Transcript Slides - Health Affairs

Health Information
Technology Adoption & Use
John K. Iglehart
Founding Editor
Health Affairs thanks
for its ongoing support of the journal
as well as today’s briefing
Keynote
Farzad Mostashari, M.D., Sc.M.
National Coordinator for Health IT,
US Department of Health And Human Services
Meaningful Use:
Where Are We Now?
Michael W. Painter, J.D., M.D.
Senior Program Officer
Robert Wood Johnson Foundation
Adoption of Electronic Health
Records Grows Rapidly
But Fewer Than Half of US Hospitals
Had At Least a Basic System in 2012
Catherine M. DesRoches, Ph.D.
Senior Survey Researcher
Mathematica Policy Research
Methodology
• 2012 health IT supplement to the AHA’s annual
survey.
• Field period: October 2012 – January 2013.
• Analytic sample: 2,796 general, acute care
hospitals.
• Measures: basic and comprehensive EHR, stage
1 MU and stage 2 MU proxies.
• All results are weighted to adjust for nonresponse bias.
Changes In Adoption Of Basic And
Comprehensive EHR
DesRoches CM, Charles D, Furukawa MF, et al. (2013) Adoption of Electronic Health Records Grows Rapidly, But Fewer
Than Half of US Hospitals Had At Least A Basic System in 2012. Health Aff (Millwood). 2013;32(8)
Meaningful Use
• 42.2% of hospital met our proxy
measure of stage 1 meaningful use
• Hospitals meeting stage 1
– Larger hospitals
– Major teaching hospitals
– Private non-profit status
– Located in urban areas
• 5.1% of hospitals met our proxy
measure for meaningful use stage 2.
Conclusions And Policy Implications
• Substantial increases in adoption over
prior years.
– Tremendous amount of activity across all
subgroups, although some still lag behind.
• Challenges remain.
– Fewer than half of hospitals met stage 1 proxy.
– Small proportion could meet core criteria for
stage 2.
Continued Effort Is Needed In The
Following Areas:
• Small and rural hospitals
– Both revenue and workforce challenges
• Patient access to records
• Electronic data exchange
– Among hospitals and providers
– Public health functions
• Hospitals that appear to be moving more
slowly
Office-based Physicians Are
Responding To Incentives And
Assistance By Adopting And
Using Electronic Health Records
Chun-Ju Hsiao, Ph.D., M.H.S.
Ashish K. Jha, M.D., M.P.H
Jennifer King, Ph.D.
Vaishali Patel, Ph.D.
Michael F. Furukawa, Ph.D.
Farzad Mostashari, M.D., Sc.M.
We would like to thank the Office of the National Coordinator for Health Information
Technology for funding the National Ambulatory Medical Care Survey Electronic Health Records Survey. Dr. Jha was funded by RWJF. The findings and
conclusions in this article are those of the authors and do not necessarily represent the
views of the Centers for Disease Control and Prevention, or the Office of the National Coordinator.
Policy Context And Purpose
• Substantial resources made available through
HITECH have been devoted to helping providers
achieve meaningful use of EHR systems.
• To assess who is using the systems and how their
adoption has evolved
• To examine adoption and routine use of specific
capabilities related to a Basic EHR system and
meaningful-use criteria
Data And Methods
• 2010-12 National Ambulatory Medical Care
Survey (NAMCS) - Electronic Health Records
Survey of office-based physicians
• Measuring EHR adoption
• Measuring routine use
Analysis
• Descriptive analysis examining the change in the use of
any type of EHR system and the adoption of a Basic system
between 2010 and 2012
– Multivariate analysis assessing characteristics
associated with the adoption of a Basic EHR system
• Descriptive analysis examining trends in adoption of
capabilities required for a Basic EHR system and selected
stage 1 core criteria for meaningful use
• Descriptive analysis examining whether physicians
routinely used capabilities related to stage 1 core criteria
for meaningful use and a Basic EHR system
– Multivariate analysis assessing characteristics
associated with routine use
Office-based Physician’s Adoption Of
EHR Systems, 2010-12
Adoption Of Basic EHR Systems, By Physician Characteristics,
2010 And 2012
Basic EHR adoption rate
(adjusted percent)
2010
Age
<45
45-54 years
55-64 years
≥65 years
Practice size (number of physicians)
1
2-5
6-10
≥11
**p<0.01
2012
Change in Basic EHR
adoption rate
Absolute change Relative change
(percent)
(percentage point)
29.5
26.4
25.1
16.5 **
40.0
41.3
35.4
33.3
10.5
14.9
10.3
16.8
35.6
56.4
41.1
101.8
11.3
26.0 **
29.7 **
45.0 **
25.6
36.6 **
44.0 **
57.7 **
14.3
10.6
14.3
12.6
127.2
40.6
48.1
28.1
Adoption Of Basic EHR Systems, By Physician Characteristics,
2010 And 2012
Basic EHR adoption rate
(adjusted percent)
2010
Practice ownership
Physician/physician group
Hospital/academic medical center
HMO/other health care
organization
Community health center
Other/unknown
Metropolitan status
Large central metropolitan
Large fringe metropolitan
Medium metropolitan
Small metropolitan or nonmetropolitan
**p<0.01
2012
Change in Basic EHR
adoption rate
Absolute change Relative change
(percent)
(percentage point)
23.5
28.4
34.3
47.5 **
10.8
19.1
45.9
67.3
39.8 **
13.5 **
28.6
58.4 **
32.3
31.2
18.6
18.8
2.7
46.8
139.6
9.4
23.4
26.0
25.0
36.0
35.8
39.7
12.6
9.8
14.7
54.0
37.8
58.8
30.8 **
43.5 **
12.7
41.1
Basic EHR
MU Stage 1 Core
Adoption Of Capabilities Related To Selected Stage 1 Core
Criteria For Meaningful Use And Basic EHR Systems,
2010 And 2012
2010
2012
Change 2010-2012
Adoption And Routine Use Of Capabilities Related To Selected Stage
1 Core Criteria For Meaningful Use And Basic EHR Systems, 2012
Conclusions
• Findings are consistent with the proposed positive
effect of incentives and technical assistance on
physicians’ adoption and use of health information
technology (IT)
• Key areas for continued policy focus include
monitoring trends in physicians’ use of IT and
whether gaps between physicians persist
• Rapid growth in the IT infrastructure may create a
platform for delivery of high-quality, efficient care
Operational Health Information
Exchanges Show Substantial Growth,
But Long-Term Funding Remains
Julia Adler-Milstein, PhD
David W. Bates, MD MSc
Ashish K. Jha, MD MPH
Policy Context
• Health information exchange is critical to a wellfunctioning health care system.
• Electronic sharing of data between providers can
lead to better care coordination, greater efficiency
• Prior to HITECH, growth in HIE was slow
• HITECH provided funding as well as non-financial
incentives to increase HIE
Current Study
• National census of HIE efforts to answer:
1. How many HIE efforts are there? Has it changed
over time?
2. Who is participating? What are they sharing?
A.
Can they support key elements of stage 1 Meaningful Use?
3. What are the primary barriers to long term
viability of these entities?
Key Findings
• Substantial growth in the number of operational HIEs
– 119 efforts in 2012 (up from 75 in 2010)
• Substantial growth in the number of participating
hospitals and ambulatory practices
– Hospitals:
14%  30%
– Ambulatory Practices:
3%  10%
• Broad geographic coverage
– 67% of hospitals service areas had an HIE effort that enabled
providers to meet stage 1 meaningful use
• Broad Array Of Barriers Continue To Be Reported
– Financial barriers are the most pressing
HITECH @3:
Strong Start On A Long Path
Ashish K. Jha, M.D., M.P.H.
Harvard School of Public Health
July 2013
Why HITECH?
• U.S. Healthcare “system” still a mess
– High cost, disappointing quality
• Paper-based records a contributor
– Lead to lots of errors, waste
• EHR adoption was low, moving slow
• The largest payer intervened
What Happened?
• Well-crafted, strong incentives work
• EHR adoption slow moving
• Incentives kicked in 2011
– Adoption has taken off
– Doctors, hospitals embracing technology
– Nearly half way there
• With a lot of progress in the pipeline
Health Information Exchange
• Progress slower
• Exchange remains in its infancy
– Lots of challenges
– Mostly not about technology
• Business model for HIE a challenge
Intermission: Unfinished Business
• What happens in the second half of the play?
– Will things continue to move quickly?
– Will some providers just not make it?
• How do we bring others on board?
– Nursing homes, rehab facilities, etc.?
– Major problem if they remain left out
Unfinished Business
• How do we use technology more effectively?
– What can we do to improve quality, efficiency?
– How do we ensure safe implementation?
• Integration with health reform efforts
– ACOs, Bundled Payments, etc.
– Quality measurement
Getting Health IT Right Is Essential
• Infrastructure for payment, delivery reform
• HITECH is having a big effect
• Our work is just getting started
Acknowledgements
• RWJF
• NCHS, AHA, ONC as great partners
• Health Affairs
Health Affairs thanks
for its ongoing support of the journal
as well as today’s briefing