Electronic Health Record Adoption and Implementation: A Report from the Massachusetts eHealth Collaborative

AHRQ 2008 Annual Conference

Slide Presentation from the AHRQ 2008 Annual Conference

On September 9, 2008, David W. Bates, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (626 KB).

Slide 1

Electronic Health Record Adoption and Implementation: A Report from the Massachusetts eHealth Collaborative

David W. Bates, MD, MSc
Medical Director of Clinical and Quality Analysis, Partners Healthcare
Chief, Division of General Medicine, Brigham and Women's Hospital.

Slide 2

Overview

• Formation of the Massachusetts eHealth Collaborative (MaEHC).
• Adoption of Electronic Health Records (EHRs) in the collaborative.
• Statewide adoption data.
• Conclusions.

Slide 3

MAeHC Roots are in Movement to Improve Quality, Safety, Efficiency of Care

The slide shows three logos. The American College of Physicians (ACP) and Blue Cross Blue Shield are aligned on the left side of the slide with an arrow pointing to MAeHC, which is aligned on the right side of the slide.

• ACP.
  • Universal adoption of electronic health records.
  • MA-SAFE.
• Blue Cross Blue Shield.
  • $50M commitment to heath information infrastructure.
  • Recognition of "systems" problem.
• MAeHC.
  • Company launched September 2004.
    • Non-profit registered in the State of Massachusetts.
  • Chief Executive Officer (CEO) on board January 2005.
  • Backed by broad array of 34 MA health care stakeholders.

Slide 4

Three Communities Selected from 35 Applicants

The map shows the state of Massachusetts divided into counties. Three yellow stars point out North Adams, located in the northwestern corner of the state; Newburyport, located in the northeastern corner of the state; and Brockton, located in the southeastern portion of the state.

Slide 5

Physician EHR Selections

• Newburyport—Less centralized.
  • Community down-select.
    • NextGen.
    • eClinicalWorks.
    • GE.
    • Physician Micro System, Inc.
  • Physician choice.
    • Most decentralized approach.
    • Individual physicians chose from down-selected vendors.
• Brockton—Centralized.
  • Community down-select.
    • NextGen.
    • eClinicalWorks.
    • GE.
    • ALLSCRIPTS.
  • Physician choice.
    • Physician choice was further narrowed by community orgs.
    • Brockton NHC.
    • BGPMA.
    • CGMC Individual Practice Association (IPA).
    • Brockton Hospital PHO.
• North Adams—More centralized.
  • Community down-select.
    • NextGen.
    • eClinicalWorks.
  • Physician choice.
    • Chose single vendor for entire community.
    • "Enterprise EMR" model.

Slide 6

Scope of Pilot Projects

The slide presents three bar graphs measuring the number of "Physicians," "...who care for almost 500K patients," "...in almost 200 offices."

• Physicians
  • Brockton
    • Primary Care Physicians (PCPs): 111
    • Specialists:184
  • Newburyport
    • PCPs: 37
    • Specialists: 48
  • North Adams
    • PCPs: 27
    • Specialists: 38
  • All
    • PCPs: 175
    • Specialists: 270
• Patients
  • Brockton: 350
  • Newburyport: 95
  • North Adams: 43
  • All: 488
• Offices (Majority, small)
  • Brockton: 111
  • Newburyport: 41
  • North Adams: 25
  • All: 177

Slide 7

Physicians "Going Live," by Community

The bar graph measures monthly the number of doctors who opened offices in North Adams, Newburyport, and Brockton between March 2006 and June 2007.

• Total Offices Opened.
  • North Adams: 55.
  • Newburyport: 81.
  • Brockton: 305.

Slide 8

2005 Physician Survey

Sampled 1829 practices (30% of state) within strata:

• Primary care vs. specialty.
• Urban vs. rural.
• Large vs. small practices.

Only physicians w/ambulatory practices 8-page mail survey with $20 incentive.
Overall Response Rate: 71%

Slide 9

EHR Adoption

• Percent of Office Practices Using EHRs.
  • Overall: 23%
  • Specialty.
    • Primary Care: 25%
    • Single Specialty: 20%
    • Multi-Specialty: 23%
  • Number of physicians.
    • 1: 14%
    • 2-3: 15%
    • 4-6: 33%
    • 7+: 52%

Slide 10

EHR Adoption

The bar graph presents the "Percent of Office Practices Using EHRs."

• Non-teaching: 14%
• Teaching: 40%
• Non-urban: 21%
• Urban: 24%
• Non-hospital based: 20%
• Hospital based: 52%

Slide 11

Additional Adoption Statistics

• On a physician level, a total of 45 percent of physicians in Massachusetts had EHRs.
• Among practices with EHRs, more than half (53 percent) reported having EHRs in their practice for more than 3 years.

Slide 12

Barriers to Health Information Technology (HIT) Adoption or Expansion

The table shows the results for "EHR Adopters (%)"; "EHR Non-Adopters (%)"; "Adjusted Odds Ratio"; and "95% CI" for the following:

• Lack of time to acquire knowledge about systems.
• Physician skepticism.
• Lack of computer skills.
• Lack of technical support.
• Lack of uniform standards.
• Technical limitations of systems.
• Start-up financial costs.
• Ongoing financial costs.
• Loss of productivity.
• Privacy or security concerns.

Slide 13

Implementation—Future Plans

The pie chart shows:

• Within the next 12 months: 13%
• Within the next 1-2 years: 24%
• Within 3-5 years: 11%
• Not in the foreseeable future: 52%

Slide 14

The bar graph measures the "Percent of Practices with EHRs that Have Each Functionality" and breaks that down into most or all of the time; some of the time; and none of the time.

• E-prescribing transmittal: 45%
  • Largest percent: Most or all of the time: 20%
• Lab order entry: 47%
  • Largest percent: Most or all of the time: 24%
• Alerts, warnings, reminders: 52%
  • Largest percent: Non of the time : 20%
• Radiology order entry: 53%
  • Largest percent: Most or all of the time: 26%
• Clinical messaging: 61%
  • Largest percent: Most or all of the time: 27%
• Problem lists: 71%
  • Largest percent: Most or all of the time: 41%
• Medication lists: 76%
  • Largest percent: Most or all of the time: 51%
• Radiology test results: 76%
  • Largest percent: Most or all of the time: 56%
• Visit notes: 84%
  • Largest percent: Most or all of the time: 60%
• Lab test results: 85%
  • Largest percent: Most or all of the time: 61%

Slide 15

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.

Slide 16

• 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.
  • 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).

Slide 17

Available EHR Functions, 2005—2007

The table shows the results for "2005: N=387" and "2007: N=562" for each function.

• Laboratory test results: 85%; 86%
• Laboratory order entry: 47%; 51%
• Radiology test results: 76%; 78%
• Radiology order entry: 54%; 54%
• Electronic visit notes: 84%; 87%
• Alerts and reminders: 53%; 56%
• Electronic medication lists: 75%; 81%
• Electronic problem list: 71%; 76%
• Electronic transcription of Rx: 45%; 70%
• Electronic referrals: 62%; 63%

Slide 18

Usage* of EHR Functions, 2005—2007

The table shows the results for "2005" and "2007" for each function.

• Laboratory test results: 72%; 77%
• Laboratory order entry: 52%; 64%
• Radiology test results: 74%; 81%
• Radiology order entry: 48%; 69%
• Electronic visit notes: 71%; 89%
• Alerts and reminders: 31%; 40%
• Electronic medication lists: 67%; 79%
• Electronic problem list: 58%; 72%
• Electronic transcription of Rx: 45%; 67%
• Electronic referrals: 43%; 50%

• Note: *Most or all the time.

Slide 19

2007 Massachusetts Survey Summary

• 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 and decision support).

Slide 20

Conclusions

• Adoption is increasing, and adoption rate in Massachusetts are much higher than in rest of nation.
• Use of key functions often lags behind.
  • Probably need to use features to get many of desired benefits.
• Need to target both adoption and then use of key functions.
  • Easy to get stuck.