the hit adoptioninitiative the george washington university school of public health and health...

THE HIT THE HIT ADOPTION ADOPTION INITIATIVEINITIATIVE

The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System

Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

EHR Adoption in the Ambulatory Setting

Summary of Findings

C. DesRoches, E. Campbell, S. Rao et. al.,Electronic Health Record Adoption in the Ambulatory Setting: Findings

From a a National Survey of PhysiciansNEJM

(online June 18, 2008; print edition June 26th, 2008)

Presented by

Sara RosenbaumHirsh Professor and Chair, Department of Health Policy

The George Washington University School of Public Health and Health Services




Research Questions

What proportion of U.S. physicians have EHRs available to them?

How satisfied are physicians with EHRs?

What impact, if any, do physicians believe EHRs have on practice?




Methodology

• Define key functions of EHR using evidence-based studies and expert consultation.

• Fully functional: recording patient information and demographics, results viewing and management, order entry management including e prescribing, and clinical decision support

• Basic: absence of certain order entry and clinical decision support capabilities

• Conduct survey (August 2007-March 2008) of representative sample of physicians providing direct ambulatory patient care from the AMA Masterfile: 61% rate of return among 4,484 survey recipients.

• Key characteristics considered in relation to EHR use: gender, ethnicity, race, number of years in practice and specialty, practice size, setting, location, and region. Characteristics of responders mirror all eligible physicians.




Finding: Current Level of Adoption Among Ambulatory Physicians

Basic EHR 13%

Fully Functional

EHR 4%

• 17% purchased system but not yet implemented

• 26% intend to purchase within 2 years

No Functional EHR 83%




Percentage of Physicians Reporting Positive Impact of EHR, by Activity

95%

72%

92%

82%

85%

59%

86%

63%

0% 20% 40% 60% 80% 100%

Prescription refills*

Quality ofcommunication with

patients*

Quality ofcommunication with

other providers

Quality of clinicaldecisions*

Fully Functional Basic

* Difference between fully functional and basic is significant at p < .05




Percentage of Physicians Reporting Positive EHR Impact, by Activity

82%

85%

86%

97%

56%

55%

80%

96%

0% 20% 40% 60% 80% 100%

Delivery of chronicillness care that

meets guidelines*

Delivery ofpreventive care that

meets guidelines*

Avoiding medicationerrors

Timely access tomedical records

Fully Functional Basic

* Difference between fully functional and basic is significant at p < .05




Physician Satisfaction with EHRs

94%

89%

91%

87%

82%

79%

0% 20% 40% 60% 80% 100%

Overallsatisfaction

Ease of use whenproviding care

Reliability ofsystem

Fully functional Basic

Percent of physicians very or somewhat satisfied




44%

29%36%

24% 24%

37%28%

51% 54%45%

39% 41%29%

67%

0%

25%

50%

75%

100%

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Have an EHR Do not have functional EHR

Percent of physicians reporting a “major barrier”

Physician Perceived Adoption Barriers: Economic and Practice




Physician Perceived Adoption Barriers: Legal

6%12% 11% 8%11%

18% 19% 15%

0%

25%

50%

75%

100%

Legality of hospitaldonated EHR

Inappropriatedisclosures of patient

info

Illegal tampering orhacking

Increased patientaccess liability

Have an EHR Do not have functional EHR

Percent of physicians reporting a “major barrier”




Physician Perception of Adoption Incentives

82% 82% 80%71%

55%

0%

25%

50%

75%

100%

Monetaryincentives for

purchase

Additionalpayment

Legalphysicianprotection

Publishedcertificationstandards

Legal liabilityif NOT usingtechnology

Percent of physicians reporting incentive would have an impact




Conclusions

I. Basic EHRs in use by 13% of U.S. Physicians, with full functionality for

only 4%.

II. Physicians who use EHRs report high degree of satisfaction in relation to

measures of practice improvement and health care quality.

Representative nature of adopters suggests potential of EHRs to reach a

wide audience.

III. Serious perceived barriers, most important of which are economic and

operational in nature. Legal concerns remain a measurable barrier.

IV. Achieving greater adoption will take a combination of financial, practice,

and legal incentives, combined with significant operational support.

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