Opportunities and Challenges for Implementing HIT Steven R. Simon, MD, MPH August 2007

1. 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)

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

3. Outline Massachusetts e-Health Collaborative Statewide survey of physicians, 2007

4. 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

5. 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 Evaluation Formal Pilot completion

6. 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

7. HEALTH INFORMATION EXCHANGENorthern Berkshire Example Referrals mgmt Patient portal Health data exchange Patient recruitment

8. State of the State: Physician Survey

9. Massachusetts Physician Survey Stratified random sample of practices (N=1884) 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.

10. 2007 Follow Up Survey (N=1345) May – July, 2007 Multiple mailings to all 1345 respondents from 2005 Excluded: moved, retired, deceased (N=200) 902 completed surveys (response rate 79%) ***Preliminary Analysis***

11. Characteristics of Respondentswith EHRs (N=562, >60% of sample)

12. 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) 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.

13. Available EHR Functions, 2005 - 2007

14. Usage* of EHR Functions, 2005 - 2007 *Most or all the time

15. 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)

16. Questions?

18. 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