Physician Adoption of HIT AHRQ 2007 Annual Meeting September by cye22025

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									Physician Adoption of HIT
    AHRQ 2007 Annual Meeting
       September 26, 2007
Melissa M. Goldstein, JD
Department of Health Policy
School of Public Health and Health Services
The George Washington University Medical Center
                   Background
• U.S. Healthcare System:
       • High Costs, Variable Quality
• Greater use of HIT may improve care
       • Potential annual savings of billions by reducing:
               » Duplicate services
               » Administrative costs
               » Medical errors and adverse events
       • Improve quality
• Adoption rates low
       • Estimates inconsistent (5% to 65%) and unhelpful
      HIT Adoption Initiative
            (www.hitadoption.org)

• HHS -- ONC
  – GWU
    • Partners/Massachusetts General Hospital
    • Brigham and Women’s Hospital


• Annual Report (October 2006) –
  RWJF/ONC
              Objectives
• Summarize current state of EHR use
• Describe major barriers and facilitators
• Examine current state of Health
  Information Exchange
                  Methods
• Define EHR
• Synthesize the evidence of EHR use:
    • Environment scan of existing surveys (e.g.,
      NAMCS, NHAMCS, HIMSS)
       – Some devoted to HIT, some only with sections
       – Only one survey devoted expressly to assessing
         adoption among safety net providers
    • Rate using objective criteria
                     Results
• Electronic Health Records
     •   Electronic documentation
     •   Results reporting
     •   Electronic-prescribing
     •   Decision support
• 36 surveys identified
     • 17 surveys had adequate information for quality
       scoring
  Results: Outpatient EHR Use

• Summary High Quality Surveys (5):
  – EHR adoption rate in U.S.: 17% - 27%
    • Highest quality survey (2005): 24% use some
      EHR
• Summary of all surveys:
  – EHR adoption rate in U.S.: 20% - 25%
            Best Estimates of EHR Adoption
                                    Range from Medium                Best Estimates
                                      or High Quality                Based on High
                                          Surveys                    Quality Surveys
     EHRs in                              17 to 25%                          17%
     physician offices
     Solo practitioners                  12.9 to 13%                         13%
     Large physicians                     19 to 57%                          39%
     offices*
     EHRs in hospitals                 16+ to 59% ++                        None

     CPOE in hospitals                     4 to 21 %                          5%
* Large is defined as > 20 physicians by one study (with an estimate of 39%) and > 50 physicians (with
an estimate of 57%).
+Estimate from a survey rated “low” in quality of methodology
++Estimate from a survey quality of content suggested “low” in confidence in the estimate
       Projected diffusion of EHRs among
         office-based physicians: 2001-
                       2014
 100

  80                           6% annual increase

  60

  40                                        3% annual increase
  20

   0
     01

     02

     03

     04

     05

     06

     07

     08

     09

     10

     11

     12

     13

     14
  20

  20

  20

  20

  20

  20

  20

  20

  20

  20

  20

  20

  20

  20
* 2006-2014 %’s are estimated based on current rate of adoption.
     Implications of Report
• EHRs are promising solutions
• EHR adoption increasing
    • Slow increases
    • At current pace, full EHR use by 2030
    • Hasn’t yet hit tipping point
   Factors affecting adoption
• Financial: systems are expensive
     • $50,000 up front per MD in ambulatory care
     • $2-20 Million for hospitals
• Disruption
     • Often creates significant downtime
     • Changes the way doctors and nurses practice
• Lack of perceived value
     • Savings accrue to others
• Lack of standards
• Privacy concerns
 Factors affecting adoption, cont.
• EHR adoption contingent on value creation
     • Most adopters have seen a business need
             » Large practices, multi-site practices
     • Financial barriers critical for small practices
             » Where most Americans receive healthcare
     • Capturing and re-distributing value
             » Role of payers?
     • Cultural barriers need to be understood in context
             » Disruption always difficult
             » Many have made the change
             » Generational issues often over-played
        Safety Net Providers
           HIT Adoption
• National survey federally funded CHCs
  (Health Affairs, Sept./Oct. 2007)
• 26% some EHR capacity
• 13% minimal set of EHR functionalities
• CHCs serving the most poor &
  uninsured less likely to have functional
  EHR
• Lack of capital top barrier
   Getting better data on EHR
            Adoption
• Define EHR:
   – Institute of Medicine definition laying out 8 key functionalities
   – HIT Adoption Initiative modification
• Define Adoption
   – Acquisition
   – Installation
   – Use
• Design data collection methods
   – Development of new survey tools (PM, physician, hospital,
     consumer)
   – Identify goals and objectives of policy
   – Build upon existing federal and private surveys
   – Develop survey questions that add to and fill in the gaps of
     other existing programs of data collection
 Getting better data on EHR
Value, Barriers and Incentives
• Define measures of value
   – Quality
   – Efficiency
   – Safety net providers
• Compare value and efficiency of care with and
  without EHRs
• Identify barriers and incentives to adoption
• Include measures of barriers and incentives in
  regular data collection activities
• Real and perceived legal barriers
            Legal barriers
• Concerns about
  – New legal exposures
  – Actual or perceived legal burden of
    compliance
  – Actual or perceived legal exposures
    associated with the disclosure of
    information
Melissa M. Goldstein

   mgoldste@gwu.edu

								
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