THE HIT ADOPTION INITIATIVE

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 Physicians

NEJM

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

Presented by Sara Rosenbaum Hirsh Professor and Chair, Department of Health Policy The George Washington University School of Public Health and Health Services

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

THE HIT ADOPTION INITIATIVE

Research Questions

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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?

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

THE HIT ADOPTION INITIATIVE

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.

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

THE HIT ADOPTION INITIATIVE

Finding: Current Level of Adoption Among Ambulatory Physicians

No Functional EHR 83% Fully Functional EHR 4% Basic EHR 13%

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17% purchased system but not yet implemented

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26% intend to purchase within 2 years 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

THE HIT ADOPTION INITIATIVE

Percentage of Physicians Reporting Positive Impact of EHR, by Activity

Quality of clinical decisions* Quality of communication with other providers Quality of communication with patients* Prescription refills* 0% * Difference between fully functional and basic is significant at p < .05

Fully Functional Basic 63% 82% 59% 72% 86% 92% 85% 95% 20% 40% 60% 80% 100% 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

THE HIT ADOPTION INITIATIVE

Percentage of Physicians Reporting Positive EHR Impact, by Activity

Timely access to medical records Avoiding medication errors Delivery of preventive care that meets guidelines* Delivery of chronic illness care that meets guidelines* 0% * Difference between fully functional and basic is significant at p < .05

96% 97% Fully Functional Basic 80% 86% 55% 85% 56% 82% 20% 40% 60% 80% 100% 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

THE HIT ADOPTION INITIATIVE

Physician Satisfaction with EHRs

Percent of physicians very or somewhat satisfied

Reliability of system Ease of use when providing care Overall satisfaction 0% Fully functional Basic 79% 91% 82% 89% 87% 94% 20% 40% 60% 80% 100%

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

THE HIT ADOPTION INITIATIVE

Physician Perceived Adoption Barriers: Economic and Practice

Percent of physicians reporting a “major barrier” 100%

Have an EHR Do not have functional EHR

75% 67% 51% 54% 50% 25% 44% 29% 36% 24% 45% 24% 39% 37% 41% 28% 29% 0% 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

THE HIT ADOPTION INITIATIVE

Physician Perceived Adoption Barriers: Legal

Percent of physicians reporting a “major barrier” 100% Have an EHR Do not have functional EHR 75% 50% 25% 6% 11% 12% 18% 11% 19% 0% Legality of hospital donated EHR Inappropriate disclosures of patient info Illegal tampering or hacking 8% 15% Increased patient access liability 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

THE HIT ADOPTION INITIATIVE

Physician Perception of Adoption Incentives

Percent of physicians reporting incentive would have an impact 100% 82% 82% 80% 75% 71% 55% 50% 25% 0% Monetary incentives for purchase Additional payment Legal physician protection Published certification standards Legal liability if NOT using technology 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

THE HIT ADOPTION INITIATIVE

Conclusions

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Basic EHRs in use by 13% of U.S. Physicians, with full functionality for only 4%. 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.

Serious perceived barriers, most important of which are economic and operational in nature. Legal concerns remain a measurable barrier.

Achieving greater adoption will take a combination of financial, practice, and legal incentives, combined with significant operational support.

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