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  • 1. <ul><li>Opportunities and Challenges for Implementing HIT </li></ul><ul><li>Steven R. Simon, MD, MPH </li></ul><ul><li>August 2007 </li></ul><ul><li>Supported by a grant from the US Agency for Healthcare Research and Quality (AHRQ) </li></ul>
  • 2. Prologue <ul><li>Widespread (universal?) EHR adoption by 2014 </li></ul><ul><li>Has adoption reached tipping point? </li></ul><ul><li>Do EHRs improve quality of care? </li></ul><ul><li>How are physicians using EHRs? </li></ul>
  • 3. Outline <ul><li>Massachusetts e-Health Collaborative </li></ul><ul><li>Statewide survey of physicians, 2007 </li></ul>
  • 4. Massachusetts e-Health Collaborative (MAeHC) <ul><li>Formed in 2004 </li></ul><ul><li>Major health care stakeholders </li></ul><ul><li>$50 million from Blue Cross Blue Shield of MA </li></ul><ul><li>Statewide EHR adoption </li></ul><ul><li>Demonstration project: </li></ul><ul><ul><li>Universal EHR adoption in 3 communities </li></ul></ul><ul><ul><li>Intra-community (and, ultimately, inter-community) data exchange </li></ul></ul>
  • 5. 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. PHYSICIANS “GOING LIVE”, BY COMMUNITY # 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. HEALTH INFORMATION EXCHANGE Northern Berkshire Example Patient recruitment Health data exchange Referrals mgmt Patient portal
  • 8. State of the State: Physician Survey
  • 9. Massachusetts Physician Survey <ul><li>Stratified random sample of practices (N=1884) </li></ul><ul><li>Randomly sampled one physician per practice. </li></ul><ul><li>2005: 1345 respondents (71%) </li></ul><ul><ul><li>EHR Adoption: 23% of practices, 45% of physicians </li></ul></ul><ul><ul><li>EHR Usage: wide variability in available functions and reported usage. </li></ul></ul>
  • 10. 2007 Follow Up Survey (N=1345) <ul><li>May – July, 2007 </li></ul><ul><li>Multiple mailings to all 1345 respondents from 2005 </li></ul><ul><li>Excluded: moved, retired, deceased (N=200) </li></ul><ul><li>902 completed surveys (response rate 79%) </li></ul><ul><li>***Preliminary Analysis*** </li></ul>
  • 11. Characteristics of Respondents with EHRs (N=562, >60% of sample) 60 Number of Patients/Week (median) 35% Incentives for HIT Adoption 28% Incentives for HIT Usage 22% 10+ Years with Practice 65% Teaching (Students/Residents) 32% Practice Ownership 44% 7+ Physicians in Office 16% Primary Care 39% 20+ Years Since Med School 37% Female
  • 12. 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. <ul><li>Laboratory test results </li></ul><ul><li>Laboratory order entry </li></ul><ul><li>Radiology test results </li></ul><ul><li>Radiology order entry </li></ul><ul><li>Electronic visit notes </li></ul><ul><li>Reminders for care activities (e.g. overdue health maintenance) </li></ul><ul><li>Electronic medication lists of what each patient takes </li></ul><ul><li>Electronic problem list </li></ul><ul><li>Can transmit prescriptions to pharmacy electronically or via electronic faxing </li></ul><ul><li>Electronic referrals or clinical messaging (secure e-mailing between providers) </li></ul>
  • 13. Available EHR Functions, 2005 - 2007 63% 62% Electronic referrals 70% 45% Electronic transcription of Rx 76% 71% Electronic problem list 81% 75% Electronic medication lists 56% 53% Alerts and reminders 87% 84% Electronic visit notes 54% 54% Radiology order entry 78% 76% Radiology test results 51% 47% Laboratory order entry 86% 85% Laboratory test results (N=562) (N=387) Function 2007 2005
  • 14. Usage* of EHR Functions, 2005 - 2007 *Most or all the time 50% 67% 72% 79% 40% 89% 69% 81% 64% 77% 2007 ▲ ▲ ▲ ▲ ▲ ▲ 43% Electronic referrals 45% Electronic transcription of Rx 58% Electronic problem list 67% Electronic medication lists 31% Alerts and reminders 71% Electronic visit notes 48% Radiology order entry 74% Radiology test results 52% Laboratory order entry 72% Laboratory test results 2005 Function
  • 15. 2007 Massachusetts Survey Summary <ul><li>EHR adoption continues to increase </li></ul><ul><ul><li>Majority of Massachusetts’ physicians use EHRs </li></ul></ul><ul><li>Large segments of the physician population have “light” models of EHRs </li></ul><ul><ul><li>Just over half of physicians with EHRs have </li></ul></ul><ul><ul><ul><li>Lab and radiology order entry </li></ul></ul></ul><ul><ul><ul><li>Clinical decision support </li></ul></ul></ul><ul><li>Use of available EHR functions is increasing </li></ul><ul><li>Substantial proportions of EHR users do not use key functions that may improve quality and safety (order entry, e-Rx, and decision support) </li></ul>
  • 16. Questions?
  • 17.  
  • 18. EHR SELECTION Preferred Vendors Selection Community down-select <ul><ul><li>EHR RFP distributed in May, 2005 </li></ul></ul><ul><ul><li>Over 30 responses received </li></ul></ul><ul><ul><li>Vendor Selection Committee validated 7 vendors to go forward </li></ul></ul><ul><ul><li>Community Steering Committees down-select to smaller number for individual physician choice in each community </li></ul></ul><ul><ul><li>3 or 4 in each community </li></ul></ul><ul><ul><li>Initial vendor fairs completed in each community and down-select complete </li></ul></ul>Physician choice <ul><ul><li>Individual physician vendor fairs </li></ul></ul><ul><ul><li>Each community developing different model of physician choice </li></ul></ul>

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