# Presentation: 245298

## 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 or High Quality Surveys | Best Estimates Based on High Quality Surveys |
| --- | --- | --- |
| EHRs in physician offices | 17 to 25% | 17% |
| Solo practitioners | 12.9 to 13% | 13% |
| Large physicians offices* | 19 to 57% | 39% |
| 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

*** 2006-2014 %’s are estimated based on current rate of adoption.**

**3% annual increase**

**6% annual increase**

## 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](mailto:mgoldste@gwu.edu)__[.](mailto:mgoldste@gwu.edu)__[edu](mailto:mgoldste@gwu.edu)_