# Presentation: 727877

## American Health Information Community

**AHIC EHR Work Group**
**Catherine DesRoches, PhD**
**MGH Institute for Health Policy**
**February 2008**

## Methodology

**Mail survey**
**Sample frame:  5,000 currently practicing physicians randomly selected from the AMA Masterfile**
**Proposed sample size:  3,000 physicians **
**Field period:  Began in July 2007, currently in the field**
**Physicians were sent two questionnaires.  They were directed to fill out the “physician” instrument and to give the second questionnaire to the person most knowledgeable about the practice characteristics and HIT use.**
**Current analysis**:  **N approximately equal to 2,458**
**Target response rate:  60%**

## Definitions of an EHR

**Historical NAMCS Definition**:  “Does your main practice use an electronic health record system (not including billing records)?”
**Minimally Functional EHR**:  Based on a set of functionalities used in 2005 and 2006 to encompass a minimum set of functionalities.
**Functional EHR**:  Definition developed by our Expert Consensus Panel based on the Institute of Medicine framework.

## Definition of a EHR – Minimally Functional and Functional

|  | Minimally Functional EHR | Functional EHR |
| --- | --- | --- |
| Health Information and Data |  |  |
| Patient demographic information |  |  |
| Patient problem lists |  |  |
| Patient medication lists |  |  |
| Clinical notes |  |  |
| Notes include medical history and follow up notes |  |  |
| Order Entry Management |  |  |
| Computerized orders for prescription |  |  |
| Computerized orders for labs |  |  |
| Computerized orders for Radiology |  |  |
| Orders sent electronically for prescriptions |  |  |
| Orders sent electronically for labs |  |  |
| Orders sent electronically for radiology |  |  |

## Definition of a EHR – Minimally Functional and Functional (con’t)

|  | Minimally Functional
EHR | Functional
EHR |
| --- | --- | --- |
| Results management |  |  |
| Viewing lab results |  |  |
| Viewing imaging results |  |  |
| Electronic images are returned |  |  |
| Decision Support |  |  |
| Warnings of drug interactions or contraindications are returned |  |  |
| Out of range lab levels are highlighted |  |  |
| Reminders for guideline-based interventions and screenings |  |  |

## Availability of an EHR Varies By Definition 

**43%**

**Percent of physicians**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## EHR Functionality Use by Practice Size

**Use of the following: prescription orders, lab orders and viewing, radiology tests**
** ****and results viewing and clinical notes**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## EHR Functionality Use by Specialty Practice

**Use of the following: prescription orders, lab orders and viewing, radiology tests**
** ****and results viewing and clinical notes**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## EHR Functionality Use by Primary Setting

**Use of the following: prescription orders, lab orders and viewing, radiology tests**
** ****and results viewing and clinical notes**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## Major Barriers to EHR Adoption

**Percent of physicians reporting a “major barrier”**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## Incentives for EHR Adoption

**Percent of physicians reporting incentive would have an impact**

**Source: MGH Institute for Health Policy, George Washington University and RTI, A National Survey of Health Record ****Keeping among Physicians & Group Practices in the United States, Preliminary Data **

## Hospital Survey

- Currently collaborating with the AHA
- Expected field period: March – June 2008
- Overview of survey instrument:
- Implementation of computerized system for specific functionalities
- Implementation of EHR in specific settings
- Estimates for patients who are managed by EHR
- Emergency planning
- Ability of EHR for public health reporting and biosurveillance
- Participation in RHIOS through EHR use
- Barriers and incentives to implementation

## Research Team 

| Mass General Hospital’s 
Institute for Health Policy | George Washington University
 |
| --- | --- |
| Harvard School of Public Health | RTI  |

## IOM Criteria and IHP/GWU Criteria for a Functional EHR

| IOM Core Functionalities | Functional EHR |
| --- | --- |
| Health Information and Data | Patient Demographics, Clinical Notes, Notes Include Medical History and Follow Up, Medication Lists, Patient Problem Lists |
| Order Entry Management | Orders for Prescriptions, Labs, and Radiology Tests, Orders sent Electronically |
| Results Management | Viewing Lab and Imaging Results, Electronic Images Returned |
| Decision Support | Warning and Contra-indications Provided for Prescriptions, Out of Range Levels Highlighted, Reminders for Interventions and Screening Tests |
| Electronic Communication and Connectivity |  |
| Patient Support |  |
| Administrative Processes |  |
| Reporting and Population Health Management |  |