RecentTrendsinAdoptionandUseofITinPhysicianPractices

1、Recent Trends in Adoption and Use of IT in Physician PracticesPresentation to Washington State Health Information Infrastructure Advisory Board, July 29, 2008Joy M. Grossman, Ph.D.HSCNon-partisan policy research organizationFunded principally by The Robert Wood Johnson FoundationTracking health syst

2、em change in local communities and nationallyActively monitoring HIT adoption and useFindings Drawn From Selected HSC IT StudiesTracking IT adoption in local communities (RWJF)Community Track Study (CTS) site visits 12/04-7/05Largest practices (20+ physicians) and hospitals Hospital strategies to su

3、pport physician practices purchasing EMRsPhysician experiences with ITImplementing 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)Presentation Out

4、lineClinical IT in physician practicesTrends in adoption Barriers to implementationClinical data sharing across patient care settings (HIE)Trends in adoption Barriers to implementationGap between IT vision and realityCTS Site Visit CommunitiesPhoenix, AZOrange County, CALittle Rock, ARMiami, FLGreen

5、ville, SCIndianapolis, INLansing, MINorthern NJSyracuse, NYCleveland, OHBoston, MASeattle, WAPhysician EMR Adoption Appears to be uptick in adoption among larger PCP and specialty practices between CTS site visits in 2005 and 2007Consistent with national trend for all practices (NAMCES)Unknown if ad

6、option gap between smaller and larger practices is growing NAMCES and prior HSC survey research show growing gap Physician IT AdoptionMany practices that had lagged in adoption implemented EMRs between 2005 and 2007 or were actively engaged in selecting vendorsHospitals actively buying EMRS for owne

7、d practices now that hospital IT implementation is farther along Factors Driving IT Adoption Among Larger PracticesAnticipation of implementation of P4P by Medicare and private health plansCompetition in recruiting new physicians, especially in markets with large integrated delivery systems with EMR

8、sHospital 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 provi

9、de support to physicians purchasing EMRs as allowed under recent Stark exception/Anti-kickback Statute safe harborHospital Strategies to Support Physician EMR PurchasesAbout half of 24 hospitals interviewed were considering subsidies, while others were limiting offer to extending hospital EMR vendor

10、 discount and/or providing technical support Hospital interest in improving care delivery while increasing physician alignmentPhysician demand is NOT a major motivation in most marketsStrategies for enhancing clinical data exchange vary substantiallyOverall impact on adoption rates likely to be smal

11、lHospitals offering subsidies are starting with small-scale roll outsMost hospitals unlikely to implement before 2009; regulatory sunset is 2013Physician take-up uncertain Challenges to IT Implementation in Physician PracticesImplementation and ongoing maintenance takes substantial time and resource

12、s even by large, sophisticated practicesDriven by:EMR products and other technological barriersHow practices implement the systemsHow individual physicians and other caregivers use them to deliver careSubstantial barriers external to the practiceBarriers to HIT Implementation External to Physician P

13、racticesElectronic prescribingImplementing EDI with pharmaciesAccessing medication historyIdentifying formulary dataUse 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 analysisDiff

14、iculties using data to automate quality improvement activities Care coordinationSelective efforts/work-arounds to address lack of interoperability with most important data sourcesClinical Data Sharing Among Affiliated Providers GrowingWidespread technical and competitive barriers to data sharing con

15、tinue to exist within and across affiliated and unaffiliated organizationsMany examples of how affiliated providers are creating work-arounds to share dataYet also many examples where physicians do not access electronic data when availableData sources are proliferating but it is unclear that physici

16、ans are using sourcesCommunity-Wide Clinical Data Sharing Lags SubstantiallyIn most CTS sites, progress is slowProviders and health plans report “no business case” Physician demand limitedSmall number of grant-funded projects underwayIn existing HIEs:Patients and their data continue to be viewed as

17、key competitive assets by providers and health plans, impeding willingness to contribute dataSome HIEs have found success in starting with clinical messagingNot clear extent to which physicians rely on HIEs for dataBecause these HIEs are designed to meet requirements of data providers, challenging t

18、o move to clinical data repository necessary to support aggregated patient records, population health improvement, quality reporting, P4P, etc.Large Gap between IT Vision and Reality in the FieldLarger, better-off organizations more likely to respond to competitive and policy driversSmaller physicia

19、n practices are in more need of supportEven if physicians adopt EMRs, implementation barriers decrease probability of achieving desired outcomesTo date, physician demand for existing sources of electronic data limited, with exception of lab dataQuestion data accuracyProcess for accessing data must be incorporated into work flowImportant role for policy makers in mitigating implementation chall