1. 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 June 17, 2010 Public Health and Health Policy Muskie School, USM 1

2. Overview Project Background –Purpose and Timeframe(s) –Strengths & Limitations Survey Methods –Ambulatory Practices –Dental Practices –Acute Care Hospitals 2

3. Overview Results to Date –Report follows outline for “as is” assessment –Frequencies for each survey provide additional detail (Appendixes A – C) –Analysis compares data to criteria outlined in draft rule Discussion –Determine any necessary additional analyses for SMHP (e.g. estimated # of eligible professionals, analysis by adoption) –Determine next steps for additional follow-up to increase survey participation among groups surveyed –Discuss next steps to set approach for next phase of work of interest to OSC and OMS 3

4. Project Background 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. 4

5. Project Background AprilMayJuneJulyAugust Ambulatory Practice Survey Survey Development Survey Launch Follow-Up Data Cleaning And Analysis Hospital Survey Survey Development Survey Launch Follow-Up Data Cleaning And Analysis Dental Practice Survey Survey Development Survey Launch Follow-Up Data Cleaning And Analysis Reporting Initial Frequencies Populated SMHP Outline Data Cleaning and Analysis Analysis to OMS/OSC Draft Report Deliver to OMS/OSC Scope Data Collection for Statewide HIT Project Review existing Information Meet with Key Stakeholders Outline Scope and Methods 5

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

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 - 538 7

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 8

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 9

10. Results to Date Overall HIT Adoption among Maine Providers 10

11. Results to Date Ambulatory Practice Survey 11

12. Results to Date Ambulatory Practice Survey 12

13. Results to Date Ambulatory Practice Survey Among 418 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 practices use CCHIT certified systems –70% reported completing installation in 2008 or earlier –26% reported completing installation more recently (2009 or 2010) 13

14. Results to Date Ambulatory Practice Survey EHR Adoption by Practice Size – 68% of 102 large practices (6 or more providers) – 60% of 124 medium size practices (3 to 5 providers) – 32% of 180 small practices (1 or 2 providers) 14

15. Results to Date Ambulatory Practice Survey EHR Adoption by Practice Type –38% of 190 specialty practices – 60% of 215 primary care practices –Note: Multi-specialty groups are included with specialists and may include primary care providers 15

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

17. Results to Date Ambulatory 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 17

18. Results to Date Ambulatory Practices Meaningful Use RequirementCriteria for Eligible Professionals Status among respondents with EHR CPOE80 percent of all orders69% meet criteria Drug-drug, drug allergy, drug formulary checkingAll capabilities enabled 35% drug-drug 34% Drug-allergy Formulary 18% (at point of prescribing) Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems 84% meet criteria Generate and transmit e-Rx At least 75 percent permissible Rx transmitted electronically 60% meet criteria Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none. 89 % meet criteria for medications 92% meet criteria for allergies Record demographics 80 percent of patients seen have gender, race, DOB, ethnicity, preferred language, insurance recorded. Age, DDOB, Gender 97% meet Race 57% meet Ethnicity 48% meet Lang. 46% meet Insurance 95% meet Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20 BP-83% meet BMI-63% meet Chart growth-57% Record smoking status80 percent of patients over 13 seen62% meet criteria (tobacco use) Incorporate test results into EHR 50 percent of results expressed as a number or positive/negative. Generate at least one report 74% meet criteria Generate list of patients with specific conditionsGenerate at least one report88% meet criteria 18

19. Results to Date Ambulatory Practice Survey Meaningful Use RequirementCriteria for Eligible Professionals Status among respondents with EHR Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically 55% using EHR 17% using EHR and paper chart Send reminders for preventive/follow-up care Send reminders for preventive/follow-up care to 50 percent of patients age 50+ 51% meet criteria 14% send reminders, but for fewer than 50% Check insurance eligibility Check eligibility electronically for 80 percent patients seen 39% meet criteria (30% check for fewer than 80% of patients) Submit claims electronicallyFile 80 percent of claims electronically84% meet criteria Provide patients with their health information on request 80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies 29% usually provide within 48 hours of request (electronic copy) 59% do not have or do not know if they have this capability. Provide access to clinical summaries Clinical summaries provided for 80 percent of office visits 28% meet 19% provide for fewer than 80% of visits Provide timely access to new results 10 percent of all patients seen receive access to lab results, problem list, medication and allergy lists within 96 hours of provider receipt 9% meet (electronic access) Exchange meaningful clinical information with care team One test of capability to exchange key clinical information A small percentage of practices routinely exchange electronic data with other providers, hospitals and other care settings Perform medication reconciliation Provide at least 80 percent of encounters and care transitions 46% meet criteria (17% for fewer than 80% of encounters and transitions; 37% do not or are not sure) Provide summary record at transitions in care and referrals Provide at least 80 percent of encounters and care transitions in care and referral 43% meet criteria (6% for fewer than 80% of transitions or referrals; 51% do not or are not sure) Information to immunization registries submitted electronically Capability to submit data to immunization registries and submission where required and accepted (Stage 1-at least one test of electronic submission capability) 4% report sending electronic data to immunization registries electronically 19

20. Results to Date Ambulatory Practice Survey Intent to Apply for Incentives 35% Not Sure 14% Not Applying 36% Applying for Both (Medicaid and Medicare) 7% Applying for Medicaid only 20

21. Results to Date Ambulatory 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 1-2 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 67% cite cost as a significant barrier 45% cite cost to maintain as a significant barrier 21

22. Results to Date Dental Practice Survey 22

23. Results to Date Dental 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 23

24. Results to Date Hospital Survey 24

25. Results to Date Hospital 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) 25

26. Results to Date Hospital 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% 26

27. Results to Date Hospital Survey Meaningful Use RequirementCriteria for Eligible Professionals Status among respondents with EHR CPOE10 percent of all orders Lab orders – 70% meet criteria Radiology – 70% meet criteria Medications– 66% meet criteria Consultation–39% meet criteria Nursing – 76% meet criteria Drug-drug, drug allergy, drug formulary checkingAll capabilities enabled 47% drug-drug 47% Drug-allergy Formulary 20% (at point of prescribing) Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none 86 % meet criteria for medications 92% meet criteria for allergies Record demographics 80 percent of patients admitted have gender, race, DOB, ethnicity, preferred language, insurance recorded, and cause of death recorded Name address contact info. 100% meet Gender and DOB 100% meet Race and ethnicity 86% meet Preferred language 81%meet Insurance 100% meet Cause of death 56% meet Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20 Height, weight, BP - 82% meet criteria Calculate display BMI - 68% meet criteria Growth chart - 43% meet criteria Incorporate test results into EHR50 percent of results expressed as a number or positive/negative Of respondents with EHR providing data: Lab. Reports – 100% meet criteria Radiology reports– 100% meet Radiology images – 100% meet Diagnostic test results – 77% Diagnostic test images – 32% 27

28. Results to Date Hospital Survey Meaningful Use RequirementCriteria for Eligible ProfessionalsStatus among respondents with EHR Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically To outside Organization 15% using EHR only 74% using EHR and paper chart To Public health agencies 63% (electronically submit) Check insurance eligibility Check eligibility electronically for 80 percent patients admitted 79% meet criteria 7% check, but for <80% Submit claims electronicallyFile 80 percent of claims electronically96% meet criteria Provide patients with their health information on request 80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies, discharge summary, procedures 18% meet criteria 25% provide information but to <80% 57% Do not provide patients (does your current system provide electronic copy?) Provide patients with discharge information 80 percent of patients who request it, receive electronic copy of discharge instructionsMedication list – 82% meet Exchange meaningful clinical information with care team One test of capability to exchange key clinical information (cannot share EHR) 96% (EHR not specified) Perform medication reconciliation Provide at least 80 percent of encounters and care transitions Nine of the 15 hospitals reporting data on this item meet criteria Provide summary record at transitions in care and referrals Provide summary care record at 80 percent of transitions in care and referral 7% meet criteria 18% provide, but for less than 80% percent of transitions/referrals 28

29. Results to Date Hospital 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 hospitals), 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). 29

30. Discussion –Determine any necessary additional analyses for SMHP (e.g. estimated # of eligible professionals, analysis by adoption) –Determine next steps for additional follow-up to increase survey participation among groups surveyed –Discuss next steps to set approach for next phase of work for of interest to OSC and OMS –Other discussion topics?????? 30

31. Questions? 31