Community Mental Health Affiliates, Inc EHR Survey Implementation

Transcription

1 Community Mental Health Affiliates, Inc EHR Survey Implementation Minakshi Tikoo, Ph.D. Director of Evaluation Biomedical Informatics Core (BMIC) Connecticut Institute for Clinical and Translational Science (CICATS) University of Connecticut Health Center Dowling South, Suite 1030 UConn Health Center 263 Farmington Avenue, MC 6233 Farmington, CT Telephone: (860) Prepared By: Minakshi Tikoo, Ph.D. Michael Hettinger Darcé Costello, Ph.D. Samantha Edgerly 0

2 Introduction Community Mental Health Affiliates Inc. (CMHA) was one of the 64 grantees that were awarded a 4-year Primary and Behavioral Health Care Integration (PBHCI) grant by Substance Abuse and Mental Health Services Administration (SAMHSA) to help demonstrate the value of integrating primary care with behavioral health services. CMHA is part of Cohort II grantees from September The primary focus of the larger 4-year grant is to demonstrate: Improved access to primary care services; Improved prevention, early identification, and intervention to reduce the incidence of serious physical illnesses, including chronic disease; Increased availability of integrated, holistic care for physical and behavioral disorders; and Better overall health status of clients. In the second year of the grant CMHA received additional $200,000 to adopt and demonstrate use of health information technology (HIT). The primary focus of the HIT supplement awarded in September 2011 were prescribed to support the following activities (A and B): A. Electronic Health Records (EHR) Development or enhancement of a certified Electronic Health Record System; and/or Development to achieving Stage 1EHR meaningful Use Specification B. Health Information Exchange (HIE) Development and implementation to participate in appropriate health information exchange (local, regional or state); and Development and implementation to use the exchange of health information to achieve improved health outcomes for patients. CMHA, Inc. implemented their electronic health record (EHR), CareLogic Survey in July To help evaluate its HIT supplement CMHA contracted with Minakshi Tikoo, PhD, Director of Evaluation, Biomedical Informatics Center (BMIC), University of Connecticut Health Center. One part of the proposed evaluation was to conduct a survey to assess the EHR Implementation process. This report focuses on the survey results for the EHR Implementation survey. Summary of Findings Background characteristics of respondents Two hundred eleven surveys were completed. Twenty surveys were set aside because the respondents did not use Care Logic. The remaining 170 surveys were analyzed for this report. More than two-thirds (68%) of the respondents were female, 18% were male, and 14% were missing information on gender. The majority of respondents were white (63%). Because of the small numbers of respondents in each of the other race categories, the remaining 37% of respondents were classified as nonwhite. More than a third (36%) of respondents were between ages 23-39; 16% were between ages 40-50; 15% were between ages 51-68; 32% were missing information on age. 1

3 Most respondents reported education levels beyond high school. Forty-six percent had graduate degrees; 26% had college degrees; 15% had some college; 2% had high school diplomas; 12% were missing information on education level. Responses to survey questions Overall, respondents viewed the EHR implementation in positive terms: o 78% felt they could handle whatever changes accompanied the EHR implementation o 76% felt the change was a good strategy for their organization o 75% believed in the value of the change o 73% felt the change served an important purpose o 71% felt the change was necessary o 66% felt the change ultimately improved their organization o 61% felt they reacted to the change as problem solvers o 59% felt they could ask questions about the change o 52% felt they handled the change with ease o 51% felt they received useful information about the change At the same time, respondents noted challenges imposed by the EHR implementation: o 68% felt they had no choice but to go along with the change o 63% felt they needed some training in order to perform their job well following the EHR implementation o 46% felt they had no control over the implementation of the change o 42% felt the change caused them stress o 41% felt they lacked opportunities to provide input into how the EHR was introduced o 35% felt the information they received prior to the EHR implementation was not adequate; 28% felt the information they received was not timely; 26% felt the information they received did not answer their questions o 32% felt pressured to go along with the change Group differences in responses to survey questions Gender Men were significantly more likely than women to disagree with the statement: I coped with this change better than most with whom I work. Women were significantly more likely than men to neither agree nor disagree with that statement. Race Whites were significantly more likely than non-whites to disagree with the statement: This particular change was beyond or organizational abilities. Age Older (ages 51-68) respondents were significantly more likely than younger respondents to agree with the statement: I received adequate information about this change prior to the implementation. Younger (ages 23-29) respondents were significantly more likely to neither agree nor disagree with that statement. Professional License Respondents with professional licenses were significantly more likely than those without professional licenses to agree with these statements: o This organizational change caused me stress. 2

4 o It was irresponsible for me to resist this change. Agency Leadership Respondents who were part of their agency s leadership team were significantly more likely than non-leadership staff to agree with these statements: o I was a leader of this change effort within the organization. o I often find myself leading change efforts in this organization. o I was able to participate in the implementation of this change. o I had opportunities to provide input into how this change was introduced. Agency Morale Respondents who rated agency morale as bad were significantly more likely than those who rated agency morale as good or fair to: o o Agree with this statement: This organizational change caused me stress. Disagree with this statement: This organizational change opened new career opportunities for me. Work Experience Respondents with the most (21-41) years of work experience were significantly more likely than those with fewer years of work experience to disagree with this statement: When this change occurred, I felt I handled it with ease. 3

5 Basic Survey Frequencies Count Percent Respondent Uses CareLogic (N = 190) Yes % No % Overall Reaction to Organizational Change (N = 170) Worked to ensure that change would fail % Took action to prevent the success of the change % Reluctantly went along with the change % Accepted the change % Became an enthusiastic supporter of the change % No Response % Minutes/Wk. Spent Entering Client Data on Paper Before Go-Live (N = 170) % % % % % % % > % No Response % Minutes/Wk. Spent Entering Client Data into Computer Before Go-Live (N = 170) % % % % % % % > % No Response % Respondents' Use of Computers at Work (N = 170) 1 Administrative 5 2.9% Administrative; Clinical % Administrative; Clinical; Other % Administrative; Clinical; Work-Related Research % Administrative; Clinical; Work-Related Research; Other % Administrative; Other % Administrative; Work-Related Research 4 2.4% Administrative; Work-Related Research; Other 4 2.4% Administrative; Clinical % Clinical % 4

6 Count Percent Clinical; Other 7 4.1% Clinical; Work-Related Research; Other 1 0.6% Work-Related Research 1 0.6% Other 7 4.1% No Response % Respondent Has Computer at Home (N = 170) Yes % No % No Response % Respondent's Use of Home Computer (N = 137 Respondents with Home Computers) 2 Banking 2 1.5% Banking; Other % Banking; Shopping 3 2.2% Banking; Shopping; Other % Shopping 2 1.5% Shopping; Other % Other % No Response 4 2.9% Respondent's Skills as a Technology User (N = 170) Expert % Moderate % Good % Fair 8 4.7% Does Not Use Technology 2 1.2% No Response % Respondent Participated in Workgroups Formed to Design and Implement EHR (N = 170) Yes % No % No Response % Respondent Received Training Before Implementation of the EHR (N = 170) Yes % No % No Response % Hours of Training Received by Respondent on EHR (N = 170) % % % % % % % % > % No Response % Respondent's Level of Anxiety About Impact of EHR on Job Performance (N = 170) 5

7 Count Percent A Lot % Somewhat % A Little % Not at All % No Response % Did Respondent Feel That EHR Implementation Was Handled Well? (N = 170) Yes % Somewhat % No % No Response % Since EHR Implementation, Does Respondent Have Better Access to Client Information? (N = 170) Yes % No % No Response % Does Respondent Feel More Productive Because Information Is Readily Available? (N = 170) Yes % No % No Response % Respondent Understands Agency's Long-Term Goals and Vision (N = 170) Yes % No % No Response % Characteristics of EHR Implementation (N = 170) More Complicated Than Expected % User-Friendly % Intuitive 8 4.7% Follows Business Process 5 2.9% Has More Bugs Than Expected % More Complicated Than Expected; Has More Bugs Than Expected % More Complicated Than Expected; User-Friendly 2 1.2% More Complicated Than Expected; Follows Business Process 1 0.6% User-Friendly; Intuitive 2 1.2% User-Friendly; Follows Business Process 6 3.5% User-Friendly; Has More Bugs Than Expected 5 2.9% Intuitive; Has More Bugs Than Expected 1 0.6% Follows Business Process; Has More Bugs Than Expected 2 1.2% More Complicated Than Expected; User-Friendly; Has More Bugs Than Expected 1 0.6% More Complicated Than Expected; Intuitive; Follows Business Process 1 0.6% More Complicated Than Expected; Follows Business Process; Has More Bugs Than Expected 1 0.6% User-Friendly; Intuitive; Follows Business Process 3 1.8% User-Friendly; Follows Business Process; Has More Bugs Than Expected 2 1.2% More Complicated Than Expected; User-Friendly; Intuitive; Follows Business Process 1 0.6% 6

8 Count Percent More Complicated Than Expected; User-Friendly; Follows Business Process; Has More Bugs Than Expected 1 0.6% No Response % During the EHR Planning Phase, Did Respondent Have Sufficient Information About EHR Progress? (N = 170) Yes % No % No Response % Years of Work Experience (N = 170) % % % % % % % % > % No Response % Years Working for CMHA (N = 170) % % % % % % % % > % No Response % Respondent Supervises Staff (N = 170) Yes % No % No Response % Number of Staff Supervised by Respondent (N = 36) % % % % % % > % No Response 3 1.8% Patients Seen During Last Full Work Week (N = 170) % 7

9 Count Percent % % % % > % No Response % Respondent's CMHA Employment Status (N = 170) Full-Time % Part-Time % No Response % Gender (N = 170) Female % Male % No Response % Highest Level of Education (N = 170) Less Than High School 0 0.0% Some High School 0 0.0% High School Diploma 3 1.8% Some College % College Degree % Graduate School % No Response % Respondent Licensed in Field in Which He/She Practices (N = 170) Yes % No % No Response % Race (N = 170) White % Black/African-American % Asian 2 1.2% White/Black 1 0.6% White/American Indian 1 0.6% No Response % Ethnicity (N = 170) Hispanic/Latino % Non-Hispanic/Latino % No Response % Age (N = 170) % % % % % % No Response % 8

10 Count Percent Minimum Age 23 Maximum Age 68 Mean Age Median Age 38 Standard Deviation of Age Mode of Age 30 Respondent Is Part of Agency Leadership (N = 170) Yes % No % No Response % Morale of Staff Working for Respondent (N = 170) 1 Better Than Other Agency Staff % Same as Other Agency Staff % Worse Than Other Agency Staff 7 4.1% No Response % Morale of Agency Staff (N = 170) Good % Fair % Bad % No Response % 9

11 Respondents Attitudes toward Organizational Change Agree Neither Disagree No Response Count Percent Count Percent Count Percent Count Percent When this change occurred, I felt I handled it with ease % % % 5 2.9% I was a leader of this change effort within the % % % 6 3.5% organization. This particular change was beyond our organizational % % % 8 4.7% abilities. This change was something to be adapted, but not % % % % embraced. I tried not to complain about this change when it % % % % occurred. This organizational change caused me stress % % % 8 4.7% This organizational change opened new career % % % % opportunities for me. This change ultimately improved my organization % % % 8 4.7% External and internal pressures presented opportunities % % 7 4.1% % to make this change. When this change was announced, I reacted as a % 51 30% 5 2.9% % problem solver, not emotionally. I often find myself leading change efforts in this % % % % organization. I coped with this change better than most of those with % % % % whom I work. I believed in the value of this change % % 4 2.4% % I had no choice but to go along with this change % % % % I felt a sense of duty to work toward this change % % 7 4.1% % The change was a good strategy for this organization % % 3 1.8% % I felt pressure to go along with this change % % % % I did not think it would be right for me to oppose this % % % % change. I thought that management was making a mistake by introducing this change % % % % 10

12 Agree Neither Disagree No Response Count Percent Count Percent Count Percent Count Percent I had too much at stake to resist this change % % 51 30% % I did not feel bad about opposing this change % % % % The change served an important purpose % % 6 3.5% % It was too costly for me to resist this change % % % % It was irresponsible of me to resist this change % % % % Things were better without this change % % % % It was risky to speak out against this change % % % % I felt guilty about opposing this change % % % % This change was not necessary % % % % Resisting this change was not a viable option for me % % % % I did not feel any obligation to support this change % % % % The information received about this change was timely % % % % I was able to ask questions about this change % % % % The information received about this change was useful % % % % Information received about this change adequately % % % % answered my questions. I was able to participate in the implementation of this % % % % change. I had some control over the implementation of this % % % % change. I received adequate information about this change prior % % % % to implementation. I had opportunities to provide input into how this % % % % change was introduced. Wherever this change takes me, I'm sure I can handle it % % 3 1.8% % I did not think I would be able to do all that the change % % % % demanded of me. I believed that I might not perform my job well % % % % following this change. I needed some training to perform my job well following this change % % % % 11

13 Respondents Use of EHR Components Uses Does Not Use Not Applicable No Response Count Percent Count Percent Count Percent Count Percent Computerized Physician Order Entry % % % % E-Prescribing 7 4.1% % 68 40% % Collection of Patients' Demographics % % % % Collection of Patients' Vital Signs % % % % Collection of Patients' Smoking Status % % % % Collection of Patients' Diagnoses % % % % Collection of Patients' Medications % % % % Collection of Patients' Allergies % % % % Generation of Continuity of Care Documents % % % % Receipt of Continuity of Care Documents % % % % Generation of Continuity of Care Records % % % % Receipt of Continuity of Care Records % % % % Impacts of EHR on Clinical Practice Positive Impact No Impact Negative Impact Not Applicable No Response Count % Count % Count % Count % Count % Clinical Decision-Making % % 7 4.1% % % Communication with Other Providers % % 1 0.6% % % Communication with Patients % % % 34 20% % Prescription Refills % % % % 17 10% Timely Access to Medical Records % % 1 0.6% % % Avoidance of Medication Errors % % 7 4.1% % % Delivery of Preventative Care That % % % % Meets Guidelines Delivery of Chronic Illness Care That Meets Guidelines % % % % 12

14 Ratings of IT Support Satisfied Neutral Dissatisfied Not Applicable No Response Count Percent Count Percent Count Percent Count Percent Count Percent Access to % % 5 2.9% 2 1.2% % Internet Connection % % 7 4.1% 3 1.8% % Being Able to Work from Remote Sites 68 40% % % % % Performance of Air Cards % % % % % 13