Variation in Physician Adoption of EHRs by Specialty:

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1 Variation in Physician Adoption of EHRs by Specialty: Vaishali Patel MPH PhD Office of Economic Analysis, Evaluation and Modeling Office of the National Coordinator for Health IT(ONC) Academy Health, 2011

2 Value of Health IT Use of health IT associated with improved efficiency and effectiveness of care 1 Evidence within smaller practices and organizations Health IT serves as foundation to enable the transformation of clinical care 2 Patient-Centered Medical Home (PCMH) model Yet, unlikely to reap these potential benefits because the adoption of EHRs remains relatively low Buntin M. et al, Health Affairs, Buntin M. et al, Health Affairs, Des Roches C. et al, NEJM, 2008; Hsiao, C.J, et.al, NCHS Health E-Stat,

3 Federal Health IT Policy Health Information Technology (HITECH) Act seeks to increase physicians adoption and use of EHRs 4 Incentive payments for meaningful use (MU) of EHRs Regional extension centers (RECs) Limited data on physicians varying levels of readiness to respond to HITECH Act at baseline 5 4. Maxon E. et al Annals of Internal Medicine Rao R. et al JAMIA

4 Study Aims Examine recent trends in office-based physician adoption of EHRs by specialty Identify physician and practice characteristics associated with adoption of EHRs 4

5 Methods National Ambulatory Medical Care Survey (NAMCS) EMR Supplement Mail survey of nationally representative sample of officebased physicians Response rates vary btw 62-74% Increased sample size in 2010 for state-level estimates Survey includes: EHR adoption & functionalities Physician/practice characteristics 5

6 Methods Definition of Primary Care 6 Family practice Family medicine General Practice Internal medicine Pediatricians Obstetrics/Obstetrics and gynecology/gynecology Definition of EHR Any EHR : Does this practice use electronic medical records or electronic health records (not including billing records)? Basic EHR vs. EHR with core functions required for MU 6 NCHS NAMCS Use Micro-Data file 6

7 Evolving Definition of an EHR: Mapping to NAMCS EHR Functionality Basic EHR EHR with Core Functionality Medication List Demographics Problem List CPOE for medication Viewing Lab results Viewing images Clinical Notes Medication allergy list E Prescribe Medication Alerts Clinical Decision Support Source: NAMCS Health E-Stat ( ). Note: Unable to report on all MU functionality (e.g. record smoking status, provide patient with clinical summaries post-visit) 7

8 RESULTS 8

9 Specialist vs. Primary Care Physician (PCP) Physician/Practice Characteristic Specialists (% ) (n=3475) Primary Care (% ) (n=3088) Gender (Female) * Solo and single Specialty Settings * Metropolitan Statistical Areas * Physician owned Practice/Clinic * Non Physician owned Practice/Clinics Hospital/Health Care Corp owned * 6 12 HMO owned * 3 5 Community Health Center * 2 5 * Significant differences, p<0.05 9

10 Trends in EHR Adoption: Any EHR * Primary Care Specialist *Significantly different from previous year estimate at p<

11 Trends in EHR Adoption: Basic vs. Core Primary Care Specialist Primary Care Specialist 11

12 Trends of Basic EHR adoption: Across Primary Care Family Medicine * Internal Medicine Ob/gyn Pediatricians *Significantly different from previous year estimate at p<0.05 Estimates for 2008 not shown because relative standard error >0.30 for pediatricians and internal medicine estimates 12

13 Functionality related to Core MU: 2010 EHR Functionality related to Core MU Primary Care N=2385 (%) Specialist N=2281 (%) E prescribe Medication interaction alerts Problem List Medication allergy list Active medication list CDS CPOE for medications Record patient demographics Proportion with allfunctions

14 Physician/Practice Characteristics Associated with Adoption of a Core EHR Physician/Practice Characteristic Odds Ratio 95% Confidence Interval Year of Survey, 2010 (vs. 2008) Specialist (vs. Primary care) years or older (vs. <45) Practice Size 2 5 physicians (vs. solo) physicians (vs. solo) Multispecialty (vs. Solo/Single) Southern region (vs. Northeast) HMO owned vs. Physician owned private practice/clinic Note: Gender and Metropolitan Statistical Area not significantly associated with EHR adoption. 14

15 Discussion Adoption of EHRs significantly increased among office-based physicians between 2008 and 2010 Variability in EHR adoption across physicians Although overall adoption of Any EHR similar, primary care physicians adoption of EHRs with MU functions significantly higher than specialists Practice size, setting and ownership associated with EHR adoption» Smaller, solo or single specialty practices» Physician-owned practices Regional differences and physician age play a lesser role 15

16 Limitations Non-respondent bias Mapping NAMCS to MU Core Were not able to address all MU requirements Proportions reported likely to be an overestimate Includes only mail respondents, final estimates may differ 16

17 Implications Primary care physicians higher rates of more advanced EHRs enables them to: Obtain MU incentives with greater ease Participate in initiatives to transform care Regional extension centers will have to focus on practices with less resources to invest in EHRs Small, single specialty, physician-owned For enhanced coordination of care, it is critical that specialists also adopt EHRs Design of EHRs tailored to specialists & MU requirements 17

18 Collaborators NCHS Eric Jamoom, PhD Chun-Ju Hsiao, PhD Jane Sisk, PhD ONC Melinda Buntin, PhD Questions/Comments? Contact: 18

19 Response Rate & Sample Size Year Response Rate * Sample Size (N) Primary Care (N, %) Specialist (N, %) % 843 (326, 39%) (517, 61%) % 1054 (377,36%) (677,64%) % 4666 (2385, 51%) (2281, 49%) Overall 6563 (3088, 47%) (3475, 53%) * Response rate for mail only. Source: Hsiao, J. et.al. NCHS e-stat

20 Respondent Characteristics Overall Almost three-quarters (72%) 45 years or older and over a quarter female (26%) Majority worked in smaller practices 78% solo and single specialty groups 69% worked in practices with 5 or less physicians 29% solo practitioners Regional variation with higher proportion in the south (36%) Physician-owned private practice or free-standing clinic predominant (72%) 20

21 EHR MU Menu Options:2010 Menu Set Functionality Primary Care (n=2385) Specialist (N=2281) Incorporate clinical lab test results into EHRs as structured data Submit immunization data to registries electronically Submit electronic surveillance data to public health agencies %Yes * %Unknown/ Missing %Yes * %Unknown/ Missing % % % % % % * Missing treated as no -Missing treated as yes. Range calculated when missing/unknown >10% 21

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