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Physician Adoption of HIT AHRQ 2007 Annual Meeting September 26, 2007

Physician Adoption of HIT AHRQ 2007 Annual Meeting September 26, 2007. Melissa M. Goldstein, JD Department of Health Policy School of Public Health and Health Services The George Washington University Medical Center. Background. U.S. Healthcare System: High Costs, Variable Quality

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Physician Adoption of HIT AHRQ 2007 Annual Meeting September 26, 2007

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  1. Physician Adoption of HITAHRQ 2007 Annual MeetingSeptember 26, 2007 Melissa M. Goldstein, JD Department of Health Policy School of Public Health and Health Services The George Washington University Medical Center

  2. Background • U.S. Healthcare System: • High Costs, Variable Quality • Greater use of HIT may improve care • Potential annual savings of billions by reducing: • Duplicate services • Administrative costs • Medical errors and adverse events • Improve quality • Adoption rates low • Estimates inconsistent (5% to 65%) and unhelpful

  3. HIT Adoption Initiative(www.hitadoption.org) • HHS -- ONC • GWU • Partners/Massachusetts General Hospital • Brigham and Women’s Hospital • Annual Report (October 2006) – RWJF/ONC

  4. Objectives • Summarize current state of EHR use • Describe major barriers and facilitators • Examine current state of Health Information Exchange

  5. Methods • Define EHR • Synthesize the evidence of EHR use: • Environment scan of existing surveys (e.g., NAMCS, NHAMCS, HIMSS) • Some devoted to HIT, some only with sections • Only one survey devoted expressly to assessing adoption among safety net providers • Rate using objective criteria

  6. Results • Electronic Health Records • Electronic documentation • Results reporting • Electronic-prescribing • Decision support • 36 surveys identified • 17 surveys had adequate information for quality scoring

  7. Results: Outpatient EHR Use • Summary High Quality Surveys (5): • EHR adoption rate in U.S.: 17% - 27% • Highest quality survey (2005): 24% use some EHR • Summary of all surveys: • EHR adoption rate in U.S.: 20% - 25%

  8. Best Estimates of EHR Adoption * Large is defined as > 20 physicians by one study (with an estimate of 39%) and > 50 physicians (with an estimate of 57%). +Estimate from a survey rated “low” in quality of methodology ++Estimate from a survey quality of content suggested “low” in confidence in the estimate

  9. Projected diffusion of EHRs among office-based physicians: 2001-2014 6% annual increase 3% annual increase * 2006-2014 %’s are estimated based on current rate of adoption.

  10. Implications of Report • EHRs are promising solutions • EHR adoption increasing • Slow increases • At current pace, full EHR use by 2030 • Hasn’t yet hit tipping point

  11. Factors affecting adoption • Financial: systems are expensive • $50,000 up front per MD in ambulatory care • $2-20 Million for hospitals • Disruption • Often creates significant downtime • Changes the way doctors and nurses practice • Lack of perceived value • Savings accrue to others • Lack of standards • Privacy concerns

  12. Factors affecting adoption, cont. • EHR adoption contingent on value creation • Most adopters have seen a business need • Large practices, multi-site practices • Financial barriers critical for small practices • Where most Americans receive healthcare • Capturing and re-distributing value • Role of payers? • Cultural barriers need to be understood in context • Disruption always difficult • Many have made the change • Generational issues often over-played

  13. Safety Net ProvidersHIT Adoption • National survey federally funded CHCs (Health Affairs, Sept./Oct. 2007) • 26% some EHR capacity • 13% minimal set of EHR functionalities • CHCs serving the most poor & uninsured less likely to have functional EHR • Lack of capital top barrier

  14. Getting better data on EHR Adoption • Define EHR: • Institute of Medicine definition laying out 8 key functionalities • HIT Adoption Initiative modification • Define Adoption • Acquisition • Installation • Use • Design data collection methods • Development of new survey tools (PM, physician, hospital, consumer) • Identify goals and objectives of policy • Build upon existing federal and private surveys • Develop survey questions that add to and fill in the gaps of other existing programs of data collection

  15. Getting better data on EHR Value, Barriers and Incentives • Define measures of value • Quality • Efficiency • Safety net providers • Compare value and efficiency of care with and without EHRs • Identify barriers and incentives to adoption • Include measures of barriers and incentives in regular data collection activities • Real and perceived legal barriers

  16. Legal barriers • Concerns about • New legal exposures • Actual or perceived legal burden of compliance • Actual or perceived legal exposures associated with the disclosure of information

  17. Melissa M. Goldstein mgoldste@gwu.edu

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