jennifer horowitz ehr adoption in michigan & nationwide

EHR ADOPTION IN MICHIGAN AND NATIONWIDEJennifer 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 Affordable Care Act» Conversion to ICD-10

• Patient Care Focus» Improved Quality Outcomes» Reduced Medical Errors» Standardized Clinical Care

24TH ANNUAL HIMSS LEADERSHIP SURVEY

BUSINESS ISSUE WITH MOST IMPACT ON HEALTHCARE

Hospital Infrastructure Needs

Staffing Issues

Privacy/Security Issues

Consumer Considerations

Technology Considerations

Shifting Healthcare Landscape

Health Information Exchange

Policy Mandates

Financial Considerations

Healthcare Reform

0%

2%

3%

3%

5%

3%

8%

23%

14%

40%

1%

2%

4%

4%

4%

7%

8%

14%

16%

37%

2013

2012

N = 298

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

0%

1%

2%

1%

1%

3%

11%

15%

13%

12%

38%

1%

1%

2%

2%

2%

6%

9%

11%

17%

20%

28%

2013

2012

N = 298

TOP IT PRIORITY IN THE NEXT TWO YEARS

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

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%

2013

2012Not Applicable

N = 298

PRIMARY CLINICAL IT FOCUS

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

0%

0%

6%

3%

5%

7%

16%

22%

38%

1%

2%

3%

4%

5%

7%

8%

12%

25%

31%

2013

2012

Not Applicable

N = 298

AREA THAT IT CAN MOST IMPACT PATIENT CARE

HIMSS ANALYTICS® DATABASE

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

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

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

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

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

EMRAM STAGE 6 HOSPITALS IN MICHIGAN

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

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.

OVERALL RADIOLOGY PACS INSTALLATIONS

2007 (N=5073)

2008 (N=5168)

2009 (N=5237)

2010 (N=5283)

2011 (N=5339)

2012 (N=5467)

2103 (N=5445)

70.85%

79.18%

84.40%

87.06%

89.89%

89.94%

90.10%

Percent of Hospitals With At Least One Modaility Automated

Source: HIMSS Analytics® Database

Hospitals in Michigan = 89.74%

CPOE AUTOMATION AND PLAN ANALYSIS

2013 (N=156)

2013 (N=5445)

63%

56%

19%

13%

12%

11%

6%

17%

Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In ProcessFirst Time Purchase Not Automated, No Plans to Purchase


National

Michigan

Adoption in 2007 = 19%

DATA WAREHOUSING/MINING – CLINICALAUTOMATION AND PLAN ANALYSIS

2013 (N=156)

2013 (N=5321)

40%

41%

54%

55%

Automated Replacement Purchases Contracted - Not Yet InstalledContracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase

National


Michigan


DATA WAREHOUSING/MINING – FINANCIAL AUTOMATION AND PLAN ANALYSIS

2013 (N=156)

2013 (N=5318)

58%

51%

38%

46%24%

Automated Replacement Purchases


National

Michigan


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


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


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

AMBULATORY EMR ADOPTIONMICHIGAN


• National – 65.84%• Michigan – 61.97%

Automated


Contracted or Installing


Not Automated

National N = 29,129 Michigan N = 1370

Jennifer HorowitzSenior Director, [email protected]

jennifer horowitz ehr adoption in michigan & nationwide

Health & Medicine

clinical care

patient information

research himss analytics

clinical systems

impact patient care

healthcare environment

stage model stage

quality team data