Health Information Technology Adoption & Use John K. Iglehart Founding Editor.
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Transcript of Health Information Technology Adoption & Use John K. Iglehart Founding Editor.
Health Information Technology Adoption & Use
John K. IglehartFounding Editor
Health Affairs thanks
for its ongoing support of the journal as well as today’s briefing
Keynote
Farzad Mostashari, M.D., Sc.M.
National Coordinator for Health IT, US Department of Health And Human Services
Meaningful Use: Where Are We Now?
Michael W. Painter, J.D., M.D.
Senior Program OfficerRobert Wood Johnson Foundation
Adoption of Electronic Health Records Grows RapidlyBut Fewer Than Half of US Hospitals Had At Least a Basic System in 2012
Catherine M. DesRoches, Ph.D.
Senior Survey Researcher Mathematica Policy Research
Methodology• 2012 health IT supplement to the AHA’s
annual survey.• Field period: October 2012 – January 2013.• Analytic sample: 2,796 general, acute care
hospitals.• Measures: basic and comprehensive EHR,
stage 1 MU and stage 2 MU proxies.• All results are weighted to adjust for non-
response bias.
Changes In Adoption Of Basic And Comprehensive EHR
DesRoches CM, Charles D, Furukawa MF, et al. (2013) Adoption of Electronic Health Records Grows Rapidly, But Fewer Than Half of US Hospitals Had At Least A Basic System in 2012. Health Aff (Millwood). 2013;32(8)
Meaningful Use• 42.2% of hospital met our proxy
measure of stage 1 meaningful use • Hospitals meeting stage 1
– Larger hospitals– Major teaching hospitals– Private non-profit status– Located in urban areas
• 5.1% of hospitals met our proxy measure for meaningful use stage 2.
Conclusions And Policy Implications• Substantial increases in adoption over
prior years.– Tremendous amount of activity across all
subgroups, although some still lag behind.
• Challenges remain.– Fewer than half of hospitals met stage 1
proxy.– Small proportion could meet core criteria
for stage 2.
Continued Effort Is Needed In The Following Areas:• Small and rural hospitals
– Both revenue and workforce challenges
• Patient access to records• Electronic data exchange
– Among hospitals and providers– Public health functions
• Hospitals that appear to be moving more slowly
Office-based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health RecordsChun-Ju Hsiao, Ph.D., M.H.S. Ashish K. Jha, M.D., M.P.HJennifer King, Ph.D.Vaishali Patel, Ph.D.Michael F. Furukawa, Ph.D.Farzad Mostashari, M.D., Sc.M.
We would like to thank the Office of the National Coordinator for Health Information Technology for funding the National Ambulatory Medical Care Survey - Electronic Health Records Survey. Dr. Jha was funded by RWJF. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, or the Office of the National Coordinator.
Policy Context And Purpose
• Substantial resources made available through HITECH have been devoted to helping providers achieve meaningful use of EHR systems.
• To assess who is using the systems and how their adoption has evolved
• To examine adoption and routine use of specific capabilities related to a Basic EHR system and meaningful-use criteria
Data And Methods• 2010-12 National Ambulatory Medical Care
Survey (NAMCS) - Electronic Health Records Survey of office-based physicians
• Measuring EHR adoption
• Measuring routine use
Analysis• Descriptive analysis examining the change in the use
of any type of EHR system and the adoption of a Basic system between 2010 and 2012– Multivariate analysis assessing characteristics
associated with the adoption of a Basic EHR system
• Descriptive analysis examining trends in adoption of capabilities required for a Basic EHR system and selected stage 1 core criteria for meaningful use
• Descriptive analysis examining whether physicians routinely used capabilities related to stage 1 core criteria for meaningful use and a Basic EHR system– Multivariate analysis assessing characteristics
associated with routine use
Office-based Physician’s Adoption Of EHR Systems, 2010-12
Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012
Basic EHR adoption rate
(adjusted percent)Change in Basic EHR
adoption rate
2010 2012 Absolute change (percentage point)
Relative change(percent)
Age <45 29.5 40.0 10.5 35.6 45-54 years 26.4 41.3 14.9 56.4 55-64 years 25.1 35.4 10.3 41.1 ≥65 years 16.5** 33.3 16.8 101.8
Practice size (number of physicians) 1 11.3 25.6 14.3 127.2 2-5 26.0** 36.6** 10.6 40.6 6-10 29.7** 44.0** 14.3 48.1 ≥11 45.0** 57.7** 12.6 28.1
**p<0.01
Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012
**p<0.01
Basic EHR adoption rate
(adjusted percent)Change in Basic EHR
adoption rate
2010 2012 Absolute change (percentage point)
Relative change(percent)
Practice ownership Physician/physician group 23.5 34.3 10.8 45.9 Hospital/academic medical center 28.4 47.5** 19.1 67.3 HMO/other health care organization 39.8** 58.4** 18.6 46.8 Community health center 13.5** 32.3 18.8 139.6 Other/unknown 28.6 31.2 2.7 9.4
Metropolitan status Large central metropolitan 23.4 36.0 12.6 54.0 Large fringe metropolitan 26.0 35.8 9.8 37.8 Medium metropolitan 25.0 39.7 14.7 58.8 Small metropolitan or non- metropolitan 30.8** 43.5** 12.7 41.1
Adoption Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2010 And 2012
MU
Sta
ge 1
Cor
e
2010 Change 2010-20122012
Bas
ic E
HR
Adoption And Routine Use Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2012
Conclusions
• Findings are consistent with the proposed positive effect of incentives and technical assistance on physicians’ adoption and use of health information technology (IT)
• Key areas for continued policy focus include monitoring trends in physicians’ use of IT and whether gaps between physicians persist
• Rapid growth in the IT infrastructure may create a platform for delivery of high-quality, efficient care
Operational Health InformationExchanges Show Substantial Growth, But Long-Term Funding Remains
Julia Adler-Milstein, PhDDavid W. Bates, MD MScAshish K. Jha, MD MPH
Policy Context
• Health information exchange is critical to a well-functioning health care system.
• Electronic sharing of data between providers can lead to better care coordination, greater efficiency
• Prior to HITECH, growth in HIE was slow
• HITECH provided funding as well as non-financial incentives to increase HIE
Current Study• National census of HIE efforts to
answer:
1. How many HIE efforts are there? Has it changed over time?
2. Who is participating? What are they sharing?
A. Can they support key elements of stage 1 Meaningful Use?
3. What are the primary barriers to long term viability of these entities?
Key Findings• Substantial growth in the number of
operational HIEs
– 119 efforts in 2012 (up from 75 in 2010)
• Substantial growth in the number of participating hospitals and ambulatory practices
– Hospitals: 14% 30%
– Ambulatory Practices: 3% 10%
• Broad geographic coverage
– 67% of hospitals service areas had an HIE effort that enabled providers to meet stage 1 meaningful use
• Broad Array Of Barriers Continue To Be Reported
– Financial barriers are the most pressing
HITECH @3: Strong Start On A Long Path
Ashish K. Jha, M.D., M.P.H.
Harvard School of Public HealthJuly 2013
Why HITECH? • U.S. Healthcare “system” still a
mess– High cost, disappointing quality
• Paper-based records a contributor– Lead to lots of errors, waste
• EHR adoption was low, moving slow
• The largest payer intervened
What Happened?• Well-crafted, strong incentives
work• EHR adoption slow moving• Incentives kicked in 2011
– Adoption has taken off – Doctors, hospitals embracing
technology– Nearly half way there
• With a lot of progress in the pipeline
Health Information Exchange• Progress slower• Exchange remains in its infancy
– Lots of challenges– Mostly not about technology
• Business model for HIE a challenge
Intermission: Unfinished Business
• What happens in the second half of the play?– Will things continue to move quickly?– Will some providers just not make it?
• How do we bring others on board?– Nursing homes, rehab facilities, etc.?– Major problem if they remain left out
Unfinished Business• How do we use technology more
effectively?– What can we do to improve quality,
efficiency?– How do we ensure safe implementation?
• Integration with health reform efforts– ACOs, Bundled Payments, etc.– Quality measurement
Getting Health IT Right Is Essential
• Infrastructure for payment, delivery reform
• HITECH is having a big effect• Our work is just getting started
Acknowledgements• RWJF• NCHS, AHA, ONC as great partners• Health Affairs
Health Affairs thanks
for its ongoing support of the journal as well as today’s briefing