computing for administration: Most practices use computers for recording billing information and generating patient bills Q. C4 Does your practice use computers for any of the following functions? Proportion of patients for which practices are using computers for recording billing information and generating patient bills Asked of physicians who have computer in their office or practice setting (n = 708)

Physicians on their practice’s use of computing for administration: Most offices submit the majority of their claims online . . . Proportion of patients for which practices are using computers to submit claims electronically Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Physicians on their practice’s use of computing for administration: . . . but most claims submission is batch, not real-time Q.C4a If you currently use a computer to submit claims electronically, are these submitted as they arise or in a batch at the end of the day? Asked of physicians whose practices submit claims electronically (n = 481)

Q.C4a If you currently use a computer to submit claims electronically, are these submitted as they arise or in a batch at the end of the day?

Proportion of patients for which practices are using for computers for scheduling and other practice administration Physicians on their practice’s use of computing for administration: Over half use computers for patient scheduling Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion which practices are using computer for looking up billing codes, CPT information, Medicare information, etc. Physicians on their practice’s use of computing for administration: Over half look up billing codes on a computer Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices are using computers to submit claims status inquiries to health plans Physicians on their practice’s use of computing for administration: Nearly half submit claims status inquiries to health plans online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices are using computers to inquire about patient eligibility verification from health plans Physicians on their practice’s use of computing for administration: Only one third use a computer for inquiring about patient eligibility, but this should see modest growth Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion which practices are using computers to receive electronic payments from health plans, IPAs and payers Physicians on their practice’s use of computing for administration: Nearly one in three receive electronic payments Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion which practices are using computers to document patient encounters for reporting to health plans or IPAs Physicians on their practice’s use of computing for administration: Three in ten use a computer for documenting patient encounters to report to health plans or IPAs Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices use computers to authorize referrals from health plans Physicians on their practice’s use of computing for administration: Less than one quarter authorize referrals online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices are using computers to receive earned remittance advice from health plans, IPAs and payers Physicians on their practice’s use of computing for administration: One in five receive earned remittance advice from payers Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices are using computers to look up directories of providers supplied by health plans or IPAs Physicians on their practice’s use of computing for administration: Fewer than one in five look-up provider directories on a computer Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Proportion for which practices are using computers to pre-certify hospital admissions Physicians on their practice’s use of computing for administration: Only a tiny minority pre-certify hospital admissions online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

Why is the practice using computers for office functions? Computers provide a better way! Q.C4b If you currently use a computer for office functions or intend to use one in the next 18 months, what are your main reasons for deciding to use a computer for these functions? (more than one answer permitted) Practice currently or intends to use computer for various office functions (n=706)

Q.C4b If you currently use a computer for office functions or intend to use one in the next 18 months, what are your main reasons for deciding to use a computer for these functions? (more than one answer permitted)

Part Four: Services for Patients “ Most physicians’ practices provide very few information services for patients ”

Overview of services for patients Most physicians’ practices provide very few information services for patients apart from pamphlets and handouts, and videos. But significant minorities say they plan to provide computer or Internet-based access to histories, heath risk assessments, etc. within 18 months. With several vendors targeting this type of service free to physicians, we can expect fast growth in this type of service. Note: In this chart lay-out, on the left the pie chart shows the yes/no. The bar on the right shows the likely activities in 18 months as a fraction of all practices not just those saying no (e.g the bar percentages total the “no’s” not 100%).

Most physicians’ practices provide very few information services for patients apart from pamphlets and handouts, and videos.

But significant minorities say they plan to provide computer or Internet-based access to histories, heath risk assessments, etc. within 18 months. With several vendors targeting this type of service free to physicians, we can expect fast growth in this type of service.

Note: In this chart lay-out, on the left the pie chart shows the yes/no. The bar on the right shows the likely activities in 18 months as a fraction of all practices not just those saying no (e.g the bar percentages total the “no’s” not 100%).

For patients, most practices only offer information on videos or paper Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Asked of all physicians (n = 769) Percent physicians offer in their practice setting

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Pamphlets and handouts Almost all physicians offer pamphlets and handouts Asked of all physicians (n = 769)

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Informational videos that can be viewed in the office Asked of all physicians (n = 769) Nearly half offer informational videos

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Patients have ability to complete histories or health risk assessments at home on paper before they visit the office Asked of all physicians (n = 769) Two in five practices offer patients the ability to complete histories or HRAs at home before they visit the office

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Directions to pre-selected healthcare websites that can be accessed from home One in six suggest healthcare websites to patients Asked of all physicians (n = 769)

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Access to computer-based information in office Asked of all physicians (n = 769) One in ten offer computer-based information for patients in their offices

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Ability to complete health risk assessments on computer in office Asked of all physicians (n = 769) Few patients have the ability to complete HRAs on computers in their offices . . .

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Ability to complete histories on computer in office Asked of all physicians (n = 769) … and fewer offer patients the ability to complete histories on computers in their office

Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Offer patients ability to complete histories or health risk assessment from home via the Internet before they visit the office Asked of all physicians (n = 769) … and none of this is offered over the Net yet!

Part Five: Practice and Office Use of “ Administrative Clinical Computing” “ More than half of practices access lab test results online”

Overview of administrative clinical computing We define administrative clinical computing as clinical transactions that are usually dealt with by members of the physician’s office or clinical staff. Despite the efforts to connect physicians offices to clinical networks, the only commonly used computer-based application is receiving lab results. Substantially more lab results will be received electronically in 18 months time, and there is increased interest in using computers for HCFA E&M coding. Almost no use of computers for ordering Rx refills thus far. Note: This section uses a complex chart layout. On the left a pie chart shows the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

We define administrative clinical computing as clinical transactions that are usually dealt with by members of the physician’s office or clinical staff.

Despite the efforts to connect physicians offices to clinical networks, the only commonly used computer-based application is receiving lab results.

Substantially more lab results will be received electronically in 18 months time, and there is increased interest in using computers for HCFA E&M coding.

Almost no use of computers for ordering Rx refills thus far.

Note: This section uses a complex chart layout. On the left a pie chart shows the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

Clinical transactions done online in physicians’ practices: Viewing lab results is the only commonly-used application Asked of all physicians (n = 769) Percentage of physicians whose practice uses a computer for the following function Q.E1 Does your practice use computers for any of the following functions?

Plan to use within 18 months Proportion for which computers are used to access lab tests and/or other diagnostic results Asked of all physicians (n = 769) More than half of practices access lab test results online, and more will soon Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Plan to use within 18 months Proportion for which an automated system is used to verify HCFA E&M coding accuracy Asked of all physicians (n = 769) Only one in ten practices use the computer to verify E&M coding accuracy Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Plan to use within 18 months Proportion of hospital discharge/medical attestations signed off on computer Asked of all physicians (n = 769) Few physicians are in practices using computers to sign off on hospital discharges or Medicare attestations Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Plan to use within 18 months Proportion for which prescription refills are ordered online Asked of all physicians (n = 769) Few practices order prescription refills online Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Plan to use within 18 months Proportion of patients for whom hospital admission forms are completed online Asked of all physicians (n = 769) Hospital admission forms are rarely completed online Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Plan to use within 18 months Proportion for which computers are used to communicate with pharmacies, pharmacy benefits management companies or health plans Asked of all physicians (n = 769) Despite the rhetoric about formularies, few practices communicate online with pharmacies, PBMs or health plans Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Part Six: Physician‘s Use of Computing for Clinical Purposes “ Physicians want better access to test results, and easier ways to generate notes ”

Overview of clinical computing We define clinical computing as clinical transactions that are usually dealt with by the physicians themselves. Paper (and phone and tape) rule in the clinical environment--only 28% of physicians use a computer to access information about a patient, and less than 1 in 3 of them did it for more than half their patients, and only 1 in 5 did it when the patient was present. Physicians want better access to test results, easier ways to generate notes, and better availability of previous notes. Clinical notes are all now handwritten or dictated, but change is likely. A substantial minority believes they’ll be using computers, PDAs or voice recognition for taking notes in 18 months, and a large majority believes they will use one of those technologies in 5 years.

We define clinical computing as clinical transactions that are usually dealt with by the physicians themselves.

Paper (and phone and tape) rule in the clinical environment--only 28% of physicians use a computer to access information about a patient, and less than 1 in 3 of them did it for more than half their patients, and only 1 in 5 did it when the patient was present.

Physicians want better access to test results, easier ways to generate notes, and better availability of previous notes.

Clinical notes are all now handwritten or dictated, but change is likely. A substantial minority believes they’ll be using computers, PDAs or voice recognition for taking notes in 18 months, and a large majority believes they will use one of those technologies in 5 years.

Limited use of computers to access clinical information QE2. Do you personally or do other staff in your practice use a computer or handheld device such as a Palm Pilot for any of the following? Asked of all physicians (n = 769)

QE2. Do you personally or do other staff in your practice use a computer or handheld device such as a Palm Pilot for any of the following?

Physicians biggest desires? Immediate access to patients’ results, and a better way to take notes Q.A9 Assuming the underlying technologies worked well, which two solutions from the following list would you find most helpful? Asked of all physicians (n = 769)

Physicians use paper to track their work for billing purposes Q.E4 How do you track your clinical work for billing purposes? Asked of all physicians (n = 769)

Q.E4 How do you track your clinical work for billing purposes?

Share of patients used for Q.E-3 In the past week, did you personally use a computer or handheld device like a Palm Pilot to access clinical information about individual patients? Q.E-A (If Yes,) For what share of patients did you do this? Overall, one in four physicians is accessing clinical information about specific patients using a computer Asked of all physicians (n = 769)

. . . But those clinical “power users” aren’t doing it while the patient is there Q.E3B If personally used a computer to access patient clinical information, did you usually do this? Asked of physicians who used a computer or handheld device in past week (n = 208)

Q.E3B If personally used a computer to access patient clinical information, did you usually do this?

Doctors take their clinical notes after they see the patient Q.E6 In the past week, when did you finish the bulk of your notes for a typical consultation? Asked of all physicians (n = 769)

Q.E6 In the past week, when did you finish the bulk of your notes for a typical consultation?

After 30 years of the “Electronic Medical Record”, clinical notes stay on paper . . . Q.E5 On your most recent full day of treating patients, what percentage of your clinical notes did you take by each of the following methods? Asked of all physicians (n = 769) Percentage who said they used any of the following ways to take clinical notes (multiple answers allowed)

. . . but the majority don’t expect it to stay that way for too long; voice recognition is the great (white coat) hope Q.E5A If you are mainly taking notes via an assistant, handwriting, and/or dictating onto a tape, do you expect to use a computer, handheld device, or voice recognition software in 18 months?….in five years? Asked of all physicians who mainly record notes manually or dictate into tape (n = 676) 44% 85%

Conclusions This is the first phase of a detailed look at physician computing, and it yields a few conclusions: Physicians are using the Internet and are optimistic about the potential of computing. Growth has been VERY fast (x 2 since 1997). Physicians (and their staff) are frustrated with their current use of computing for administrative transactions, but most are accessing the Internet and the other infrastructure required to start automating more functions. Clinical computer use is in its infancy, but most physicians are expecting to make big changes in the next 2 to 5 years.

This is the first phase of a detailed look at physician computing, and it yields a few conclusions:

Physicians are using the Internet and are optimistic about the potential of computing. Growth has been VERY fast (x 2 since 1997).

Physicians (and their staff) are frustrated with their current use of computing for administrative transactions, but most are accessing the Internet and the other infrastructure required to start automating more functions.

Clinical computer use is in its infancy, but most physicians are expecting to make big changes in the next 2 to 5 years.