Recent Trends in Adoption and Use of IT in Physician Practices

1. Recent Trends in Adoption and Use of IT in Physician Practices Presentation to Washington State Health Information Infrastructure Advisory Board, July 29, 2008

3. Findings Drawn From Selected HSC IT Studies Tracking IT adoption in local communities (RWJF) Community Track Study (CTS) site visits 12/04-7/05 Largest practices (20+ physicians) and hospitals Hospital strategies to support physician practices purchasing EMRs Physician experiences with IT Implementing e-prescribing (AHRQ) Using EMRs for quality reporting and improvement (RWJF) Using EMRs for care coordination (Commonwealth) HIE developments via CTS site visits (RWJF) and study of four local HIEs (AHRQ)

4. Presentation Outline Clinical IT in physician practices Trends in adoption Barriers to implementation Clinical data sharing across patient care settings (HIE) Trends in adoption Barriers to implementation Gap between IT vision and reality

5. CTS Site Visit Communities

6. Physician EMR Adoption Appears to be uptick in adoption among larger PCP and specialty practices between CTS site visits in 2005 and 2007 Consistent with national trend for all practices (NAMCES) Unknown if adoption gap between smaller and larger practices is growing NAMCES and prior HSC survey research show growing gap

9. Physician IT Adoption Many practices that had lagged in adoption implemented EMRs between 2005 and 2007 or were actively engaged in selecting vendors Hospitals actively buying EMRS for owned practices now that hospital IT implementation is farther along

10. Factors Driving IT Adoption Among Larger Practices Anticipation of implementation of P4P by Medicare and private health plans Competition in recruiting new physicians, especially in markets with large integrated delivery systems with EMRs Hospital strategies affecting adoption rates Clinical implementation of IT in hospitals, where successful, may be increasing some physicians� comfort with IT In Boston, hospitals are using network participation and health plan contracts to drive IT adoption Hospitals rolling out or planning to provide support to physicians purchasing EMRs as allowed under recent Stark exception/Anti-kickback Statute safe harbor

11. Hospital Strategies to Support Physician EMR Purchases About half of 24 hospitals interviewed were considering subsidies, while others were limiting offer to extending hospital EMR vendor discount and/or providing technical support Hospital interest in improving care delivery while increasing physician alignment Physician demand is NOT a major motivation in most markets Strategies for enhancing clinical data exchange vary substantially Overall impact on adoption rates likely to be small Hospitals offering subsidies are starting with small-scale roll outs Most hospitals unlikely to implement before 2009; regulatory sunset is 2013 Physician take-up uncertain Challenges to IT Implementation in Physician Practices Implementation and ongoing maintenance takes substantial time and resources even by large, sophisticated practices Driven by: EMR products and other technological barriers How practices implement the systems How individual physicians and other caregivers use them to deliver care Substantial barriers external to the practice

12. Barriers to HIT Implementation External to Physician Practices Electronic prescribing Implementing EDI with pharmacies Accessing medication history Identifying formulary data Use of EMRs for quality reporting and improvement Hard to get data in (often need from outside practice) Hard to get data out for internal and external quality reports and analysis Difficulties using data to automate quality improvement activities Care coordination Selective efforts/work-arounds to address lack of interoperability with most important data sources

13. Clinical Data Sharing Among Affiliated Providers Growing Widespread technical and competitive barriers to data sharing continue to exist within and across affiliated and unaffiliated organizations Many examples of how affiliated providers are creating work-arounds to share data Yet also many examples where physicians do not access electronic data when available Data sources are proliferating but it is unclear that physicians are using sources

14. Community-Wide Clinical Data Sharing Lags Substantially In most CTS sites, progress is slow Providers and health plans report �no business case� Physician demand limited Small number of grant-funded projects underway In existing HIEs: Patients and their data continue to be viewed as key competitive assets by providers and health plans, impeding willingness to contribute data Some HIEs have found success in starting with clinical messaging Not clear extent to which physicians rely on HIEs for data Because these HIEs are designed to meet requirements of data providers, challenging to move to clinical data repository necessary to support aggregated patient records, population health improvement, quality reporting, P4P, etc.

15. Large Gap between IT Vision and Reality in the Field Larger, better-off organizations more likely to respond to competitive and policy drivers Smaller physician practices are in more need of support Even if physicians adopt EMRs, implementation barriers decrease probability of achieving desired outcomes To date, physician demand for existing sources of electronic data limited, with exception of lab data Question data accuracy Process for accessing data must be incorporated into work flow Important role for policy makers in mitigating implementation challenges

16. HSC IT Studies Publications available at www.hschange.org Go to �Hot Issues� and click on �Health Information Technology� Or email me at: JGrossman AT hschange DOT org

17. Hospital Clinical IT Adoption In CTS sites, most hospitals have or are implementing advanced clinical IT Multi-year process - within a hospital across departments, across system hospitals Most hospitals have basic systems, PACs, and at a minimum, historical chart is made electronic post discharge Now are working on: Enterprise-wide integration of multiple legacy systems with single sign on and view or system replacement MMAR Clinical documentation - nursing, then others, then doctors last CPOE