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