Trends In The Adoption
Of Health Information
Technology
Susan Dentzer
Editor-In-Chief
Health Affairs thanks
for its ongoing support of the journal
as well as today’s briefing
David Muntz, MBA
Principal Deputy National Coordinator
Office of the National Coordinator for Health IT,
US Department of Health And Human Services
Health Affairs Forum
Meaningful Use
National Press Club Meeting
April 25, 2012
David S. Muntz, CHCIO, FCHIME, FHIMSS
Principal Deputy National Coordinator
Office of the National Coordinator for Health IT
Department of Health & Human Services
4
The Time is for Health IT is Now!
• The goals to achieve Meaningful Use are
ambitious, but achievable
• $22.5B available to healthcare providers in
form of incentives
• The momentum is building
5
“HIT Is The Means, But Not The End.”
Dr. David Blumenthal, previous National
Coordinator of HIT, emphasizes,
“Getting an EHR up and running in health
care is not the main objective behind the
incentives provided by the federal
government under ARRA. Improving health
is.”
- At the National HIPAA Summit
in Washington, D.C.
on September 16, 2009
6
Health IT: Helping to Drive the 3-Part Aim
Better healthcare
Improving patients’ experience of care within the Institute of
Medicine’s 6 domains of quality: Safety, Effectiveness, PatientCenteredness, Timeliness, Efficiency, and Equity.
Better health
Keeping patients well so they can do what they want to do.
Increasing the overall health of populations: address behavioral
risk factors; focus on preventive care.
Reduced costs
Lowering the total cost of care while improving quality, resulting
in reduced monthly expenditures for Medicare, Medicaid, and
CHIP beneficiaries.
$
Health Information Technology
77
Meaningful Use as a Building Block
Use information
to transform
Improved
population health
Improve access
to information
Enhanced access
and continuity
Data utilized to
improve delivery
and outcomes
Data utilized to
improve delivery
and outcomes
Patient self
management
Patient engaged,
community
resources
Care coordination
Care coordination
Patient centered
care coordination
Patient informed
Evidenced based
medicine
Team based care,
case management
Basic EHR
functionality,
structured data
Structured data
utilized
Registries for
disease
management
Registries to
manage patient
populations
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Privacy & security
protections
Stage 2 MU
PCMHs
3-Part Aim
ACOs
Stage 3 MU
Utilize
technology to
gather
information
Stage 1 MU
8
“How are we doing?”
• Physician adoption of any EHR system has more than
tripled since 2002, going from 17 percent to 57 percent in
2011 (NCHS Data Brief).
• The adoption of basic EHRs has doubled since 2008, going
from 17% to 34% in 2011 (NCHS Data Brief).
• Adoption has grown significantly important subgroups of
physicians including small practices and rural providers.
• The share of hospitals using EHRs has more than doubled
from 16% to 35%.
9
Who is helping?
•
•
•
•
•
The public – patients and consumers
The IT industry
The Health Care industry
Professional and consumer organizations
Other Federal agencies including but not limited to:
–
–
–
–
–
–
–
–
–
AHRQ -- HRSA
CMS
FCC
FDA
NIST
NLM
NTSB
OCR
USDA
10
Providers Registered for
Medicare and Medicaid EHR
Incentive
Programs
Over 225 thousand providers are registered to achieve Meaningful Use
through the Medicare or Medicaid EHR Incentive Programs
222,282 eligible professionals
3,483 eligible hospitals
Source: CMS EHR Incentive
Program Data as of 3/31/2012
4/13/2015
Office of the National Coordinator for
Health Information Technology
11
Number of EHR Incentive Payments Made to
Eligible Professionals as of March 31, 2012
Source: CMS EHR Incentive Program
Note: Medicaid payments are for adopting, implementing, or upgrading EHR technology. Medicare payments are for the
meaningful use of certified EHR technology.
12
Number of EHR Incentive Payments Made
to Eligible Hospitals as of March 31, 2012
Source: CMS EHR Incentive Program
Note: Medicaid payments are for adopting, implementing, or upgrading EHR technology. Medicare payments are for the
meaningful use of certified EHR technology. 566 hospitals have received payments under both Medicare and Medicaid.
13
Regional Extension Centers (RECs)
Over 132,000 primary care providers are working with a Regional
Extension Center to achieve Meaningful Use
This includes
• Over 40% of all primary care providers in the nation
• Over half of all primary care providers working in rural
locations
• Small providers are having successes at getting on EHR
systems
• Working with 963 Critical Access Hospitals (CAHs) and 85 rural
hospitals, all of whom have 25 beds or less
4/13/2015
Office of the National Coordinator for
Health Information Technology
14
Online Job Postings Have Grown Substantially
Health IT Implementation & Support Jobs
15,000
Health IT Clinical User Jobs
14,512
13,000
Number of Health IT Job Postings per Month
HITECH Act
February 2009
11,000
9,000
7,000
4,850
5,000
3,000
Jan-12
Nov-11
Jul-11
Sep-11
May-11
Jan-11
Mar-11
Nov-10
Jul-10
Sep-10
May-10
Jan-10
Mar-10
Nov-09
Jul-09
Sep-09
May-09
Jan-09
Mar-09
Nov-08
Jul-08
Sep-08
May-08
Jan-08
Mar-08
Nov-07
Jul-07
Sep-07
May-07
Jan-07
-1,000
Mar-07
1,000
SOURCE: ONC analysis of data from O’Reilly Job Data Mart
•
Supporting activities
–
–
–
–
Community College Consortia
University Based Training
Curriculum development
Competency Exam
15
How does Health IT transform health and
health care? By hardwiring the 3-Part Aim.
• Improving adherence to evidence-based best practice
–
–
–
–
–
–
Order Sets
Care Plans
Clinical Decision Support (CDS)
Documentation Templates
Collection and Reporting of Clinical Quality Measures (CQM’s)
Data aggregation for new knowledge generation
• Facilitating access to information during encounters, between encounters
and across care venues
–
–
–
–
Collect once, use many times
Anytime, anywhere access to patient information
Easy access to clinical reference data
Health information exchange (HIE)
• Involving and engaging the patients, their families, and consumers
– Patient as partner - Empowered
– Participation in care – Compliance with care
16
Why is HIT important?
Patients are not averages. They are part of a community.
59 year-old woman in
Dallas, TX who was
diagnosed with
glaucoma in 1982 and
has been taking
Timoptic eye drops
daily.
Last Sunday, April 15,
10 minutes after
entering the water for
the first leg of a minitriathlon she suffered
what was eventually
diagnosed as a nonSTEMI cardiac event.
She was admitted to
the Heart Hospital at
Baylor Plano.
During the admission, she
received personalized risk
assessment forms, was placed
on standardized order sets.
Medication reconciliation was
done. She was sent to the
Cath Lab for an angiogram.
Prior to and after her
procedures, telemetry results
were entered automatically
into the EHR.
Using an EHR with imaging,
her physician was able to
review her angiogram with her
on the TV screen in her room
and discuss the potential risks
of an additional beta blocker to
ensure the best possible
outcome. Personalized
discharge instructions were
given to her spouse. The
outcome and prognosis are
good.
17
Thank you!
For additional comments or questions please contact
David.Muntz@HHS.gov
18
Stay Connected. Communicate. Collaborate.
Centers for Medicare & Medicaid Services
19
CMS References for Stage 2
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
20
Stay Connected.
Communicate and Collaborate.
• Browse the ONC website at: HealthIT.gov
click the Facebook “Like” button to add us to your network
• Contact us at: onc.request@hhs.gov
• Subscribe, watch, and share:
@ONC_HealthIT
http://www.youtube.com/user/HHSONC
Health IT and Electronic Health Records
http://www.scribd.com/HealthIT/
http://www.flickr.com/photos/healthit
Health IT Buzz Blog
21
Michael W. Painter, JD, MD
Senior Program Officer
Robert Wood Johnson Foundation
Small, Non-Teaching, And
Rural Hospitals Continue To Be
Slow In Adopting Electronic
Health Record Systems
Catherine M. DesRoches, PhD
Maulik Joshi, Chantal Worzala, Peter
Kralovec, & Ashish K. Jha
Introduction



By February 2012, more than three
thousand hospitals had registered for
Medicare or Medicaid electronic
health record incentive program.
Overall pace of adoption has been
slow.
A recent study suggests that the pace
of adoption may be quickening but
nationally representative data has
been missing.
2
Research Questions
 What proportion of US hospitals had a


basic or comprehensive electronic health
record system or could meet our proxy
standard of meaningful use in 2011?
Are there specific types of hospitals that
appear to be making progress more rapidly
than others?
Which electronic functions appear to be
the biggest barriers to hospitals reaching
the meaningful use mark?
25
Methodology
 National survey of U.S. hospitals
 Field period: October – December 2011
 Response rate: 58%
 Analytic sample: 2,646 acute care hospitals
 Measures: 1) basic and comprehensive EHR

2) proxy measure for meaningful
use
All results are weighted to adjust for potential
non-response basis.
26
Overall Findings



Hospital adoption of EHRs
accelerated between 2010 and 2011.
Gaps in adoption based on hospital
size, teaching status and location
appear to be widening.
Meeting Stage 1 meaningful use
criteria is a challenge for most
hospitals.
27
Substantial Increase In Adoption Of At Least A
Basic EHR: 2010-2011
DesRoches CM, Joshi M, Worzala C, Kralovec P, Jha AK. (2012) Small, non-teaching, and rural hospitals continue to be slow in adopting electronic
health record systems. Health Aff (Millwood). 2012;31(5). [Epub ahead of print] archived and available at www.healthaffairs.org
Percent of hospitals
Smaller, Non-Teaching Hospitals Fell
Further Behind
Hospital Size
Teaching Status
DesRoches CM, Joshi M, Worzala C, Kralovec P, Jha AK. (2012) Small, non-teaching, and rural hospitals continue to be slow in adopting electronic
health record systems. Health Aff (Millwood). 2012;31(5). [Epub ahead of print] archived and available at www.healthaffairs.org
Rural Hospitals Had The Lowest Rate Of Adoption
DesRoches CM, Joshi M, Worzala C, Kralovec P, Jha AK. (2012) Small, non-teaching, and rural hospitals continue to be slow in adopting electronic
health record systems. Health Aff (Millwood). 2012;31(5). [Epub ahead of print] archived and available at www.healthaffairs.org
30
Fewer Than 1 In 5 Hospitals Met The Proxy For
Meaningful Use
Electronic functionality
% of hospitals
Patient demographics
81.9
Patient medication allergy list
79.2
Vital signs
75.5
Smoking status
71.3
Clinical decision support
74.4
Patient medication list
74.2
Electronic copy of discharge instructions
68.8
Patient problem list
55.5
Computerized provider order entry
50.1
Provide patients with copy of record upon request
49.6
Generate quality measures
46.8
Implement drug-drug/drug allergy interaction checks
41.7
18.4% of
hospitals had all
12 measures
implemented in
at least one unit
of the hospital.
Barriers Remain, Even For Hospitals That Are
Close To Meaningful Use
Percent of acute care hospitals with 9 to 11 of the 12 meaningful use functions
DesRoches CM, Joshi M, Worzala C, Kralovec P, Jha AK. (2012) Small, non-teaching, and rural hospitals continue to be slow in adopting electronic
health record systems. Health Aff (Millwood). 2012;31(5). [Epub ahead of print] archived and available at www.healthaffairs.org
Continued Federal Efforts Are Needed In The
Following Areas:
• Hospitals that appear to be moving more slowly – their
needs may be beyond the capabilities of the Regional
Extension Centers.
• The shortage of trained HIT professionals
• Vendor supply appears to be strained – smaller hospitals
may have a hard time competing with large, urban
facilities.
• Lack of infrastructure for health information exchange
• Setting the bar for Stage 2 of meaningful use
Study team
American Hospital Association
Chantal Worzala
Peter Kralovec
Maulik Joshi
Harvard School of Public Health
Ashish K. Jha
34
Physicians In Nonprimary Care And
Small Practices And Those Age 55 And
Older Lag In Adopting Electronic Health
Record Systems
Sandra L. Decker, Ph.D.
Eric W. Jamoom, Ph.D.
Jane E. Sisk, Ph.D.
The authors thank the Office of the National Coordinator for Health
Information Technology (ONC) for funding the National Ambulatory Care
Electronic Medical Records supplement. The findings and conclusions in this
presentation are those of the authors and do not necessarily represent he
views of the Centers for Disease Control and Prevention, the Institute of
Medicine, or the Office of the National Coordinator.
Goal and Methods
Background
In 2002, about one-in-five office-based physicians had Electronic Health Records
(EHRs) (Burt & Sisk, Health Affairs, Sept/Oct 2005). By 2011, more than half of
physicians had EHRs (Hsiao et al., NCHS Data Brief 79).
Purpose
To trace the increase in adoption of EHRs among office-based physicians in the past
decade by physician and practice characteristics.
Data
2002-2011 National Ambulatory Medical Care Survey (NAMCS) of office-based
physicians, excluding radiologists, anesthesiologists, and pathologists (N =22,885).
Outcomes
Any EHR
Basic EHR system includes computerized capabilities hypothesized to lead to
improved quality and efficiency of care (i.e. ability to record information on
patient demographics, problem lists, medications, and clinical notes, and the
ability to view laboratory and imaging results and use computerized
prescription ordering)
Physicians with Electronic Health Records, 2002-2011
60
Any EHR
Basic EHR
55
50
% (Unadjusted)
40
36
30
20
18
12
10
0
2002
2003
2004
2005
2006
Years
2007
2008
2009
2010
2011
Physicians With Any Electronic Health Records
By Practice Size
≥ 10 Physicians with Any EHR
3-9 Physicians with Any EHR
1-2 Physicians with Any EHR
90
83.1
80
70
61.3
% (Unadjusted)
60
50
40
36.7
30
29.2
20.1
20
10
12.4
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Physicians With Any Electronic Health Records By Age
80
Age 45 years or younger
70
Ages 46-55
Age over 55 years
68
60
60
% (Unadjusted)
50
40
45
30
22
20
20
16
10
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Physicians With Any Or Basic Electronic
Health Records By Specialty
% (Unadjusted)
70.0
60.0
60.1
50.0
50.5
Primary-Care Specialists with
Any EHR
40.0
41.3
Non-Primary-Care Specialists
with Any EHR
31.5
Primary-Care Specialists with
Basic EHR
30.0
20.0
Non-Primary-Care Specialists
with Basic EHR
18.7
16.5
10.0
15.0
10.0
0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Physicians With Any Or Basic Electronic
Health System By Ownership
80.0
68.3
70.0
60.0
49.6
% (Unadjusted )
50.0
48.0
Other Ownership Arrangment with
Any EHR
40.0
Practice Owned by Physician or
Physician Group with Basic EHR
30.7
30.0
Practice Owned by Physician or
Physician Group with Any EHR
26.6
29.0
20.0
16.1
10.0
9.4
0.0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Other Ownership Arrangment with
Basic EHR
Conclusions
● Upturn in EHR adoption from 2004 as federal efforts ramped up
● By 2011, more than half of physicians reported some use, but only
about one-third had basic capabilities hypothesized to lead to improved
quality and efficiency of care
● During the 2002-2011 decade, differences in adoption by specialty and
practice size, as well as by physician age and practice ownership,
persisted or widened
● Federal programs have targeted primary-care specialists and those in
small practices. To achieve the stated aim of widespread use, they may
need to also focus on non-primary care specialists.
Most Physicians Were Eligible
For Federal Incentives In 2011,
But Few Had EHR Systems That
Met Meaningful-Use Criteria
Chun-Ju Hsiao, Ph.D., M.H.S.
Sandra L. Decker, Ph.D.
Esther Hing, M.P.H.
Jane E. Sisk, Ph.D.
We would like to thank the Office of the National Coordinator for Health Information Technology
for funding the Electronic Medical Records Supplement to the National Ambulatory Medical Care
Survey. 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,
the Institute of Medicine, or the Office of the National Coordinator.
Policy Context And Purpose
• Eligible professionals must show meaningful use
of certified EHRs to receive financial incentives
from Medicaid or Medicare
• To assess physicians' eligibility and intentions to
apply for these incentives and the computerized
capabilities of physicians' EHRs to support
meaningful use
Data And Methods
• 2011 National Ambulatory Medical Care Survey
(NAMCS) Electronic Medical Record (EMR)
Supplement of office-based physicians
• Assessed eligibility for financial incentives based
on Medicare revenue or approximate Medicaid
volume
• Assessed intentions to apply for financial
incentives
• Assessed capabilities/readiness of EHRs to
support 10 of the 15 required stage 1 objectives
for meaningful use
Results
• 91% of physicians eligible for Medicare or Medicaid
financial incentives
• 51% intended to apply
• 11% both intended to apply and had EHRs with capabilities
to support two-thirds of the stage 1 core objectives
– More likely: physicians in practices of 11 or more
physicians, physicians in practices not owned by
physician/physician group
– Less likely: non-primary care specialists, physicians
eligible for Medicaid incentives
• States with higher percentages intending to apply differed
from states with higher percentages ready with the
required EH R capabilities
Conclusions
• Great discrepancy exists between physicians’
intentions to apply for incentives and their EHRs’
readiness
• Gaps in readiness are widespread across the states
• Low level of EHR readiness illustrates meeting
federal schedule for financial incentives will be
challenging
HITECH @3:
How Far Have We Come?
How Far Do We Have To Go?
Ashish K. Jha, MD, MPH
Harvard School of Public Health
Why HITECH?
• U.S. Healthcare “system” is 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
• Through 2010, EHR adoption slow moving
– 3-5% per year
• 2011 was the game-changer year
– 1 in 10 physicians, hospitals adopted an EHR
• Broad enthusiasm in the marketplace
– Majority of docs, hospitals intend to apply for
MU
Health Information Exchange
Health Information Exchange
• The vision: Broad-based exchange of
structured clinical data
• Appears deceptively simple
– Likely the hardest part of HITECH
Health Information Exchange
• Five major challenges ahead:
– Concerns about privacy, security
– Exchange of structured data
– Those left out of HITECH
• Leaves large gaps in the patient’s care picture
– Competitiveness
– Clinical data workflow
• Dealing with an onslaught of new data
Moving Forward On HIE
• Steps for policymakers
– Reassurance about privacy/security
– Bringing excluded providers in
– Pushing for structured data exchange
– Focus on new payment models
• ACOs, etc. are a double-edged sword
• Innovations in the market place
– Manage the explosion of data
Challenges Beyond HIE
Big Challenges Ahead
• Ensuring safe implementation
• Digital divide emerging
– Widening gap by size, location
• Getting benefits out of Health IT
– Recent debate on cost, quality misses point
– EHR systems have differential effects
– We don’t know why
Summary: Looking Back,
Moving Forward
Getting Health IT Right Is Essential
• Infrastructure for payment, delivery reform
• HITECH is having an effect
– Early in the ballgame
• Metrics to watch in the years ahead:
–
–
–
–
Will adoption continue to accelerate?
Will we begin to narrow the digital divide?
Will clinical data begin to flow?
Will we learn to get the benefits out of HIT?
Acknowledgements
•
•
•
•
RWJF
NCHS, AHA
ONC
Health Affairs
Health Affairs thanks
for its ongoing support of the journal
as well as today’s briefing