Opportunities and Challenges for Implementing HIT

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• Opportunities and Challenges for Implementing HIT
• Steven R. Simon, MD, MPH
• August 2007
• Supported by a grant from the US Agency for
  Healthcare Research and Quality (AHRQ)

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Prologue

• Widespread (universal?) EHR adoption by 2014
• Has adoption reached tipping point?
• Do EHRs improve quality of care?
• How are physicians using EHRs?

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Outline

• Massachusetts e-Health Collaborative
• Statewide survey of physicians, 2007

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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, ultimately,
  inter-community) data exchange

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Pilot Timeline Overview
Activities
2004
2005
2006
2007
2008
ACP-MA summit MAeHC launch Community RFA
launch Pilot communities announced EHR vendor
RFP EHR vendor finalization Community EHR
implementation Intra-community connectivity Evalua
tion Formal Pilot completion
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PHYSICIANS GOING LIVE, BY COMMUNITY
9
7
5
19
21
33
25
24
27
43
51
9
88
1
77
1
441
MDs
North Adams (55)
Newburyport (81)
Brockton (305)
2006
2007
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HEALTH INFORMATION EXCHANGENorthern Berkshire
Example
Referrals mgmt
Patient portal
Health data exchange
Patient recruitment
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State of the State Physician Survey
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Massachusetts Physician Survey

• Stratified random sample of practices (N1884)
• Randomly sampled one physician per practice.
• 2005 1345 respondents (71)
• EHR Adoption 23 of practices, 45 of physicians
• EHR Usage wide variability in available
  functions and reported usage.

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2007 Follow Up Survey (N1345)

• May July, 2007
• Multiple mailings to all 1345 respondents from
  2005
• Excluded moved, retired, deceased (N200)
• 902 completed surveys (response rate 79)
• Preliminary Analysis

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Characteristics of Respondentswith EHRs (N562,
gt60 of sample)
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Please indicate all features of the EHR that you
have available in your practice. For those
features that you have, indicate the extent to
which you use them.

• Laboratory test results
• Laboratory order entry
• Radiology test results
• Radiology order entry
• Electronic visit notes
• Reminders for care activities (e.g. overdue
  health maintenance)

• Electronic medication lists of what each patient
  takes
• Electronic problem list
• Can transmit prescriptions to pharmacy
  electronically or via electronic faxing
• Electronic referrals or clinical messaging
  (secure e-mailing between providers)

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Available EHR Functions, 2005 - 2007
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Usage of EHR Functions, 2005 - 2007
Most or all the time
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2007 Massachusetts SurveySummary

• EHR adoption continues to increase
• Majority of Massachusetts physicians use EHRs
• Large segments of the physician population have
  light models of EHRs
• Just over half of physicians with EHRs have
• Lab and radiology order entry
• Clinical decision support
• Use of available EHR functions is increasing
• Substantial proportions of EHR users do not use
  key functions that may improve quality and safety
  (order entry, e-Rx, and decision support)

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Questions?
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(No Transcript)
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EHR SELECTION
Preferred Vendors Selection

• EHR RFP distributed in May, 2005
• Over 30 responses received
• Vendor Selection Committee validated 7 vendors to
  go forward

Community down-select

• Community Steering Committees down-select to
  smaller number for individual physician choice in
  each community
• 3 or 4 in each community
• Initial vendor fairs completed in each community
  and down-select complete

Physician choice

• Individual physician vendor fairs
• Each community developing different model of
  physician choice