H lth IT in
Health
i the
th U.S.:
U S An
A Update
U d t
Ashish K. Jha, MD, MPH
Harvard School of Public Health
VA Boston
B t Healthcare
H lth
System
S t
June 28,
28 2010
AcademyHealth ARM
U S Healthcare
U.S.
 $2.5
$2 5 trillion in 2009 and rising
 17.3% of GDP
 Biggest domestic policy issue
 Quality
Q lit is
i disappointing
di
i ti
 Failure to translate knowledge into practice
 Care is often unsafe
 Tens of thousands of Americans die from MEs
Whyy HIT?

Paper--based records part of the problem
Paper
– Inability to access key data at the point of care
– Leads to large number of errors
– Practice of “defensive”
defensive medicine
– Redundant and un
un--necessary tests
HITECH 2009
 Over $30 Billion for HIT
 Mostly in direct incentives for providers for
“meaningful
meaningful use”
use”
 Incentives start in 2011
 Must adopt by 2014
 Penalties (lower reimbursements) kick in thereafter
Where are we with EHRs?
 What
do we mean by EHR?
 What are the adoption rates in:
 Ambulatoryy Care?
 Hospitals?
Survey Overview
 Nationally representative sampling
 Focus on adequate RR
 EHR Definitions from Expert Panel
 Basic: 7 functions
 Clinical notes,
notes problem lists,
lists medication lists
 Electronic prescribing, results management
 Comprehensive: 17 functions
Ambulatory EHRs
25%
20.5%
20%
16.7%
Adoption Ra
ate
15%
11 8%
11.8%
Comprehensive
10.5%
10%
Basic
6.3%
5%
3.8%
4.4%
3.1%
0%
2006
Based on NAMCS data
2007
2008
2009
Hospital Survey
 Survey of all acuteacute-care hospitals
 Lead by AHA
 High response rates
 EHR Definitions:
 Basic:
i
10
0 functionalities
f
i
li i in
i at least
l
one clinical
li i l unit
i
 Comprehensive: 24 functionalities in ALL major
clinical units

Follows the pattern of ambulatory care
Prelim Results: Hospital EHRs 2009
10%
9 2%
9.2%
9%
8%
7.6%
7%
Adoption R
Rate
6%
5%
Comprehensive
Basic
4%
2.7%
3%
2%
1.5%
1%
0%
2008
2009
What might
g we predict
p
about
Meaningful Use?
MU in U.S. hospitals
p
2009
Meaningful Use Criteria
%
Use Computerized Physician Order Entry
35
Implement drug-drug, drug-allergy checks
14
M i t i an up-to-date
Maintain
t d t problem
bl
list
li t
46
Maintain active medication list
66
Record key demographics
86
Incorporate clinical lab-test results into EHR
84
Report hospital quality measures to CMS
26
Implement five clinical decision supports (do any 5 of 6)
33
Capability to exchange key clinical information
11
Perform medication reconciliation
53
All of the above
0.7%
Health
H
lth Information
I f
ti
E h
Exchange
Longitudinal Results
Number of Efforts: Growth over Time
300
2007
2008
2009
247
250
Number of Effforts
N
207
200
150
145
100
75
73
70
55
42
50
44
32
20
36
34
16
0
Total Identified
Planning
Operational
Large Operational
Large,
Defunct
13
Functional Definition: Operational HIEs
Basic
Comprehensive
TOTAL
14
0
Number of States
Involved
15
0
Number of Hospitals
Participating
145 (3%)
0
Number of Practices
Participating
1,415 (0.6%)
0
14
Summary
Health IT critical to high performing
healthcare system
y
 The market is moving forward

 Progress has been slow

HITECH as a catalyst?