Sage Healthcare Insights

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1 Sage Healthcare Insights Special Report: Trends in Electronic Healthcare Records System Adoption A Survey of the Effect of Implementing an EHR System on Physicians and Their Patients

2 2 SAGE HEALTHCARE INSIGHTS SAGE HEALTHCARE INSIGHTS 3 Executive Summary Background: The adoption of electronic health records has grown in recent years as the U.S. government s incentive plans and the benefits of these systems are realized by more and more office-based physicians. The CDC s National Center for Health Statistics estimates that more than half of office-based physicians have adopted a basic EHR, while just over 10% have adopted a fully functional system such as Sage Intergy EHR. As adoption of advanced health information technologies increases, EHR systems will impact patients and physicians alike. Objectives: This study examines the effect of implementing an electronic health record system on both physicians and their patients. The purpose is to understand how the perceptions of physicians who use EHR systems differ or are similar to the perceptions of the patients who recall seeing their physician use the system. The results of the study will help Sage design solutions that maximize the benefit to physicians and their patients. Design: Two surveys were administered during a period in early December In the survey, patients were asked to recall their last visit to a doctor for treatment or evaluation. While thinking about this visit, the patient is asked if they recall seeing their physician use a computer or other electronic Methodology This report was designed to understand the similarities and differences in physicians and patient opinions of documenting care using an electronic health record during an evaluation. Since the patient and physician interaction is highly confidential, Sage Healthcare Insights used a survey instrument to ask for this personal information. For patients, the survey asked respondents to recall how their physician documented patient care during their last treatment or evaluation. Patients who recall seeing their doctor use a computer for electronic device to document patient care were asked to rate their perception of the physician s note device to take notes during the evaluation. Patients who recall seeing their doctor use an electronic device to document patient care are asked about their perception of such note taking during the office visit. The study isolated the perception of Sage physicians and other clinicians who use an EHR system to document care during a patient encounter. Results: Physicians and patients agreed on the benefits of using electronic devices to document patient care during an encounter. The most important benefits of EHR systems agreed upon by the two groups are: Gives the physician access to patients medical records and history in real time. When appropriate, helps the physician securely and seamlessly share information with other doctors, pharmacies and payers. Helps the physician make good decisions about patient care. In addition to these benefits, patients identified a separate benefit that was unique to them. Their comments suggest that they are more confident with their physician when they witness them document patient care in an electronic device. Their comments in the taking during an in-office evaluation. Openended questions allowed respondents to describe their perception and enhance the results. For physicians Sage Healthcare asked similar questions to understand their perception of documenting patient care using an electronic health records solution during a treatment or evaluation. The study was conducted online from 12/8/2010 to 12/21/2010. The survey was sent to 7,738 physicians or other clinical users of a Sage product or service. The patient survey was sent to 18,000 healthcare consumers. survey suggest that this confidence may be enhanced by verbal confirmation from the physician or clinician while they document patient care (e.g. the physician confirming allergies before entering it in the computer or electronic device.) While physicians and patient mostly agree on the benefits, the negatives of documenting patient care with an electronic device are different between the two groups. The study found that 81% of patients are concerned with the security and privacy of their medical records. A smaller proportion of Sage physicians and clinicians (62%) were concerned with security and privacy of electronic medical records. An opportunity exists for the HIT industry to educate health care consumers about the procedures in place to protect them. Physicians were mostly negative on the lack of infrastructure to support the full capability of EHR systems as well as incorporating the systems into their current workflow. Overall, most Sage physicians and patients agree that medical records stored electronically will help improve patient care. Sage physicians and other clinicians are quick to point out that EHR is just a tool to help them become better doctors. 119 Sage physician or other clinician responses 275 U.S. healthcare consumer responses Market Research Results Patients and physicians have a positive perception of using electronic devices to document patient care. About 42% of Sage physicians or other clinicians use an electronic health record solution to document patient care and about 1 in 3 Sage physicians or other clinicians use an EHR during the patient encounter. This is similar to the 47% of U.S. patients who recall their doctor or their assistant using an electronic device such as a computer or tablet to document their care. Using a scale of 1 to 7, where 1 is very negative and 7 is very positive, please rate your overall perception of using an EHR document patient care. N = 48 physicians or other clinicians who use an EHR to document patient care VERY NEGATIVE Physicians and consumers both have an overall positive perception of electronic documentation of patient care during an encounter. However, EHR-using physicians are slightly less positive than the patients who saw an EHR in use. Overall, 62% of physicians documenting patient care electronically have a positive perception of doing so while 81% of patients have a positive perception. 2% 4% 13% 19% 19% 21% 22% Using a scale of 1 to 7, where 1 is very negative and 7 is very positive, please rate your overall perception of your physician s or their nurse/assistant s note taking during your treatment. N = 115 patients who recall seeing their physician or a nurse/assistant input information into a computer or other electronic device during treatment VERY NEGATIVE 62% of EHR users have a positive perception of documenting patient care with an EHR. 0% 3% 1% 15% 12% 24% 45% Physician comments suggest that the EHR system is faster, more accurate and easier to retrieve patient records across patient care settings. However, they are aware that integrating EHR into their workflow is still a work in progress. VERY POSITIVE VERY POSITIVE 81% of patients who recall seeing their physicians or a nurse/assistant use an electronic device to input information during their treatment have a positive perception of their physician or clinician documenting patient care.

3 4 SAGE HEALTHCARE INSIGHTS SAGE HEALTHCARE INSIGHTS 5 Please rate your overall perception of documenting patient care using an EHR. (1-7 scale where 1 is very negative; 7 is very positive) Positive perception (5-7 rating) EHR is faster, more accurate, patients love it (and they have) access to information on the internet. Internal medicine physician in a doc suburban group practice; Sage Intergy User I am able to capture the HPI during the visit, so I believe it is more accurate. I am able to instantly send the prescription to the pharmacy. Overall documentation is faster, I m home earlier than when I dictated for paper charts. Pediatrician in a 6-10 doc suburban group practice; (EHR is) faster, more accurate, easier to read and share data with partners and hospital. Gynecologist in a 6-10 doc urban group practice; Negative perception (1-3 rating) The computer is distracting; it takes my attention away from the patient. Physician in a doc multispecialty urban group practice; Sage Medical Manager user The (EHR) concept is cumbersome compared to using dictation and a skilled transcriptionist. Physician in a 75+ doc suburban group practice; Patient comments suggest that seeing their physician use an electronic device to take notes during the encounter gives them confidence their record is accurate and can be accessed easily in the future. Please rate your overall perception of your care provider documenting patient care in a computer or other electronic device. (1-7 scale where 1 is very negative; 7 is very positive) Select Patient Comments: Positive perception (5-7 rating) I feel it gives them a better record of what my issues are. Female, Age 45-54, Missouri, 2-3 doctor visits past year I know they are listening to me and ask questions while they are typing so at least the notes will be in my file. Female, Age 45-54, California, 2-3 doctor visits past year They are getting what I am telling them down while the information is fresh so it will be more accurate than if they enter notes into a chart at a later date. Female, Age 55-64, California, 1 doctor visit past year I changed healthcare providers. My new provider has a digital records system that allows me and my physician to see all of my family s history on-line and in a clinical setting. This was the primary reason I changed. Male, Age 35-44, Ohio, 2-3 doctor visits past year The doctor spoke into a hand held device. I don t know whether it was a voice recorder or recorded his voice directly to my chart. I thought it clarified and reinforced our communication during the visit to hear him dictate his notes. Female, Age 55-64, Ohio, 2-3 doctor visits past year Negative perception (1-3 rating) The computer system was very slow and they had recently upgraded data and we spent more time talking about the inefficiency of using the computer instead of my health condition. Female, age 55-64, Nevada, 5 or more doctor visits past year Typing notes requires eyes on the screen or keyboard and occupies the care provider. The eyes should be on the patient! There are many tips as to how the patient/client is really doing that must be observed. Female, age 45-54, Washington, 2-3 doctor visits past year Patients and physicians agree about the most important benefits of electronic health records. Sage asked physicians and patients to choose the three most important statements that describe the benefits of electronic health records from a fixed list of potential benefits. Physicians and patients agreed that the most important benefits were related to real time access to patient medical history, helps physicians make good decisions and when appropriate allows sharing of patient data with other medical organizations. Patients vs. Physicians Concern with security and privacy of electronic health records. Patients are concerned with the privacy and security of their electronic health records. More than 4 out of 5 health care consumers said they were concerned with the security and privacy of electronic medical records. Sage physicians, while still concerned, were less concerned than patients. Only about 49% of physicians were concerned with security and privacy of electronic medical records. Using a scale of 1 to 7, where 1 is not at all concerned and 7 is very concerned, please indicated how concerned you are with the security and privacy of medical records stored electronically. N = 113 physicians or other clinicians 13% 16% 9% 13% 8% 13% 28% Using a scale of 1 to 7, where 1 is not at all concerned and 7 is very concerned, please indicated how concerned you are with the security and privacy of medical records stored electronically. N = 275 outlets NOT AT ALL CONCERNED NOT AT ALL CONCERNED Most important benefits of electronic medical records (% of times statement was among top three physician benefits) TOP 3 PHYSICIAN STATEMENTS 61% 41% 37% Gives me access to my patients medical records and history in real time. When appropriate, helps me securely and seamlessly share information with other doctors, pharmacies and payers. Helps me make good decisions about my patient s care. TOP 3 PATIENT STATEMENTS 72% 60% 54% 49% of physicians or other clinicians are concerned with the security and privacy of medical records stored electronically. 6% 6% 8% 11% 13% 11% 45% Gives my doctor access to my medical records and history in real time. When appropriate, helps my doctor securely and seamlessly share information with other doctors, pharmacies and payers. Helps my doctor make good decisions about my care. VERY CONCERNED VERY CONCERNED 81% of health care consumers are concerned with the security and privacy of medical records stored electronically. Comments by Sage physicians and other clinicians reveals why they may be less concerned with security and privacy issues. Their comments suggest that they are more aware of the security in place to protect their patients which may play a role in their overall lower concern.

4 6 SAGE HEALTHCARE INSIGHTS SAGE HEALTHCARE INSIGHTS 7 Please indicate how concerned you are with the security and privacy of medical records stored electronically? (1-7 scale where 1 is not at all concerned; 7 is very concerned) Not concerned (1-3 rating) Please indicate how concerned you are with the security and privacy of medical records stored electronically? (1-7 scale where 1 is not at all concerned; 7 is very concerned) Select Patient Comments: Concerned (5-7 rating) Will electronic health records improve patient care? Physicians and their patients mostly agree that electronic health records will help improve the quality of patient care; 62% of Sage physicians and other clinicians agreed with this statement, while 78% of patients agreed. Patients were more likely to agree than physicians about the prospects of electronic medical records to improve patient care. Only 5% of patients disagreed that electronic medical records will help improve care. Patient privacy laws... I am concerned but I also believe the risk of my records is low with the encryption in place. Pediatrician in a single doc suburban practice; Sage MedWare User I feel our EHR is intrinsically at least as secure as our paper records and never spent much time worrying about these. Physicians in a doc urban group practice; I m confident in our procedures for safeguarding them. Nurse practitioner in a single doc rural practice; Concerned (5-7 rating) It is important to be able to assure patients that their records are safe. It can be difficult with some patients because they are worried that their information may be lost and or stolen if EHR is used. With everything they hear about big corporations computers being hacked into and information stolen they don t think that they are safe. Medical assistant in urban 6-10 doc group practice; The internet, as we have seen time and time again, is not a secure place. Pts records contain not only sensitive medical information, but personal and financial data as well. No one can guarantee the security of those data. In addition, the potential for such data to be used by pharmaceutical and other companies to direct market to patients is a real possibility. Gynecology in a rural single doc practice; Sage MedWare user Patient comments suggest they are highly concerned with keeping their information secure and private. The data is personal to them, and only people who are authorized to see the data should have access. My personal information is PERSONAL. It holds all information about myself health-wise and has my social security number in them. Female, age 35-44, Rhode Island, 1 doctor visit past year It could be used to discriminate against me in terms of higher insurance premiums, refusing treatments, etc. Female, age 55-64, North Carolina, 5 or more doctor visits past year This is private information which can be misused to my detriment. Male, age 55-64, Massachusetts, 5 or more doctor visits past year Not concerned (1-3 rating) I am not overly concerned with the confidentiality of my records as I know the offices must be HIPAA compliant. Female, Age 35-44, New Jersey, 2-3 doctor visits past year I have a concern that electronic information is generally safe but (it) is not immune to the efforts of hackers. It s not as secure as I d like it to be. Female, Age 55-64, Ohio, 2-3 doctor visits past year Overall, medical records via computer will help improve my patient s quality of care. N = 111 physicians or other clinicians 31% 31% 10% 12% Neither nor 16% Overall, medical records via computer will help improve my quality of care. N = 264 outlets 35% 10% 43% 12% Neither nor 17% Sage physician comments shed light on the potential for electronic medical records to improve patient care. Their comments suggest that the records won t improve patient care themselves; the physician also plays an important role in higher quality patient care. Overall, medical records accessed via computer will help improve my patient s quality of care. (1 5 scale where 1 is strongly disagree and 5 is strongly agree) ( or strongly agree) (Electronic records) improve communication between staff in the office, with payers and with primary care providers who are also involved in care. Therapist in a 6-10 doc suburban orthopedic practice; I find it useful to be able to access information while on call and away from the office. Pediatrician in a suburban 3-5 doc practice; Only if HIE are fully functional. Cart before horse with government as usual. Physician in a urban, 6-10 doc orthopedic practice; ( or strongly disagree) I believe we will realize the true potential within the next few months to years as we are still in the early stages of using the EHR. Family physician in a 2 doc rural practice; I don t think electronic medical records are necessary for good care. Physician in a 1 doc suburban rheumatology practice; Sage Medical Manager

5 Sage 4301 W. Boy Scout Blvd., Suite 800 Tampa, FL sagehealth.com Sage North America is part of The Sage Group plc, a leading global supplier of business management software and services. At Sage, we live and breathe business every day. We are passionate about helping our customers achieve their ambitions. Our range of business software and services is continually evolving as we innovate to answer our customers needs. Our solutions support accounting, operations, customer relationship management, human resources, time tracking, merchant services, and the specialized needs of the construction, distribution, healthcare, manufacturing, nonprofit, and real estate industries. Sage North America employs more than 5,000 people and supports nearly 2.9 million small and medium-size business customers. The Sage Group plc, formed in 1981, was floated on the London Stock Exchange in 1989 and now employs 14,800 people and supports 5.7 million customers worldwide Sage Software, Inc. All rights reserved. Sage, Sage Software, the Sage Software logos and the Sage Software product and service names mentioned herein are registered trademarks or trademarks of Sage Software, Inc., or its affiliated entities. All other trademarks are the property of their respective owners.

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