# Presentation: 903141

## Statewide Implementation of Electronic Health Records

**EHRs in Massachusetts: Who has them and how are they using them?**** **
*Supported by the*
*Agency for Healthcare Research and Quality*

## Outline

- Background: Massachusetts e-Health Collaborative
- Two statewide surveys
- 	Office practice managers
- 	Physicians in office practices

## 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 inter-community data exchange

## Most physicians do not currently use EHRs
National average 17.6% of physicians using EHRs
Large groups more likely to use EHRs than small groups
HMO-owned practices are three times more likely than physician-owned practices to use an EHR

- Most physicians do not currently use EHRs
- National average 17.6% of physicians using EHRs
- Large groups more likely to use EHRs than small groups
- HMO-owned practices are three times more likely than physician-owned practices to use an EHR

- * Burt and Sisk. *Health Affairs*.  Sep/Oct 2005.

## What is Current State of  EHR Adoption in Massachusetts?

- Two statewide surveys, summer 2005
- 	Office practice managers
- 	Physicians in office practices

## Office Practice Survey

- Stratified sample of 1829 practices
- (30% of state)
- All specialties, urban/rural, large and small practices
- 1-page mailed survey sent to the attention of *office practice managers*
- 46% response rate

## Slide 7

## Implementation – Future Plans

- Not in the foreseeable future (52%)

- Within the next 12 months (13%)

- Within 3-5 years (11%)

- Within the next 1-2 years (24%)

## Barriers to Implementation*

## Physician Survey

- Same sample of practices as office manager survey
- Included only physicians with ambulatory clinical practices
- 8-page mail survey
- $20 incentive

## Overall Response Rate: 71%

|  | Respondents | Non-
Respondents | P |
| --- | --- | --- | --- |
| Primary Care | 36% | 37% | 0.64 |
| Solo Practice | 44% | 47% | 0.24 |
| Hospital-Based | 27% | 28% | 0.63 |
| Non-Urban | 3% | 5% | 0.10 |

## EHR Adoption

## EHR Adoption

## Incentives

- Yes

- Yes

- No

- No

- Limited/None

- Moderate/Extensive

- Percent with EHR

## Additional Adoption Statistics

- On a physician level, a total of 45 percent of physicians in Massachusetts had EHRs.
- Among practices with EHRs, more than half (53 percent) reported having EHRs in their practice for more than 3 years.

## Practice characteristics as correlates of EHR Adoption 

## Office computing capabilities as correlates of EHR adoption in ambulatory care

- Office computing capabilities as correlates of EHR adoption in ambulatory care

## Perceived barriers to adoption or expansion of HIT as correlates of EHR adoption in ambulatory care

- Perceived barriers to adoption or expansion of HIT as correlates of EHR adoption in ambulatory care

## Organizations influencing practices in the decision whether to adopt a new EHR system

## Limitations

- Massachusetts only
- New measure of EHR usage (may not be comparable to other studies)
- Cross-sectional: difficult to draw causal inference

## Conclusions

- Fewer than one in four office practices in MA have EHRs
- Nearly 50% of physicians in MA have EHR in their practice
- Larger practices and hospital-based practices were more highly correlated with EHR adoption

## Conclusions (2)

- For practices without EHRs, >80% report finances as major barrier
- Both financial and non-financial (e.g., cultural) barriers persist
- EHR decision-making is local  Implications for interventions