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eHealth Reality in North America

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eHealth Reality in North America. Garets D. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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eHealth Reality in North America

  1. 1. eHealth Reality in North America David E. Garets, President & CEO, HIMSS Analytics Executive Vice President, HIMSS
  2. 2. Expectations, Limits, and Barriers for EMRs in U.S. • Expectations: • Widespread adoption of acute care and ambulatory EMRs, and “meaningful use” – via first time ever financial incentives and requirements from the federal government, increasingly stringent over 3 phases starting this calendar year. • Interoperable exchange of summary patient data among acute care and ambulatory providers, payers, health registries, and patients via health information exchanges • Limits: • Perverse incentives – hospitals and physicians get paid for helping people once they’re sick as opposed to keeping people healthy • Hospitals compete against each other – medical arms wars – most health systems don’t have good economies of scale in IT
  3. 3. Expectations, Limits, and Barriers for EMRs in U.S. • Barriers: • Clinician adoption – lack of change management strategies • Lack of pan-America standards adoption • Money is tight, in both operating and capital budgets • There’s a 40,000 – 60,000 person shortage of qualified, experienced health IT professionals • Potentially 35% of hospitals have “too far to go” to earn Phase 1 incentives.
  4. 4. 2005-2009 US EMR Adoption Model Trends 2005 2009 Final Final Complete EMR; CCD transactions to share data; Data Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7% Physician documentation (structured templates), full Stage 6 CDSS (variance & compliance), full R-PACS 0.0% 1.6% Stage 5 Closed loop medication administration .001% 3.8% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 2.5% 7.4% Nursing/clinical documentation (flow sheets), CDSS Stage 3 (error checking), PACS available outside Radiology 10.0% 50.9% CDR, Controlled Medical Vocabulary, Stage 2 CDS, may have Document Imaging; HIE capable 48.8% 16.9% Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 19.6% 7.2% Stage 0 All Three Ancillaries Not Installed 18.4% 11.5% Source: HIMSS AnalyticsTM Database N = 3,816/5,235
  5. 5. Expectations, Limits, and Barriers for EMRs/EPRs in Canada • Expectations: • Widespread adoption of physician/primary care clinic EMRs • Obligation to make minimal data available to all patients – lab/radiology diagnostic results, drug history • Minimizing number of EMR platforms in most provinces • Limits: • Full acute care implementations at a few selected sites • Extensive rural environment precludes practicality of complete paperless EMRs in most population centers.
  6. 6. Expectations, Limits, and Barriers for EMRs/EPRs in Canada • Barriers: • Clinician adoption remains a challenge • Canada has yet to adopt HL7 CCD standards • EMR strategies remain intra-provincial • Emphasis by Canada Health Infoway on pan-Canadian PHR • Economic restrictions due to large deficits
  7. 7. 2009 Canadian/U.S. Comparison CDN US Final Final Complete EMR; CCD transactions to share data; Data Stage 7 warehousing; Data continuity with ED, ambulatory, OP 0.0% 0.7% Physician documentation (structured templates), full Stage 6 CDSS (variance & compliance), full R-PACS 0.2% 1.6% Stage 5 Closed loop medication administration 0.0% 3.8% Stage 4 CPOE, Clinical Decision Support (clinical protocols) 1.1% 7.4% Nursing/clinical documentation (flow sheets), CDSS Stage 3 (error checking), PACS available outside Radiology 28.8% 50.9% CDR, Controlled Medical Vocabulary, Stage 2 CDS, may have Document Imaging; HIE capable 22.7% 16.9% Stage 1 Ancillaries – Lab, Rad, Pharmacy – All Installed 11.7% 7.2% Stage 0 All Three Ancillaries Not Installed 35.6% 11.5% Source: HIMSS AnalyticsTM Database N = 660/5,235
  8. 8. IT Spending in U.S. hospitals • Projected 2009 spending: • $27.5B - $30.41B • Actual 2009 spending: • $28.03B
  9. 9. Thank you!

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