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October 14, 2010

Public Health and Health Policy. Muskie School, USM. Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State Coordinator for HIT. Project Team: Andy Coburn Cathy McGuire Martha Elbaum Williamson Al Leighton Deb Thayer

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October 14, 2010

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  1. Public Health and Health Policy Muskie School, USM Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State Coordinator for HIT Project Team: Andy Coburn Cathy McGuire Martha Elbaum Williamson Al Leighton Deb Thayer Stuart Bratesman October 14, 2010

  2. Overview • Presentation Objectives • Discuss purpose and background of the provider survey project • Describe findings from surveys • Discussion • Needed for state HIT planning efforts • Discuss areas of interest to OSC Steering Committee and OMS • Discuss interest in HIT status of other sectors (non-incented)

  3. Overview • Project Background • Purpose and Timeframe(s) • Limitations • Survey Methods • Ambulatory Practices • Dental Practices • Acute Care Hospitals

  4. ProjectBackground Purpose • To develop data collection instruments, administer them, and analyze resulting data to inform an “as is” environmental assessment of the status of HIT among providers who are potentially eligible for incentive payments for HIT adoption and use. • To develop data collection instruments, administer them, and analyze the resulting data to inform statewide HIT efforts being led by Maine’s Office of the State Coordinator for HIT.

  5. ProjectBackground

  6. Survey Methods Overall • Develop Survey Tools - Domains • Develop Survey Samples • Develop Methods Limitations • Timeframe (web-based survey) • Available Contact Information • Lack of Provider-to-Site-to-Organization Mapping • Instrument reflects current understanding of draft rules

  7. Survey Methods Ambulatory Practices • Response rate – 41 percent • Denominator/Population • Practice lists compiled from several sources • 1546 practices included in lists • 155 duplicates identified • 65 found to be ineligible (as practices) • 15 practices on list had closed • 1311 remaining practices in denominator • Practices responding - 543

  8. Survey Methods Dental Practices • Response rate – 34 percent • Denominator/Population • Practice lists compiled from OMS • 220 practices on list and used as denominator • Practices responding - 75

  9. Survey Methods Acute Care Hospitals • Response rate – 75 percent • Denominator/Population • Practice lists compiled from OMS • 40 hospitals on list used as denominator • Hospitals responding – 30

  10. Figure 1: HIT Adoption-Acute Care Hospitals, Ambulatory Practices, and Dental Practice Sites Results to DateOverall

  11. Results to DateAmbulatory Practice Survey Ambulatory Practices, by Practice Type

  12. Results to DateAmbulatory Practice Survey

  13. Results to DateAmbulatory Practice Survey • Among 407 non-hospital based practices responding • 46% Do not have an EHR • 4% Have purchased or begun installation • 6% Installed in some areas • 44% Installed and in use in all or nearly all areas • Practices with EHR • Most of these practices use CCHIT certified systems • 70% reported completing installation in 2008 or earlier • 26% reported completing installation more recently (2009 or 2010)

  14. Results to DateAmbulatory Practice Survey • EHR Adoption by Practice Size • 61% of 96 large practices (6 or more providers) • 50% of 120 medium size practices (3 to 5 providers) • 27% of 180 small practices (1 or 2 providers)

  15. Results to DateAmbulatory Practice Survey EHR Adoption by Practice Type • 31% of 190 specialty practices • 52% of 215 primary care practices Note: Multi-specialty groups are included with specialists and may include primary care providers

  16. Results to DateAmbulatory Practice Survey • EHR adoption ranges from 13% of 8 responding practices in Piscataquis County to 82% of 11 responding practices in Lincoln County

  17. Results to DateAmbulatory Practice Survey Practices with EHRs • Practices reported using their EHR systems for a variety of purposes: • Order entry(82% have CPOE systems/modules) • Decision support during patient encounter (a majority or near majority use the EHR routinely for a number of clinical decision supports) • File insurance claims

  18. Results to DateAmbulatory Practices

  19. Results to DateAmbulatory Practice Survey

  20. Results to DateAmbulatory Practice Survey Intent to Apply for Incentives • 34% Not Sure • 13% Not Applying • 36% Applying for Both (Medicaid and Medicare) • 7% Applying for Medicaid only • 9% Applying for Medicare only

  21. Results to DateAmbulatory Practice Survey Practices without EHRs – Intent to Implement EHRs • 30% have no plans to implement an EHR in 1-5 years • 13% planning to implement in 4-5 years • 40% planning to implement in 1-3 years • 17% will implement within 1 year Practices without EHRs- Functional Capacities • 95% do not have CPOE (3% have, but don’t use) • 78% do not have e-Rx systems Barriers to Implementation • 66% cite cost as a significant barrier • 45% cite cost to maintain as a significant barrier

  22. Results to DateDental Practice Survey

  23. Results to DateDental Practice Survey • Respondents • 47% General Dentistry / Solo Practice • 11% Specialty Dentistry / Solo Practice • 16% General Dentistry / Group Practice • 9% Specialty Dentistry / Group Practice • 17% Community Dental Clinic • Use of Paper Charts • 20% Entirely paperless • 24% PMS/EDR is most complete source of patient information • 20% Some paper, some electronic records • 35% Primarily paper, some electronic records

  24. Results to DateHospital Survey

  25. Results to DateHospital Survey • Among 30 hospitals responding • 3% Do not have an EHR • 17% Installed in some areas • 80% Installed and in use in all or nearly all areas • Hospitals with EHR • 80% reported completing installation in 2006 or earlier • 20% reported completing installation more recently (2007 - 2009)

  26. Results to DateHospital Survey • Clinical Staff Using EHR Routinely • 3% < 25% • 3% 25-50% • 28% 51-90% • 66% >91% • Providers Using EHR Routinely • 14% < 25% • 14% 25-50% • 41% 51-90% • 31% >91%

  27. Results to DateHospital Survey

  28. Results to DateHospital Survey

  29. Results to DateHospital Survey • Year of First Medicaid Application • 40% 2011 • 40% 2012 • 4% 2013 • 16% Not Sure • Most Challenging Meaningful Use Criteria Cited: • Generate the numerator and denominator data for quality reporting directly • from EHR, Perform medication reconciliation across settings of care (12 ), • Exchange clinical information with other providers (10), • Implement CPOE at the specified level of sophistication (9), • Implement clinical decisions support rules, give patients access to their data in • electronic form (6), and • Generate problem lists using codified data sets (6).

  30. Discussion • Additional information useful for state HIT planning efforts • Topics of interest to OSC Steering Committee and OMS • Discuss interest in HIT status of other sectors (non-incented) • Additional Topics

  31. Questions?

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