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David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare

Electronic Health Record Adoption and Implementation: A Report from the Massachusetts eHealth Collaborative. David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare Chief, Division of General Medicine, Brigham and Women’s Hospital. Overview.

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David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare

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  1. Electronic Health Record Adoption and Implementation: A Report from the Massachusetts eHealth Collaborative • David W. Bates, MD, MSc • Medical Director of Clinical and Quality Analysis, Partners Healthcare • Chief, Division of General Medicine, Brigham and Women’s Hospital

  2. Overview • Formation of the MaEHC • Adoption of EHRs in the collaborative • Statewide adoption data • Conclusions

  3. Company launched September 2004 • Non-profit registered in the State of Massachusetts • CEO on board January 2005 • Backed by broad array of 34 MA health care stakeholders MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE • Universal adoption of electronic health records • MA-SAFE • $50M commitment to heath information infrastructure • Recognition of “systems” problem

  4. THREE COMMUNITIES SELECTED FROM 35 APPLICANTS • North Adams • Newburyport • Brockton

  5. PHYSICIAN EHR SELECTIONS • Less centralized • More centralized Newburyport Brockton North Adams Community down-select Physician choice • Most decentralized approach • Individual physicians chose from down-selected vendors • Physician choice was further narrowed by community orgs • Brockton NHC • BGPMA • CGMC IPA • Brockton Hospital PHO • Chose single vendor for entire community • “Enterprise EMR” model

  6. Patient population (000) 488 43 95 350 SCOPE OF PILOT PROJECTS …in almost 200 offices. Almost 450 physicians… …who care for ~500K patients… Offices Physicians 177 65 445 25 Large Med 85 41 295 111 Specialists Small PCPs Brockton N. Adams Brockton N. Adams Brockton N. Adams Newburyport All Newburyport All Newburyport All

  7. PHYSICIANS “GOING LIVE”, BY COMMUNITY 9 7 5 19 21 33 25 24 27 43 51 9 88 1 77 1 441 # MDs North Adams (55) Newburyport (81) Brockton (305) 2006 2007

  8. 2005 Physician Survey Sampled 1829 practices (30% of state) within strata: • Primary care vs. specialty • Urban vs. rural • Large vs. small practices • Only physicians w/ambulatory practices • 8-page mail survey with $20 incentive • Overall Response Rate: 71%

  9. EHR Adoption

  10. EHR Adoption

  11. Additional Adoption Statistics On a physician level, a total of 45 percent of physicians in Massachusetts had EHRs. Among practices with EHRs, more than half (53 percent) reported having EHRs in their practice for more than 3 years.

  12. Barriers to HIT Adoption or Expansion

  13. Implementation – Future Plans Within the next 12 months (13%) Not in the foreseeable future (52%) Within the next 1-2 years (24%) Within 3-5 years (11%)

  14. 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

  15. 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) 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.

  16. Available EHR Functions, 2005 - 2007

  17. Usage* of EHR Functions, 2005 - 2007 *Most or all the time

  18. 2007 Massachusetts SurveySummary • 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 and decision support)

  19. Conclusions • Adoption is increasing, and adoption rate in Massachusetts are much higher than in rest of nation • Use of key functions often lags behind • Probably need to use features to get many of desired benefits • Need to target both adoption and then use of key functions • Easy to get stuck

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