Health Information Technology Adoption & Use John K. Iglehart Founding Editor

Health Affairs thanks for its ongoing support of the journal as well as today’s briefing

Keynote Farzad Mostashari, M.D., Sc.M. National Coordinator for Health IT, US Department of Health And Human Services

Meaningful Use: Where Are We Now? Michael W. Painter, J.D., M.D. Senior Program Officer Robert Wood Johnson Foundation

Adoption of Electronic Health Records Grows Rapidly But Fewer Than Half of US Hospitals Had At Least a Basic System in 2012 Catherine M. DesRoches, Ph.D. Senior Survey Researcher Mathematica Policy Research

Methodology 2012 health IT supplement to the AHA’s annual survey. Field period: October 2012 – January Analytic sample: 2,796 general, acute care hospitals. Measures: basic and comprehensive EHR, stage 1 MU and stage 2 MU proxies. All results are weighted to adjust for non- response bias.

Changes In Adoption Of Basic And Comprehensive EHR DesRoches CM, Charles D, Furukawa MF, et al. (2013) Adoption of Electronic Health Records Grows Rapidly, But Fewer Than Half of US Hospitals Had At Least A Basic System in Health Aff (Millwood). 2013;32(8)

Meaningful Use 42.2% of hospital met our proxy measure of stage 1 meaningful use Hospitals meeting stage 1 – Larger hospitals – Major teaching hospitals – Private non-profit status – Located in urban areas 5.1% of hospitals met our proxy measure for meaningful use stage 2.

Conclusions And Policy Implications Substantial increases in adoption over prior years. – Tremendous amount of activity across all subgroups, although some still lag behind. Challenges remain. – Fewer than half of hospitals met stage 1 proxy. – Small proportion could meet core criteria for stage 2.

Continued Effort Is Needed In The Following Areas: Small and rural hospitals – Both revenue and workforce challenges Patient access to records Electronic data exchange – Among hospitals and providers – Public health functions Hospitals that appear to be moving more slowly

Office-based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health Records Chun-Ju Hsiao, Ph.D., M.H.S. Ashish K. Jha, M.D., M.P.H Jennifer King, Ph.D. Vaishali Patel, Ph.D. Michael F. Furukawa, Ph.D. Farzad Mostashari, M.D., Sc.M. We would like to thank the Office of the National Coordinator for Health Information Technology for funding the National Ambulatory Medical Care Survey - Electronic Health Records Survey. Dr. Jha was funded by RWJF. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, or the Office of the National Coordinator.

Policy Context And Purpose Substantial resources made available through HITECH have been devoted to helping providers achieve meaningful use of EHR systems. To assess who is using the systems and how their adoption has evolved To examine adoption and routine use of specific capabilities related to a Basic EHR system and meaningful-use criteria

Data And Methods National Ambulatory Medical Care Survey (NAMCS) - Electronic Health Records Survey of office-based physicians Measuring EHR adoption Measuring routine use

Analysis Descriptive analysis examining the change in the use of any type of EHR system and the adoption of a Basic system between 2010 and 2012 – Multivariate analysis assessing characteristics associated with the adoption of a Basic EHR system Descriptive analysis examining trends in adoption of capabilities required for a Basic EHR system and selected stage 1 core criteria for meaningful use Descriptive analysis examining whether physicians routinely used capabilities related to stage 1 core criteria for meaningful use and a Basic EHR system – Multivariate analysis assessing characteristics associated with routine use

Office-based Physician’s Adoption Of EHR Systems,

Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012 Basic EHR adoption rate (adjusted percent) Change in Basic EHR adoption rate Absolute change (percentage point) Relative change (percent) Age < years years ≥65 years16.5 ** Practice size (number of physicians) ** 36.6 ** ** 44.0 ** ≥ ** 57.7 ** **p<0.01

Adoption Of Basic EHR Systems, By Physician Characteristics, 2010 And 2012 **p<0.01 Basic EHR adoption rate (adjusted percent) Change in Basic EHR adoption rate Absolute change (percentage point) Relative change (percent) Practice ownership Physician/physician group Hospital/academic medical center ** HMO/other health care organization39.8 ** 58.4 ** Community health center13.5 ** Other/unknown Metropolitan status Large central metropolitan Large fringe metropolitan Medium metropolitan Small metropolitan or non- metropolitan30.8 ** 43.5 **

Adoption Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2010 And 2012 MU Stage 1 Core 2010Change Basic EHR

Adoption And Routine Use Of Capabilities Related To Selected Stage 1 Core Criteria For Meaningful Use And Basic EHR Systems, 2012

Conclusions Findings are consistent with the proposed positive effect of incentives and technical assistance on physicians’ adoption and use of health information technology (IT) Key areas for continued policy focus include monitoring trends in physicians’ use of IT and whether gaps between physicians persist Rapid growth in the IT infrastructure may create a platform for delivery of high-quality, efficient care

Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains Julia Adler-Milstein, PhD David W. Bates, MD MSc Ashish K. Jha, MD MPH

Policy Context Health information exchange is critical to a well- functioning health care system. Electronic sharing of data between providers can lead to better care coordination, greater efficiency Prior to HITECH, growth in HIE was slow HITECH provided funding as well as non-financial incentives to increase HIE

Current Study National census of HIE efforts to answer: 1.How many HIE efforts are there? Has it changed over time? 2.Who is participating? What are they sharing? A.Can they support key elements of stage 1 Meaningful Use? 3.What are the primary barriers to long term viability of these entities?

Key Findings Substantial growth in the number of operational HIEs – 119 efforts in 2012 (up from 75 in 2010) Substantial growth in the number of participating hospitals and ambulatory practices – Hospitals: 14%  30% – Ambulatory Practices: 3%  10% Broad geographic coverage – 67% of hospitals service areas had an HIE effort that enabled providers to meet stage 1 meaningful use

Broad Array Of Barriers Continue To Be Reported – Financial barriers are the most pressing

Strong Start On A Long Path Ashish K. Jha, M.D., M.P.H. Harvard School of Public Health July 2013

Why HITECH? U.S. Healthcare “system” still a mess – High cost, disappointing quality Paper-based records a contributor – Lead to lots of errors, waste EHR adoption was low, moving slow The largest payer intervened

What Happened? Well-crafted, strong incentives work EHR adoption slow moving Incentives kicked in 2011 – Adoption has taken off – Doctors, hospitals embracing technology – Nearly half way there With a lot of progress in the pipeline

Health Information Exchange Progress slower Exchange remains in its infancy – Lots of challenges – Mostly not about technology Business model for HIE a challenge

Intermission: Unfinished Business What happens in the second half of the play? – Will things continue to move quickly? – Will some providers just not make it? How do we bring others on board? – Nursing homes, rehab facilities, etc.? – Major problem if they remain left out

Unfinished Business How do we use technology more effectively? – What can we do to improve quality, efficiency? – How do we ensure safe implementation? Integration with health reform efforts – ACOs, Bundled Payments, etc. – Quality measurement

Getting Health IT Right Is Essential Infrastructure for payment, delivery reform HITECH is having a big effect Our work is just getting started

Acknowledgements RWJF NCHS, AHA, ONC as great partners Health Affairs

Health Affairs thanks for its ongoing support of the journal as well as today’s briefing