# Presentation: 742667

## Opportunities and Challenges for Implementing HIT

Steven R. Simon, MD, MPH
August 2007
Supported by a grant from the US Agency for Healthcare Research and Quality (AHRQ)

*Steven R. Simon, MD, MPH*
*August 2007*
*Supported by a grant from the US Agency for Healthcare Research and Quality (AHRQ)*

## Prologue

**Widespread (universal?) EHR adoption by 2014**
**Has adoption reached tipping point?**
**Do EHRs improve quality of care?**
_**How are physicians **__***using***__** EHRs?**_

## Outline

**Massachusetts e-Health Collaborative**
**Statewide survey of physicians, 2007**

## Massachusetts e-Health Collaborative (MAeHC)

**Formed in 2004**
**Major health care stakeholders**
**$50 million from Blue Cross Blue Shield of MA**
**Statewide EHR adoption**
**Demonstration project:**
**Universal EHR adoption in 3 communities**
**Intra-community (and, ultimately, inter-community) data exchange**

## Pilot Timeline Overview

**Pilot Timeline Overview**

**Activities**

**2004**

**2005**

**2006**

**2007**

**2008**

**ACP-MA summit**
**MAeHC launch**
**Community RFA launch**
**Pilot communities announced**
**EHR vendor RFP**
**EHR vendor finalization**
**Community EHR implementation**
**Intra-community connectivity**
**Evaluation**
**Formal Pilot completion**

## PHYSICIANS “GOING LIVE”, BY COMMUNITY

**# MDs**

**2006**

**2007**

**North Adams**
**(55)**

**Newburyport**
**(81)**

**Brockton**
**(305)**

**9**

**7**

**5**

**19**

**21**

**33**

**25**

**24**

**27**

**43**

**51**

**9**

**88**

**1**

**77**

**1**

**441**

## HEALTH INFORMATION EXCHANGENorthern Berkshire Example

***Patient recruitment***

***Health data exchange***

***Referrals mgmt***

***Patient portal***

## State of the State: Physician Survey

## Massachusetts Physician Survey

**Stratified random sample of practices (N=1884)**
**Randomly sampled one physician per practice.**
**2005: 1345 respondents (71%)**
**EHR Adoption: 23% of practices, 45% of physicians**
**EHR Usage: wide variability in available functions and reported usage.**

## 2007 Follow Up Survey (N=1345)

**May – July, 2007**
**Multiple mailings to all 1345 respondents from 2005**
**Excluded: moved, retired, deceased  (N=200)**
**902 completed surveys (response rate 79%)**
*****Preliminary Analysis*****

## Characteristics of Respondentswith EHRs (N=562, >60% of sample)

| Female | 37% |
| --- | --- |
| 20+ Years Since Med School | 39% |
| 10+ Years with Practice | 22% |
| Primary Care | 16% |
| 7+ Physicians in Office | 44% |
| Practice Ownership | 32% |
| Teaching (Students/Residents) | 65% |
| Number of Patients/Week (median) | 60 |
| Incentives for HIT Adoption | 35% |
| Incentives for HIT Usage | 28% |

## Please indicate all features of the EHR that you have available in your practice. For those features that you have, indicate the extent to which you use them.

**Laboratory test results**
**Laboratory order entry**
**Radiology test results**
**Radiology order entry**
**Electronic visit notes**
**Reminders for care activities (e.g. overdue health maintenance)**

**Electronic medication lists of what each patient takes**
**Electronic problem list**
**Can transmit prescriptions to pharmacy electronically or via electronic faxing**
**Electronic referrals or clinical messaging (secure e-mailing between providers)**

## Available EHR Functions, 2005 - 2007

|  | 2005 | 2007 |
| --- | --- | --- |
| Function | (N=387) | (N=562) |
|  |  |  |
| Laboratory test results | 85% | 86% |
| Laboratory order entry | 47% | 51% |
| Radiology test results | 76% | 78% |
| Radiology order entry | 54% | 54% |
| Electronic visit notes | 84% | 87% |
| Alerts and reminders | 53% | 56% |
| Electronic medication lists | 75% | 81% |
| Electronic problem list | 71% | 76% |
| Electronic transcription of Rx | 45% | 70% |
| Electronic referrals | 62% | 63% |

## Usage* of EHR Functions, 2005 - 2007

| Function | 2005 | 2007 |  |
| --- | --- | --- | --- |
| Laboratory test results | 72% | 77% |  |
| Laboratory order entry | 52% | 64% | ▲ |
| Radiology test results | 74% | 81% |  |
| Radiology order entry | 48% | 69% | ▲ |
| Electronic visit notes | 71% | 89% | ▲ |
| Alerts and reminders | 31% | 40% |  |
| Electronic medication lists | 67% | 79% | ▲ |
| Electronic problem list | 58% | 72% | ▲ |
| Electronic transcription of Rx | 45% | 67% | ▲ |
| Electronic referrals | 43% | 50% |  |

**Most or all the time*

## 2007 Massachusetts SurveySummary

**EHR adoption continues to increase**
**Majority of Massachusetts’ physicians use EHRs**
**Large segments of the physician population have “light” models of EHRs**
**Just over half of physicians with EHRs have**
**Lab and radiology order entry**
**Clinical decision support**
**Use of available EHR functions is increasing**
**Substantial proportions of EHR users do not use key functions that may improve quality and safety (order entry, e-Rx, and decision support)**

## Questions?

## Slide 17

## EHR SELECTION

**Preferred Vendors**
**Selection**

**Community down-select**

**EHR RFP distributed in May, 2005**
**Over 30 responses received**
**Vendor Selection Committee validated 7 vendors to go forward**

**Community Steering Committees down-select to smaller number for individual physician choice in each community**
**3 or 4 in each community **
**Initial vendor fairs completed in each community and down-select complete**

**Physician choice**

**Individual physician vendor fairs**
**Each community developing different model of physician choice **