1. - 0 - September 2007 AHRQ Annual Meeting Opportunities and Challenges for Implementing HIT Steven R. Simon, MD, MPH August 2007 Supported by a grant from the US Agency for Healthcare Research and Quality (AHRQ)

2. - 1 - September 2007 AHRQ Annual Meeting Prologue Widespread (universal?) EHR adoption by 2014 Has adoption reached tipping point? Do EHRs improve quality of care? How are physicians using EHRs?

3. - 2 - September 2007 AHRQ Annual Meeting Outline Massachusetts e-Health Collaborative Statewide survey of physicians, 2007

4. - 3 - September 2007 AHRQ Annual Meeting Massachusetts e-Health Collaborative (MAeHC) Formed in 2004 Major health care stakeholders $50 million from Blue Cross Blue Shield of MA Statewide EHR adoption Demonstration project: Universal EHR adoption in 3 communities Intra-community (and, ultimately, inter- community) data exchange

5. - 4 - September 2007 AHRQ Annual Meeting Pilot Timeline Overview Activities20042005200620072008 ACP-MA summit MAeHC launch Community RFA launch Pilot communities announced EHR vendor RFP EHR vendor finalization Community EHR implementation Intra-community connectivity Evaluation Formal Pilot completion

6. - 5 - September 2007 AHRQ Annual Meeting PHYSICIANS “GOING LIVE”, BY COMMUNITY # MDs 20062007 North Adams (55) Newburyport (81) Brockton (305) 97519213325242743519881771441

7. - 6 - September 2007 AHRQ Annual Meeting HEALTH INFORMATION EXCHANGE Northern Berkshire Example Patient recruitment Health data exchange Referrals mgmtPatient portal

8. - 7 - September 2007 AHRQ Annual Meeting State of the State: Physician Survey

9. - 8 - September 2007 AHRQ Annual Meeting Massachusetts Physician Survey Stratified random sample of practices (N=1884) Randomly sampled one physician per practice. 2005: 1345 respondents (71%) EHR Adoption: 23% of practices, 45% of physicians EHR Usage: wide variability in available functions and reported usage.

10. - 9 - September 2007 AHRQ Annual Meeting 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***

11. - 10 - September 2007 AHRQ Annual Meeting Characteristics of Respondents with EHRs (N=562, >60% of sample) Female37% 20+ Years Since Med School39% 10+ Years with Practice22% Primary Care16% 7+ Physicians in Office44% Practice Ownership32% Teaching (Students/Residents)65% Number of Patients/Week (median)60 Incentives for HIT Adoption35% Incentives for HIT Usage28%

12. - 11 - September 2007 AHRQ Annual Meeting 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)

13. - 12 - September 2007 AHRQ Annual Meeting Available EHR Functions, 2005 - 2007 20052007 Function(N=387)(N=562) Laboratory test results85%86% Laboratory order entry47%51% Radiology test results76%78% Radiology order entry54% Electronic visit notes84%87% Alerts and reminders53%56% Electronic medication lists75%81% Electronic problem list71%76% Electronic transcription of Rx45%70% Electronic referrals62%63%

14. - 13 - September 2007 AHRQ Annual Meeting Usage* of EHR Functions, 2005 - 2007 Function20052007 Laboratory test results72%77% Laboratory order entry52%64% ▲ Radiology test results74%81% Radiology order entry48%69% ▲ Electronic visit notes71%89% ▲ Alerts and reminders31%40% Electronic medication lists67%79% ▲ Electronic problem list58%72% ▲ Electronic transcription of Rx45%67% ▲ Electronic referrals43%50% *Most or all the time

15. - 14 - September 2007 AHRQ Annual Meeting 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, e-Rx, and decision support)

16. - 15 - September 2007 AHRQ Annual Meeting Questions?

17. - 16 - September 2007 AHRQ Annual Meeting

18. - 17 - September 2007 AHRQ Annual Meeting EHR SELECTION Preferred Vendors Selection Community down-select EHR RFP distributed in May, 2005 Over 30 responses received Vendor Selection Committee validated 7 vendors to go forward Community Steering Committees down-select to smaller number for individual physician choice in each community 3 or 4 in each community Initial vendor fairs completed in each community and down-select complete Physician choice Individual physician vendor fairs Each community developing different model of physician choice