Medical groups adoption of electronic health records and information systems

Transcription

1 Medical groups adoption of electronic health records and information systems The Medical Group Management Association (MGMA) Center for Research and the University of Minnesota School of Public Health surveyed a nationally representative sample of medical group practices to assess their current use of information technology (IT). More than 3,300 medical group practices participated in the Assessing Adoption of Health Information Technology project, which was funded by the federal Agency for Healthcare Research and Quality (AHRQ). The study reports current rates of EHR adoption, which EHR features are more frequently used, barriers to adopting an EHR and how users rated the benefits of having adopted an EHR. The results of the study suggest that adoption of electronic health records (EHRs) is progressing slowly, at least in smaller practices, although a number of group practices plan to implement an EHR within the next two years. The study confirmed that the process of choosing and implementing an EHR is expensive, complex and varies by size and type of practice. Not every EHR has all functions and not every medical group fully utilizes the capabilities of its EHR system. The report provides significant insight into which EHR functions are actually used by the medical groups that have adopted EHRs. It also provides a subjective evaluation by practices that have fully implemented EHRs on the benefits they realized from having an EHR. Key findings from the study are reported in the following tables and graphs: Number of FTE Physicians in the Practice Paper Medical Record Filed in Record Cabinet Type of health record by practice size Scanned Image Filed Electronically Using a Document Image Management System (DIMS) Dictation and Transcription System Combined with a Document Imaging Management System (DIMS) Electronic Health Record in a Relational Database (EHR) Other 5 or fewer 78.0% 2.3% 6.3% 12.5% 0.9% 6 to % 3.0% 7.2% 15.2% 0.7% 11 to % 1.6% 11.7% 18.9% 0.9% 21 or more 65.8% 3.1% 10.7% 19.5% 1.0% All practices* 75.3% 2.5% 7.2% 14.1% 0.9% * weighted to reflect the response by size of group

2 Number of FTE Physicians in the Practice Degree of EHR implementation by practice size (percentages within size of practice) Fully Implemented for All Physicians in All Locations Implementation in Process Implementation Planned in Next 12 Months Implementation Planned in Next 13 to 24 Months Not Implemented and No Plans to Implement in Next 24 Months 5 or fewer FTE 10.4% 10.3% 12.6% 18.9% 47.8% 6 to 10 FTE 13.6% 11.8% 15.9% 21.4% 37.3% 11 to 20 FTE 13.9% 20.7% 20.0% 18.4% 27.0% 21 or more FTE 11.0% 28.5% 15.7% 24.2% 20.2% All practices* 11.5% 12.7% 14.2% 19.8% 41.8% * weighted to reflect the response by group size Percent of Medical Groups that Have Not Implemented an EHR and Have No Plans to Implement in Next 24 Months by Size of Group 60.0% 50.0% 47.8% 40.0% 37.3% 30.0% 27.0% 20.0% 20.2% 10.0% 0.0% 5 or fewer 6 to to or more Number of FTE Physicians in the Practice

3 EHR capabilities percent of EHRs having the function Visit/encounter notes 97.6% Patient medications/prescriptions 96.5% Presenting complaint 96.4% Physical exam/review of systems 96.7% Past medical history 95.3% Procedure/operative notes 92.9% Patient medications/prescriptions 96.5% Referrals to specialists 81.9% Clinical guidelines and protocols 64.1% Consult/reports from specialists 79.8% Drug formularies 63.3% Drug interaction warnings 78.6% Drug reference information 77.3% Immunization tracking 76.4% Laboratory results 89.5% Radiology/imaging results 76.3% Integration with practice billing system 83.1% Benefit to the practice of having an HER Mean rating on scale of 1 (no value) to 5 (extremely important) Improved access to medical record information 4.60 Improved work flow 4.49 Improved patient communications 4.28 Improved accuracy for coding evaluation and management procedures 4.28 Improved drug refill capabilities 4.21 Reduced medication errors 4.19 Improved charge capture 4.16 Improved clinical decision making 4.15 Improved claim submission process 4.13 Reduced medical records staff expenses 3.96 Reduced medical records storage costs 3.92 Reduced transcription costs 3.92 Reduced medical records transportation costs 3.64 Improved physician recruitment 3.31 Rating scale: 5 = extremely important, 4 = important, 3 = some value, 2 = marginal value, 1 = no value.

4 Mean EHR Purchase and Implementation Cost per FTE Physician by Practice Size $40,000 $37,204 $35,000 $32,700 $32,606 $30,000 $29,846 $25,000 $24,988 $20,000 $15,000 $10,000 $5,000 $0 Under 5 FTE 6-10 FTE FTE 21 and greater FTE All practices Size of Medical Group Mean EHR per Month Maintenance Cost per FTE Physician by Practice Size $1,600 $1,496 $1,400 $1,267 $1,371 $1,200 $1,177 $1,000 $896 $800 $600 $400 $200 $0 Under 5 FTE 6-10 FTE FTE 21 and greater FTE All practices Size of Medical Group

5 Mean Percent EHR Implementation Costs Were Greater Than the Initial Vendor Estimate by Practice Size 40.0% 36.6% 35.0% 30.0% 25.0% 23.4% 22.2% 25.5% 24.8% 20.0% 15.0% 10.0% 5.0% 0.0% Under 5 FTE 6-10 FTE FTE 21 and greater FTE All practices Size of Medical Group Barriers to implementing an EHR Mean rating on scale of 1 (no value) to 5 (extremely important) Lack of support from practice 3.18 Lack of capital resources to invest in an EHR 3.54 Concern about ability of to input into the EHR 3.37 Concern about loss of productivity during transition to EHR 3.21 Inability to easily input historic medical record data into EHR 3.20 Available EHR software does not meet the practice needs 2.81 Insufficient return on investment (ROI) from an EHR 3.09 Lack of support from practice clinical staff 2.48 Insufficient time to select, contract, install, implement EHR 2.86 Lack of support from practice nonphysician providers 2.37 Inability to integrate EHR with practice billing/claims system 2.87 Practice staff does not have skills or training to use an EHR 2.63 Inability to evaluate, compare and select appropriate EHR 2.82 Lack of support from practice administration 2.12 Security and privacy concerns 2.34 Rating scale: 5 = makes implementation extremely difficult, 4 = makes implementation difficult, 3 = complicates implementation to some degree, 2 = minor impact on implementation, 1 = not a problem.

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