# Presentation: 376167

## The Ecology of Health ITUnderstanding the Market for EHRs and EMRs in Ambulatory Care,and the Determinants of Growth, Innovation, and Equity 

- The Ecology of Health ITUnderstanding the Market for EHRs and EMRs in Ambulatory Care,and the Determinants of Growth, Innovation, and Equity

- AHIC EHR Workgroup
- January  11, 2007
- David C. Kibbe,  M.D.  MBA
- Senior Advisor, Center for Health Information Technology
- American Academy of Family Physicians

- _[dkibbe@aafp.org](mailto:dkibbe@aafp.org)_

## AAFP Background

- American Academy of Family Physicians
- Nation’s largest primary care medical specialty physician membership association
- 60,000+ members in active practice
- 95,000+ members including residents and students
- Approx. 8% of US physician workforce, accountable for 24% of total US outpatient ambulatory care visits
- Majority of members practice in groups of five or fewer clinicians
- Center for HIT established in 2003 to promote acquisition and use of affordable, standards-based EHRs among family physicians in US
- Growth in use of commercial Electronic Health Record systems from 10% in 2002 to 30% in 2005

## Your SpeakerDavid C. Kibbe, MD MBA  recent positions

- Your SpeakerDavid C. Kibbe, MD MBA  recent positions

- Former Director, Center for Health Information Technology, AAFP
- Co-chair, Physicians’ EHR Coalition (PEHRC)
- Founder, Partners for Patients initative, 96 companies
- Project Director, Doctors Office Quality (DOQ-IT) Project
- Co-chair, Workgroup on HIT in Small Practices, eHealthInitiative
- Co-chair, Workgroup on Data Sharing and Aggregation, AQA
- Chair, Subcommittee on Information Technology, AQA
- Member,  JCAHO HIT Advisory Board
- Member, Interoperability Workgroup, CCHIT
- Member, Steering Committee, AHRQ NRC-HIT
- Member, ASTM Steering Committee, E.31.28 CCR

## < 1% revenues on IT, 2B 

*< 1% revenues on IT, 2B*

*5% revenues IT, 24B*

- Source: Mark Leavitt, MD
- HIMSS, July 2004

- The ecology of HIT -- two almost completely separate eco-spheres, inpatient and outpatient

- 2003-2005

## A View from the Trenches

- Family Practice and the Adoption of EHRs
- 2002 -- 2007

## The AAFP’s Center for HIT

- Established October, 2003
- Our mission:
- To assist family physicians acquire and use EHRs and other HIT that are affordable and standards-based, for the purposes of improving quality, enhancing safety, and making gains in efficiency.  EHRs must serve as the “central nervous system” of the  family practice.

- http://www.centerforhit.org/

## Results: consistent growth in AAFP members’ participation in network

- Center for HIT established

## EHR implementation in family medicine has tripled since 2003

- Two surveys (blue and brown bars) were web-based, which probably biased the results
- Physician Profile and Immunization Survey (large dots) were large and paper based - less selection bias
- Clear growth of EHR adoption among Family Physicians

- 5,517 respondents in 2003
- 2,569 respondents in 2005

- 2005 Physician Profile
- 2005 Immunization Survey

## UPDATE  December, 2006

## Slide 10

## Current pricing for HIT in small and

- medium size medical practices

- Source:  AAFP/CHiT Partners for Patients Vendor Survey, findings, May 2005 http://www.centerforhit.org/x983.xml

##     2003             2007

-     2003             2007

- Approximately 10% of AAFP members using EMRs or EHRs
- Very inefficient market conditions
- Vendors can’t find buyers and vice versa
- High cost of sales
- Poor or non-existent information about price, service, quality
- Most purchasers focused on ‘electronic documentation’ of clinical experience
- Predominance of small EMR firms

- Approximately 40% of AAFP members using EMRs or EHRs
- More efficient market conditions
- Reviews and social networks support transparency
- CCHIT certification
- Excellent information about price, service, quality
- Most purchasers now focus on workflows, e.g. e-rxing, and efficiencies within the practice
- Larger firms have entered the market and are exerting influence

## Remember?

- In 1985, there were over 30 personal computer companies

## Questions?

- David C. Kibbe, MD MBA
- _[dkibbe@aafp.org](mailto:dkibbe@aafp.org)_
- 919.960.5290
- 913.205.7968

- _[http://www.centerforhit.org](http://www.centerforhit.org/)_/