EHR ADOPTION IN MICHIGAN
AND NATIONWIDE
Jennifer Horowitz, MA, CPHIMS, FHIMSS
June 6, 2013
JENNIFER HOROWITZ
• Senior Director,
Research
• HIMSS Analytics
• Began with HIMSS
Analytics in 2001
INDUSTRY TRENDS
• Federal Initiatives
» 2009 American Recovery and Reinvestment Act
» 2010 Patient Protection and Affordab...
24TH ANNUAL HIMSS
LEADERSHIP SURVEY
BUSINESS ISSUE WITH MOST IMPACT ON
HEALTHCARE
0%
2%
3%
3%
5%
3%
8%
23%
14%
40%
1%
2%
4%
4%
4%
7%
8%
14%
16%
37%
Hospital I...
0%
1%
2%
1%
1%
3%
11%
15%
13%
12%
38%
1%
1%
2%
2%
2%
6%
9%
11%
17%
20%
28%
Integration of IT and Medical Devices
Securing ...
2%
1%
2%
4%
2%
3%
0%
9%
16%
15%
16%
25%
2%
2%
2%
2%
2%
3%
3%
7%
10%
10%
16%
16%
19%
Focus on Nursing Systems
Focus on Cons...
0%
0%
6%
3%
5%
7%
16%
22%
38%
1%
2%
3%
4%
5%
7%
8%
12%
25%
31%
Ensuring that Data is Secure/Private
Improving Patient Acce...
HIMSS ANALYTICS®
DATABASE
HIMSS ANALYTICS® DATABASE
• Company founded in 2004
» Market research arm of HIMSS
• HIMSS Analytics collects information ...
HIMSS ANALYTICS EMRAMSM MODEL
• Model established in 2006 to track hospitals’
adoption of EMR technology
• Eight-stage mod...
Data from HIMSS Analytics® Database © 2012 HIMSS Analytics
0.0% 1.9%
9.1%
16.3%
14.4%
36.3%
10.1%
4.2%
7.8%
0.8%
1.4%
2.2%...
HIMSS ANALYTICS EMRAMSM MODEL: MICHIGAN
EMR Adoption ModelSM (EMRAM)
Average Median Min Max
Entire HIMSS Analytics® Databa...
HIMSS ANALYTICS EMRAMSM MODEL
EMR Adoption ModelSM (EMRAM)
Average Median Min Max
Vermont (N=14) 4.9561 5.1100 3.4160 6.07...
EMRAM STAGE 6 HOSPITALS IN
MICHIGAN
GETTING ROI OUT OF CLINICAL
SYSTEMS - KAISER PERMANENTE
• Kaiser Permanente serves 8.6 million members across nine
states....
GETTING ROI OUT OF CLINICAL
SYSTEMS - CITIZENS MEMORIAL
• CMH is a 74-bed hospital with 10 rural health clinics located
in...
OVERALL RADIOLOGY PACS
INSTALLATIONS
70.85%
79.18%
84.40%
87.06%
89.89%
89.94%
90.10%
2007
(N=5073)
2008
(N=5168)
2009
(N=...
CPOE AUTOMATION AND PLAN ANALYSIS
63%
56%
19%
13%
12%
11%
6%
17%
2013
(N=156)
2013
(N=5445)
Automated Replacement Purchase...
DATA WAREHOUSING/MINING – CLINICAL
AUTOMATION AND PLAN ANALYSIS
40%
41%
54%
55%
2013
(N=156)
2013
(N=5321)
Automated Repla...
DATA WAREHOUSING/MINING – FINANCIAL
AUTOMATION AND PLAN ANALYSIS
58%
51% 24%
38%
46%
2013
(N=156)
2013
(N=5318)
Automated ...
PERCENT OF HOSPITALS USING BAR
CODE TECHNOLOGY IN THE PHARMACY
Current
• National – 72.45%
• Michigan – 84.62%
Planned
• N...
PERCENT OF HOSPITALS PARTICIPATING IN
INFORMATION EXCHANGE ORGANIZATION
Current
• National – 29.53%
• Michigan – 35.90%
Pl...
HIE capable, sharing of data between the EMR and community
based EHR, business and clinical intelligence
Advanced clinical...
AMBULATORY EMR ADOPTION
MICHIGAN
Source: HIMSS Analytics® Database
• National – 65.84%
• Michigan – 61.97%
Automated
• Nat...
Jennifer Horowitz
Senior Director, Research
Jennifer.horowitz@himssanalytics.org
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Jennifer Horowitz EHR Adoption in Michigan & Nationwide

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Connecting Michigan for Health 2013 http://mihin.org/

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  • This is a critical time for health IT. Hospitals and other eligible providers have until 2015 to demonstrate meaningful use of certified Electronic Medical Record (EMR) technology before being penalized. In order to qualify for incentive payments under ARRA, providers must use certified EMRs. Vendors of EMR systems or EMR modules must ensure their products have the features and functionality to be certified, and to enable meaningful use.Primary goal of ARRA – incentivize people to meet meaningful use Stage One – first time to qualify for incentives in 2012. Stage Two – first time to incentivize in 2014. Primary goal of the PPACA -- PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. Section 3022 of the Patient Protection and Affordable Care Act (ACA) authorizes Center for Medicare and Medicaid Services (CMS) to create the Medicare Shared Savings program (MSSP), which allows for the establishment of ACO contracts with Medicare by January 2012
  • The EMR environment is a complex and sophisticated environment. Its foundation is the clinical data repository (CDR), a real-time transaction processing database of patient clinical information for practitioners. The controlled medical vocabulary (CMV) is critical because it ensures that the practitioners who use the EMR are accessing accurate and comparable data. The CMV normalizes data from a relational and definitional hierarchy that enables other components of the EMR to optimally operate. Without a functional CMV, the clinical decision support system (CDSS) and workflow components of the EMR will not perform as expected by the clinicians in the environment.The applications of the EMR environment are clinical documentation for all clinicians/practitioners, computerized provider order entry (CPOE) for all clinicians/practitioners, and pharmacy management. We believe that the pharmacy management application has transitioned from a departmental system to an application of the EMR due to the influence of patient safety/medical error reduction concerns. A foundation of EMR applications, required to improve patient safety and reduce or eliminate medical errors, is composed of the CDR, CPOE, pharmacy management system, and the electronic medication administration record (eMAR), functionality normally found in the electronic clinical documentation systems of most vendors. These are surrounded by an enterprise master person index (EMPI), portals, and interface engine connectivity to supporting systems.A little about the EMRAM model:All application capabilities within each stage must be operational before that stage can be achieved.All lower stages must have been achieved before a higher level will be considered as achieved.A hospital can achieve Stages 3-6 if it has met all of the application requirements for a single patient care service (e.g. single nursing floor, cardiology service). Using the rules above, additional points are given for the implementation of applications in stages higher than the one fully achieved by the healthcare organization. In this fashion, other implementation paths than those prescribed by the stages can be taken into consideration for correlation with quality and financial research.
  • John – just included some notes on Kaiser below:HIMSS Analytics Stage 7 Award Winner 2011 HIMSS Enterprise Davies Award WinnerStaff of 159,000 More than 14,000 physicians Serves 8.6 million members Operates 36 hospitals with 34 in California, one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia As a large integrated care delivery system, Kaiser Permanente serves members with a full spectrum of needs, from sick care to well care. Reimbursement for care includes commercial health plans, individual health plans, Medicare, Medicaid, and charity care. Recognizing the ROI of EMR ImplementationIt is important to note that this effort was undertaken to improve the quality of care delivered to patients of Kaiser Permanente.Examples of return-on-investment follow.One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect. Another region saved more than $120,000 in dictation costs in just one year post-implementation. Saved costs for printed forms almost immediately after implementing the EMR with a $1.4 million decrease in one region on printing expenses of annual outpatient forms alone. Vacated more than 22,000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $0.4 and $3.3 million in 2001. Kaiser Permanente is now building new hospitals without medical record storage areas. Saved $200,000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space. Provide patients with test results within two days instead of a week or longer. Reduced the rate of medication errors by 57 percent one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration. Trimmed by 12 percent outpatient lab utilization two years after the implementation of KP HealthConnect, illustrating the reduction in duplicate tests.
  • John – just included some notes on Citizens below: (Please note that bottom two bullets on this slide were taken from the Davies award application completed in 2006)Citizens Memorial Healthcare (CMH)Bolivar, MissouriAnnual revenues of $100 million Staff of 1,550 125 affiliated physicians, including 60 physicians employed by CMH in 10 rural health clinics and 15 specialty clinics. CMH provides services across the continuum of care, including acute care, emergency services, home care, hospice, long term care, assisted living, ambulatory surgery, cancer care, rural health clinics and specialty physician practices. Challenge: During organizational strategic planning in 1999, CMH recognized that the system had grown to include a variety of services across a broad continuum of care for the community including the hospital, home care, long term care and physician practices - from cradle to grave.Additionally, the organization wanted to promote seamless care across the continuum to the community. Unfortunately, the care wasn’t seamless. Patients were asked for demographic and billing information repeatedly and the more important clinical information needed for care delivery was recorded on paper records located in 33 different locations. From that analysis and a strategic planning effort, CMH committed to this vision for health information technology:Enable a patient to enter anywhere into the continuum of care and have a personal identity that is maintained across that continuum. Physicians and other caregivers will have access to all of that patient’s medical information within the healthcare continuum. Providers will be able to document efficiently within the software system, which will free them to have more time to spend with patients. The investment of time, talent and money will enable CMH to be a technologically advanced healthcare organization poised to grow and offer new services to our patients and the community at large. The system is known as Project Infocare.Implementation Solutions: CMH began implementing the Project Infocare EMR in 2002 and had eliminated the paper medical record in the hospital by December 2003. Paper records were eliminated throughout the system, including long term care, home care and physician clinics by 2007. CPOE is utilized in all locations. Since that time, CMH has added emergency services, barcoding for medication administration, in-home telemanagement, ePrescribing, additional physician practices and a patient portal to the EMR system.EMR Solution: MeditechRecognizing the ROI of EMR ImplementationContinuity of care: More than 95% of patients presenting for care in the CMH system already have a record in the system. Their demographics, medications, history and allergies only need to be updated. The medication, patient history and allergy lists are common across the EMR system. Any update from any location is immediately reflected for all users accessing a record.Patient safety & quality: Medication safety/closed medication loop. Computerized provider order entry, pharmacy, nursing and barcoding all have contributed to a 70% reduction in reported medication errors in the hospital. Clinical quality measures show marked improvement. Across the CMH system, there are over 30 publicly reported quality measures from acute care, long term care and home health. CMH has made a tremendous improvement in those measures since implementing the EMR through the use of clinical decision support.Financial ROI: CMH has reduced clerical and transcription costs and kept total employee costs down – all while increasing revenue significantly since the EMR implementation. In-home tele-management is integrated into the CMH EMR. For example, blood pressure measures that a patient takes at home this morning will be in the EMR...well, this morning. This information availability has enabled CMH to reduce costs while simultaneously improving care and outcomes. Patients with in-home tele-management require two fewer home care visits, but also have a lower rate of re-admission to the hospital. Overall, CMH has been able to reduce the re-admission rate for home care patients by 35%.
  • Radiology PACS installation is calculated where at least 1 of the 10 modalities tracked has an automation status of Live and Operational, Contracted/Not Yet Installed or Installation In Process.
  • Two-thirds of ambulatory facilities in Michigan are in Stage 0. Only 5 are at a Stage 5 (none are higher). 0 = 67.7%1 = 11.40%2 = 11.27%3 = 8.8%5 = less than one percent
  • Only one percent of those that don’t have an ambulatory EMR plan to purchase a solution
  • Jennifer Horowitz EHR Adoption in Michigan & Nationwide

    1. 1. EHR ADOPTION IN MICHIGAN AND NATIONWIDE Jennifer Horowitz, MA, CPHIMS, FHIMSS June 6, 2013
    2. 2. JENNIFER HOROWITZ • Senior Director, Research • HIMSS Analytics • Began with HIMSS Analytics in 2001
    3. 3. INDUSTRY TRENDS • Federal Initiatives » 2009 American Recovery and Reinvestment Act » 2010 Patient Protection and Affordable Care Act » Conversion to ICD-10 • Patient Care Focus » Improved Quality Outcomes » Reduced Medical Errors » Standardized Clinical Care
    4. 4. 24TH ANNUAL HIMSS LEADERSHIP SURVEY
    5. 5. BUSINESS ISSUE WITH MOST IMPACT ON HEALTHCARE 0% 2% 3% 3% 5% 3% 8% 23% 14% 40% 1% 2% 4% 4% 4% 7% 8% 14% 16% 37% Hospital Infrastructure Needs Staffing Issues Privacy/Security Issues Consumer Considerations Technology Considerations Shifting Healthcare Landscape Health Information Exchange Policy Mandates Financial Considerations Healthcare Reform 2013 2012 N = 298
    6. 6. 0% 1% 2% 1% 1% 3% 11% 15% 13% 12% 38% 1% 1% 2% 2% 2% 6% 9% 11% 17% 20% 28% Integration of IT and Medical Devices Securing Patient Information Focus on Ambulatory Systems Healthcare Consumer Issues Exchange Info with Other Entities Interoperability Completing ICD-10 Conversion Focus On Clinical Systems Leveraging Information Optimizing Use of Current Systems Achieving Meaningful Use 2013 2012 N = 298 TOP IT PRIORITY IN THE NEXT TWO YEARS
    7. 7. 2% 1% 2% 4% 2% 3% 0% 9% 16% 15% 16% 25% 2% 2% 2% 2% 2% 3% 3% 7% 10% 10% 16% 16% 19% Focus on Nursing Systems Focus on Consumer Technology Installing/Upgrading Ancillary Installing/Upgrading CDR Certification of EHR Establishing Clinical Protocols Closed Loop Medication Administration Creating Continuity of Care Record Data Warehouse/Clinical Analytics Installing CPOE Linking Clinical Systems to Quality Measures Focus on Physician Systems Fully Operational EHR in Place 2013 2012 Not Applicable N = 298 PRIMARY CLINICAL IT FOCUS
    8. 8. 0% 0% 6% 3% 5% 7% 16% 22% 38% 1% 2% 3% 4% 5% 7% 8% 12% 25% 31% Ensuring that Data is Secure/Private Improving Patient Access to Information Providing Remote Monitoring of Patients Providing Competitive Advantage Enabling Remote Access of Data Sharing Information Externally Supporting Staff Productivity Standardizing Clinical Care Reducing Medical Errors Improving Quality Outcomes 2013 2012 Not Applicable N = 298 AREA THAT IT CAN MOST IMPACT PATIENT CARE
    9. 9. HIMSS ANALYTICS® DATABASE
    10. 10. HIMSS ANALYTICS® DATABASE • Company founded in 2004 » Market research arm of HIMSS • HIMSS Analytics collects information on over 100 IT applications in the healthcare environment • Data collected by dedicated team of market research associates (MRAs) • All data is cleansed by our quality team • Data is published on an annual rolling basis » Data for each hospital is published once per year
    11. 11. HIMSS ANALYTICS EMRAMSM MODEL • Model established in 2006 to track hospitals’ adoption of EMR technology • Eight-stage model » Stage 0 – hospitals that don’t have all basic ancillary applications (lab, pharmacy, radiology) » Stage 7 – hospitals no longer use paper charts to deliver and manage patient care • Ambulatory EMRAM Model Introduced in 2012 » Stage 0 – paper chart based environment » Stage 7 – organizations do not rely on paper charts to deliver and manage patient care
    12. 12. Data from HIMSS Analytics® Database © 2012 HIMSS Analytics 0.0% 1.9% 9.1% 16.3% 14.4% 36.3% 10.1% 4.2% 7.8% 0.8% 1.4% 2.2% 25.1% 37.2% 14.0% 19.3% 2007 Final 2013 Q1 Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS Closed loop medication administration CPOE, Clinical Decision Support (clinical protocols) Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable Ancillaries - Lab, Rad, Pharmacy - All Installed All Three Ancillaries Not Installed N = 5073 N = 5441
    13. 13. HIMSS ANALYTICS EMRAMSM MODEL: MICHIGAN EMR Adoption ModelSM (EMRAM) Average Median Min Max Entire HIMSS Analytics® Database 3.6500 3.4300 0.0000 7.0710 East North Central Region (N=847) 3.9757 3.5260 0.0000 7.0710 Indiana (N=149) 3.9391 3.5400 0.0000 7.0550 Michigan (N=156)) 4.0458 4.1810 0.0050 6.0710 Ohio (N=208) 3.6553 3.4030 0.0000 7.0710 Wisconsin (N=136) 4.3042 4.1845 1.0950 7.0710 East North Central region includes Illinois, Indiana, Michigan, Ohio, and Wisconsin Source HIMSS Analytics® Database (N= 5,441) First Quarter 2013
    14. 14. HIMSS ANALYTICS EMRAMSM MODEL EMR Adoption ModelSM (EMRAM) Average Median Min Max Vermont (N=14) 4.9561 5.1100 3.4160 6.0710 Delaware (N=9) 4.8592 5.1420 2.6370 7.0470 Rhode Island (N=11) 4.7805 6.0320 0.3870 6.0710 Maine (N=39) 4.6780 4.4040 0.0000 6.0710 Virginia (N=90) 4.5246 4.3825 0.0000 7.0710 Minnesota (N=136) 4.4835 4.3260 0.0660 7.0710 Connecticut (N=33) 4.3865 4.2460 1.0790 6.0710 Wisconsin (N=136) 4.3042 4.1845 1.0950 7.0710 Massachusetts (N=82) 4.2592 4.2820 0.0000 7.0630 Maryland (N=49) 4.1891 3.5420 0.0000 6.0710 Iowa (N=118) 4.0940 4.0270 0.0050 7.0710 Arizona (N=88) 4.0912 3.5060 0.0890 7.0630 Washington (N=96) 4.0712 4.2140 0.0050 6.0710 Illinois (N=198) 4.0592 3.8435 0.0000 7.0710 Michigan (N=156) 4.0458 4.1810 0.0050 6.0710 Source HIMSS Analytics® Database (N= 5,441) First Quarter 2013
    15. 15. EMRAM STAGE 6 HOSPITALS IN MICHIGAN
    16. 16. GETTING ROI OUT OF CLINICAL SYSTEMS - KAISER PERMANENTE • Kaiser Permanente serves 8.6 million members across nine states. The EMR in use is Epic. • ROI has been demonstrated across a variety of metrics: » One Kaiser Permanente region saved more than $120,000 in dictation costs in just one year post implementation » Reduced the rate of medication errors by 57 percent one hospital site using barcode scanning » Trimmed by 12 percent outpatient lab utilization two years after the implementation of KP HealthConnect » 54 percent reduction of archival storage space » Vacated more than 22,000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $0.4 and $3.3 million
    17. 17. GETTING ROI OUT OF CLINICAL SYSTEMS - CITIZENS MEMORIAL • CMH is a 74-bed hospital with 10 rural health clinics located in Bolivar, MO. The EMR in use is MEDITECH. • ROI has been demonstrated across a variety of metrics: » Reduction in re-admission rate for home care patients by 35 percent » Use of in-home tele-management has reduced number of home care visits by an average of two. » 70 percent reduction in reported medication errors in the hospital » Elimination of all medical records filming costs » Adjusted Occupied Beds (a measure of in and outpatient volume), have increased from 101 to 138 and net patient revenues have increased by 23% since in the implementation of Project Infocare.
    18. 18. OVERALL RADIOLOGY PACS INSTALLATIONS 70.85% 79.18% 84.40% 87.06% 89.89% 89.94% 90.10% 2007 (N=5073) 2008 (N=5168) 2009 (N=5237) 2010 (N=5283) 2011 (N=5339) 2012 (N=5467) 2103 (N=5445) Percent of Hospitals With At Least One Modaility Automated Source: HIMSS Analytics® Database Hospitals in Michigan = 89.74%
    19. 19. CPOE AUTOMATION AND PLAN ANALYSIS 63% 56% 19% 13% 12% 11% 6% 17% 2013 (N=156) 2013 (N=5445) Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase Source: HIMSS Analytics® Database National Michigan Adoption in 2007 = 19%
    20. 20. DATA WAREHOUSING/MINING – CLINICAL AUTOMATION AND PLAN ANALYSIS 40% 41% 54% 55% 2013 (N=156) 2013 (N=5321) Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase National Source: HIMSS Analytics® Database Michigan Adoption in 2007 = 16%
    21. 21. DATA WAREHOUSING/MINING – FINANCIAL AUTOMATION AND PLAN ANALYSIS 58% 51% 24% 38% 46% 2013 (N=156) 2013 (N=5318) Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In Process Source: HIMSS Analytics® Database National Michigan Adoption in 2007 = 22%
    22. 22. PERCENT OF HOSPITALS USING BAR CODE TECHNOLOGY IN THE PHARMACY Current • National – 72.45% • Michigan – 84.62% Planned • National – 14.93% • Michigan – 15.39% National N = 5,445 Michigan N = 156 Adoption in 2007 = 9%
    23. 23. PERCENT OF HOSPITALS PARTICIPATING IN INFORMATION EXCHANGE ORGANIZATION Current • National – 29.53% • Michigan – 35.90% Planned • National – 23.14% • Michigan – 23.08% National N = 5,445 Michigan N = 156 Adoption in 2007 = 11%
    24. 24. HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence Advanced clinical decision support, proactive care management, structured messaging Personal health record, online tethered patient portal CPOE, Use of structured data for accessibility in EMR and internal and external sharing of data Electronic messaging, computers have replaced the paper chart, clinical documentation and clinical decision support Beginning of a CDR with orders and results, computers may be at point-of-care, access to results from outside facilities Desktop access to clinical information, unstructured data, multiple data sources, intra-office/informal messaging Paper chart based US Ambulatory EMR Adoption ModelSM Data from HIMSS Analytics® Database © 2012 HIMSS Analytics N = 18,318 0.96% 4.51% 0.69% 10.06% 27.67% 5.17% 49.75% 1.2% Q1 2103
    25. 25. AMBULATORY EMR ADOPTION MICHIGAN Source: HIMSS Analytics® Database • National – 65.84% • Michigan – 61.97% Automated • National – 8.64% • Michigan – 13.72% Contracted or Installing • National – 25.52% • Michigan – 24.31% Not Automated National N = 29,129 Michigan N = 1370
    26. 26. Jennifer Horowitz Senior Director, Research Jennifer.horowitz@himssanalytics.org
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