Interoperation Research Study. April 10, 2015 EAS Planning

Transcription

1 Interoperation Research Study April 10, 2015 EAS Planning

2 Background/Objectives Research was conducted in order to: Measure the attitudes and concerns of physicians about the current state of information exchange (i.e. interoperation or interoperability) Evaluate physicians current EHR systems in terms of interoperation The results will be used to highlight the current state of interoperation, including: Perceived importance of interoperation The impact of disconnectedness on physicians Prioritize issues related to interoperation Bring attention to progress/lack of progress related to interoperation efforts Identify areas/players enabling and disabling information flow across the continuum

3 National View

4 Online interviews were conducted with Epocrates physicians nationwide Interviewing took place from March 24 th -April 2 nd, 2015 A total of 2,922 interviews were conducted South Northeast West Midwest 546 Methodology Data were tested for significance at the 90% confidence level Study was fielded by an independent research company, EAS Planning

5 Summary of Findings To improve patient care, 2 key issues rose to the top among physicians: 8 in 10 physicians (79%) agreed that it was very important to improve both the ability of EHRs to access relevant patient data from other EHRs, and security and privacy of patient data The ability to engage patients in their treatment plan/follow-up care was the #3 area of importance to address, with 77% of physicians considering this a very important issue Virtually all physicians believe that improving these areas are important to improving patient care: The ability to engage patients in their treatment plan/follow-up care (important to 96% of physicians) The ability of EHRs to access relevant patient data from other EHRs (important to 96% of physicians) The ability of EHRs to access relevant patient data from other EHRs is most important to physicians working in larger medical settings

6 Summary of Findings Given the potential for universal patient records across disparate care settings, the vast majority of physicians (93%) believe it is important for them to have the ability to control visibility and access to particular aspects of a patient record Only 14% of physicians give the industry a good grade (B or higher) on achieving interoperation. More than 6 in 10 give the industry a failing grade (D or F) Most believe that interoperation does not exist because of technical shortcomings in the EHR systems (87%), although there is also a strong sentiment that both the EHR vendors (62%) and hospitals/health systems (55%) are imposing barriers to sharing data.

7 Summary of Findings In thinking about interoperation, virtually all physicians agree: Hospitals/health systems should not present barriers to electronically sharing their patients health information with other providers for HIPAA authorized purposes (96%) They have experienced a delay or difficulty in delivering medical care because patients health records were not accessible/shared (95%) They have observed redundant tests and labs due to inadequate access to patient records (94%) They are comfortable allowing another provider that is relevant to their patient s care to view that patient's information inside of their health record (94%) Providers involved in the treatment of a patient should not have to be on the same EHR system to access a patient s clinical data/record (90%) More than half (55%) believe that the costs associated with information sharing are a major barrier to interoperation Only 1/3 see patient objections as a major barrier to interoperability

8 Summary of Findings The primary transitions where physicians notice the pains of weak interoperation are from a Medical Facility to a Physician Office: Between Emergency Department and Primary Care/Specialist s office (59%) Between Hospital and Primary Care/Specialist s office (58%) Between Skilled Nursing Facility or LTC Provider and Primary Care/Specialist s office (50%) Physicians reported that the information which was most often incomplete, inaccurate, or unavailable included many critical areas: Medication lists (77%) Lab/imaging tests (64%) Problem list (60%) Specialist/consultant notes (60%) Discharge summaries (53%) Patient history (medical, family, social) (51%)

9 Importance of Areas of Improvement for Better Patient Care % Very Important Bottom Box % The ability of EHRs to access relevant patient data from other EHRs 79% 1 Security and privacy of patient data * 79% The ability to engage patients in their treatment plan/follow-up care 77% 1 Universal patient information and consent management so patient info can be collected/updated across disparate teams 64% 1 Price transparency for more informed care decisions 45% 2 Value-based care 28% 10 0% 20% 40% 60% 80% 100% *Less than 0.5% Q3a1. In your opinion, how important is improving each of the following to providing better patient care? (SELECT ONE RESPONSE PER ROW)

10 Importance of Areas of Improvement for Better Patient Care The ability to engage patients in their treatment plan/follow-up care % Very/Somewhat Important 98% Bottom 2 Box % 2 The ability of EHRs to access relevant patient data from other EHRs 96% 4 Security and privacy of patient data 4 96% Universal patient information and consent management so patient info can be collected/updated across disparate teams Price transparency for more informed care decisions 88% 93% 7 12 Value-based care 70% 30 0% 20% 40% 60% 80% 100% Q3a1. In your opinion, how important is improving each of the following to providing better patient care? (SELECT ONE RESPONSE PER ROW)

11 Importance of Ability of EHRs to Access Relevant Patient Data from Other EHRs -- % Very Important -- % Total 79 Census South (A) 79 Northeast (B) 77 West (C) 80 Midwest (D) 78 Number of Doctors 1-6 (E) (F) 79 E 20+ (G) 83 EF Type Physician Group Practice (H) 73 Hospital Owned (I) 81 H Physician Group Directly for Hospital (J) 84 HI

12 Importance of Bringing Together Patient Information Across Disparate Care Settings Physicians to have the ability to control visibility and access to particular aspects of a patient record (A) 67%B 93%B 26% 6% 7% 1% 78% 22%A Patients/healthcare proxy to have the ability to control visibility and access to particular aspects of a patient record (B) 35% 43%A 16%A 6%A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Very important Somewhat important Not too important Not at all important Q3a2. With the potential to bring together patient information across disparate care settings, creating a universally available patient record, how important is it for? (SELECT ONE RESPONSE PER ROW)

13 Grade Physician Would Currently Give Industry on Achieving Interoperation 14% F 29% A 5% B 9% 61% C 25% D 32% Q3b. What grade do you think the healthcare industry deserves today in terms of achieving interoperation? For this survey, we ll use the following definition of interoperation...the action of systems like EHRs to exchange and use electronic health information (e.g., meds, test results, notes, etc.) from other systems without special effort. (SELECT ONE GRADE)

14 Agreement With Statements About Interoperation Hospitals/health systems should not present barriers to electronically sharing my patients health information with other providers for HIPAA authorized purposes Have observed redundant tests and labs due to inadequate access to patient records Providers involved in the treatment of a patient should not have to be on the same EHR system to access a patient s clinical data/record Have experienced a delay or difficulty delivering medical care because patient s health records were not accessible/shared Would be comfortable allowing another provider relevant to my patient s care to view that patient s information inside of my health record Can share patient information within and across the primary care organization where I practice (across different affiliated departments and care providers) Patients should have control over how and with whom their health information is shared Can access usable electronic health information across all care delivery sites to manage my patients care (affiliated and non-affiliated) Can share patient information amongst unaffiliated care organizations and care teams who provide care for some of my same patients % Completely Agree Bottom Box % 14% 12% 44% 42% 66% 71% 70% 69% 72% 0% 20% 40% 60% 80% 100% Q3c. To what extent would you agree with the following statements?

15 Agreement With Statements About Interoperation Hospitals/health systems should not present barriers to electronically sharing my patients health information with other providers for HIPAA authorized purposes % Completely/Somewhat Agree Bottom 2 Box % 96% 4 Have experienced a delay or difficulty delivering medical care because patient s health records were not accessible/shared Have observed redundant tests and labs due to inadequate access to patient records Would be comfortable allowing another provider relevant to my patient s care to view that patient s information inside of my health record Providers involved in the treatment of a patient should not have to be on the same EHR system to access a patient s clinical data/record Patients should have control over how and with whom their health information is shared 95% 94% 94% 90% 86% Can share patient information within and across the primary care organization where I practice (across different affiliated departments and care providers) Can share patient information amongst unaffiliated care organizations and care teams who provide care for some of my same patients Can access usable electronic health information across all care delivery sites to manage my patients care (affiliated and nonaffiliated) 32% 36% 76% Q3c. To what extent would you agree with the following statements? 0% 20% 40% 60% 80% 100%

16 Major Barriers to Health System Interoperation EHR systems that are not capable of sharing information with other EHR systems because of technical shortcomings or incompatibility 87% EHR vendors unwillingness to share information with competing EHR systems despite being technically capable 62% An unwillingness from hospitals and health systems to share information outside their care facility because of the cost associated with information exchange Costs associated with information sharing 55% 54% An unwillingness from hospitals and health systems to share information outside their care facility because they do not want patients seeking care elsewhere 39% An unwillingness from patients to allow information to be broadly shared across providers and organizations 32% Other 5% None, there are no barriers 1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Q4. What do you consider to be the major barriers to health system interoperation? For this survey, we ll use the following definition of interoperation...the action of systems like EHRs to exchange and use electronic health information (e.g., meds, test results, notes, etc.) from other systems without special effort. (SELECT ALL THAT APPLY)

17 Transitions Where Most Notice Lack of Adequate Information Flow Between Emergency Department and Primary Care/Specialist office 59% Between Hospital and Primary Care/Specialist office 58% Between Skilled Nursing Facility or Long-Term Care Provider and Primary Care/Specialist office 50% Between Primary Care/Specialist office and Emergency Department/Hospital Department 48% Between Specialist and Primary Care office 47% Between Primary Care office and Specialist 41% Some Other Transition 9% Q5. At which patient care transitions do you most notice a lack of adequate information flow? (SELECT ALL THAT APPLY) 0% 10% 20% 30% 40% 50% 60% 70%

18 Patient Information Most Often Incomplete, Inaccurate or Unavailable Medication lists 77% Lab/imaging tests 64% Problem list Specialist/consultant notes 60% 60% Discharge summaries Patient history (medical, family, social) List of providers Immunizations 53% 51% 49% 48% Allergies 33% Patient demographics 15% Other 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Q6. In your experience, which of the following types of patient information is often incomplete, inaccurate, or unavailable when coming from another health care organization? (SELECT ALL THAT APPLY)

19 Proportion of Patients Receiving Care Outside of Health System/Set of Affiliated Providers All or virtually all of my patients receive care from at least one provider not affiliated with my healthcare system/network 22% A significant majority 32% About half 25% A minority 19% None or virtually none; all of my patients are treated within one system (all labs, specialists and hospitals are from the same healthcare system or set of affiliated providers) 2% 0% 5% 10% 15% 20% 25% 30% 35% Q7. Thinking about the patients you treat, how many receive care from doctors or specialists outside of your health system or set of affiliated providers?

20 Primary EHRs Used Total Office/ Hospital or Clinic Physician Practice Setting % % % Epic Cerner Allscripts (including Misys and Eclipsys) Meditech eclinicalworks GE Healthcare (IDX) / GE Centricity (IDX) NextGen McKesson (Medisoft and Practice Partner) athenahealth Practice Fusion 3 3 * Advanced MD emds 2 2 * Greenway Medical 2 2 * Siemens 2 * 2 Amazing Charts 1 1 * CareCloud 1 * * Medent 1 1 * Vitera (Sage and Medical Manager) 1 1 * Anodyne * * * Chartlogic * * * Optum / Ingenix * * * Med3000 * * * Medplus/Care360 * * * MedUSA * * * Office Practicum * * * RelayHealth * * * SoapWare * * * None of these/not applicable *Less than 0.5% Q8. Which of the following do you consider to be your primary Electronic Health Record system in each setting? (SELECT ONE PER COLUMN)

21 Type of EHR Using Total 27% 43% 30% In Office Setting 32% 45% 23% In Hospital Setting 20% 44% 36% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Internet-Based Pre-Internet Don't know Q9b. How does the [INSERT EHR SYSTEM] EHR system you use run? (SELECT ONE RESONSE ONLY)

22 Type of Physician/Practice An owner or have a partnership in a physicians group office/practice 28% 33% Part of an IPA (Independent Physician Association), practicing at a physician-owned office/group practice 5% Practicing at a physician office/group practice that is hospital/health system-owned Practicing at a physician office/group practice that is affiliated with a hospital/health system through a clinicallyintegrated network or other model 11% 17% 28% Employed directly by a hospital/health system 26% None of the above 13% 0% 5% 10% 15% 20% 25% 30% Q10a. Are you...? (SELECT ONE RESPONSE ONLY)

23 Number of Physicians in Practice 38% % % 150 or more 16% % % Mean: 51 Median: 11 Q10b. Approximately how many physicians (excluding nurse practitioners or other non-physician providers) are in the practice where you work? (SELECT ONE RESPONSE ONLY)

24 Regional View: Top 12 Metro Markets

25 Online interviews were conducted with Epocrates physicians nationwide Interviewing took place from March 24 th -April 2 nd, 2015 A total of 1288 interviews were conducted across top 12 metros based on number of active physicians; sample composition is: 1. New York Los Angeles Philadelphia Chicago San Francisco DC/Virginia Detroit Atlanta Miami Boston Houston Dallas/Fort Worth 55 Methodology

26 Methodology Data were tested for significance at the 90% confidence level Study was fielded by an independent research company, EAS Planning

27 Eight in ten doctors (79%) in the top 12 metros feel the ability to access relevant patient data across EHRs is vital to improving patient care; addressing the security/privacy of patient data was equally important The need for interoperation is real, as more than ¾ of these doctors report half or more of their patients are seeing providers outside their affiliated systems. Only 2% reported that all of their patients were treated within one system Doctors currently give the industry poor grades on achieving interoperability: More than half (57%) give it a failing grade (D-F) 28% rate it an F An additional 29%, rate it a D 27% give it a C Only 16% rate it a B or better Summary of Findings

28 Summary of Findings An equal proportion of doctors (67%-70%) completely agree that health systems and providers should electronically share patient health information across systems and that they have personally experienced problems/issues (treatment delay, redundant tests/lab work) due to lack of information coordination Fewer than half of physicians in top metros can share patient information within and across affiliated departments and care providers (45%) Very few physicians completely agreed they could share information with unaffiliated care organizations or care teams (13%)

29 Summary of Findings Technical incompatibility of EHRs is seen as the biggest barrier (86%). In addition, more than half of doctors in the top 12 metros (56%-63%) believe an unwillingness of key players is also a major barrier to interoperation, including an unwillingness of EHR vendors to share across competitive systems, an unwillingness of hospitals and health systems to incur the cost of sharing across other systems, and other cost based barriers to sharing Lack of adequate information is seen across a wide range of care transitions; it is seen as most prevalent between an Emergency Room or Hospital and a Primary Care Physician/Specialist (58%-59% mention noticing lack of adequate information during these specific transitions) The information most lacking during these care transitions is medication lists (78%), followed by lab/imaging tests (66%), problem lists (62%) and specialist notes (61%)

30 Summary of Findings In terms of interoperability, doctors in the top metros give relatively low ratings to the EHRs they used Less than 25% of doctors in the top 12 metros believe their EHR does a very good job allowing them to easily share files with providers even if they use another system (22%) or includes information exchange as part of their overall service structure (23%)

31 Importance of Areas of Improvement for Better Patient Care Almost 8 in 10 doctors in the top 12 metros feel interoperability and security/privacy of patient data are very important to improving patient care; engaging the patient in their treatment was considered equally important % Very Important Bottom Box % The ability of EHRs to access relevant patient data from other EHRs 79% 1 Security and privacy of patient data 79% * The ability to engage patients in their treatment plan/follow-up care 77% * Universal patient information and consent management so patient info can be collected/updated across disparate teams 66% 1 Price transparency for more informed care decisions 45% 2 Value-based care 31% 9 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less than 0.5 Q3a1. In your opinion, how important is improving each of the following to providing better patient care? (SELECT ONE RESPONSE PER ROW)

32 Importance of Areas of Improvement for Better Patient Care Almost all doctors feel interoperability, engaging patients in their care, security/privacy of patient care, and universal patient information with consent management are important areas to be addressed to improve patient care % Very/Somewhat Important Bottom 2 Box % The ability to engage patients in their treatment plan/follow-up care 98% 2 The ability of EHRs to access relevant patient data from other EHRs 96% 4 Security and privacy of patient data 96% 4 Universal patient information and consent management so patient info can be collected/updated across disparate teams 94% 6 Price transparency for more informed care decisions 88% 12 Value-based care 72% 28 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Q3a1. In your opinion, how important is improving each of the following to providing better patient care? (SELECT ONE RESPONSE PER ROW)

33 Importance of Ability of EHRs to Access Relevant Patient Data from Other EHRs While interoperability is universally important to improving patient care, it is seen as especially important to doctors in Los Angeles and DC -- % Very Important -- % Total Top 12 Metros 79 New York (A) 75 Los Angeles (B) 84 AC Philadelphia (C) 75 DC/Virginia (D) 87 AC Chicago (E) 81 San Francisco (F) 79

34 Importance of Bringing Together Patient Information Across Disparate Care Settings With the prospect of universal patient records, doctors feel it is more important (94%) that they have control over patient information Although of relatively less perceived importance, the majority of doctors (84%) believe patients/their proxy s should be able to control visibility to particular aspects of their patient record Physicians to have the ability to control visibility and access to particular aspects of a patient record (A) 69%B 94%B 25% 6% 5% 1% Patients/healthcare proxy to have the ability to control visibility and access to particular aspects of a patient record (B) 36% 79% 43%A 16%A 21%A 5%A 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Very important Somewhat important Not too important Not at all important Q3a2. With the potential to bring together patient information across disparate care settings, creating a universally available patient record, how important is it for? (SELECT ONE RESPONSE PER ROW)

35 Grade Physician Would Currently Give Industry on Achieving Interoperation Most top metro physicians give the industry poor grades on achieving interoperation, with 57% giving current efforts a failing grade (D or F). Only 16% give the industry an A or B 16% F 28% A 6% B 10% 57% C 27% D 29% Q3b. What grade do you think the healthcare industry deserves today in terms of achieving interoperation? For this survey, we ll use the following definition of interoperation...the action of systems like EHRs to exchange and use electronic health information (e.g., meds, test results, notes, etc.) from other systems without special effort. (SELECT ONE GRADE)

36 Grade Physician Would Currently Give Industry on Achieving Interoperation Across the board, interoperation grades are low LA doctors are most likely to rate the industry favorably on interoperation A/B C D F % % % % Total Top 12 Metros New York (A) B Los Angeles (B) 23 ADF 32 E Philadelphia (C) B 26 DC/Virginia (D) B 27 Chicago (E) AB 26 San Francisco (F) AB 23

37 Doctors have experienced issues in treating patients due to interoperational problems, including redundant tests and labs (70%) and delays in delivering treatment due to inaccessible patient records (67%); they believe EHR systems (69%) and hospital systems (69%) should not present barriers to sharing patient information Hospitals/health systems should not present barriers to electronically sharing my patients health information with other providers for HIPAA authorized purposes Have observed redundant tests and labs due to inadequate access to patient records Providers involved in the treatment of a patient should not have to be on the same EHR system to access a patient s clinical data/record Have experienced a delay or difficulty delivering medical care because patient s health records were not accessible/shared Would be comfortable allowing another provider relevant to my patient s care to view that patient s information inside of my health record Can share patient information within and across the primary care organization where I practice (across different affiliated departments and care providers) Patients should have control over how and with whom their health information is shared Can access usable electronic health information across all care delivery sites to manage my patients care (affiliated and nonaffiliated) Can share patient information amongst unaffiliated care organizations and care teams who provide care for some of my same patients % Completely Agree Bottom Box % 16% 13% Q3c. To what extent would you agree with the following statements? Agreement with Statements About Interoperation 45% 43% 0% 20% 40% 60% 80% 100% 62% 69% 69% 67% 70%

38 Hospitals/health systems should not present barriers to electronically sharing my patients health information with other providers for HIPAA authorized purposes Have experienced a delay or difficulty delivering medical care because patient s health records were not accessible/shared Agreement with Statements Doctors have experienced issues in treating patients due to interoperational problems; they are looking for interoperability support from EHRs and Hospital Systems and are open to sharing their patients records Very few physicians can share information across unaffiliated care organizations (13-16%) % Completely/Somewhat Agree About Interoperation Bottom 2 Box % 95% 94% 5 6 Have observed redundant tests and labs due to inadequate access to patient records Would be comfortable allowing another provider relevant to my patient s care to view that patient s information inside of my health record Providers involved in the treatment of a patient should not have to be on the same EHR system to access a patient s clinical data/record 88% 94% 93% Patients should have control over how and with whom their health information is shared Can share patient information within and across the primary care organization where I practice (across different affiliated departments and care providers) Can share patient information amongst unaffiliated care organizations and care teams who provide care for some of my same patients Can access usable electronic health information across all care delivery sites to manage my patients care (affiliated and nonaffiliated) 37% 35% 0% 20% 40% 60% 80% 100% 76% 86% Q3c. To what extent would you agree with the following statements?

39 Agreement with: Observed Redundant Tests Due to Inadequate Access to Patient Record Redundant tests/lab work has been experienced the most by doctors in Philadelphia and Chicago, least in New York and San Francisco. % Completely Agree % Total Top 12 Metros 70 New York (A) 62 Los Angeles (B) 71 A Philadelphia (C) 78 AF DC/Virginia (D) 73 A Chicago (E) 77 AF San Francisco (F) 66

40 Agreement with: Experienced Difficulty/ Delay Because Patient Records Not Available Delay in care is least prevalent in New York % Completely Agree % Total Top 12 Metros 67 New York (A) 61 Los Angeles (B) 72 A Philadelphia (C) 69 A DC/Virginia (D) 66 Chicago (E) 69 A San Francisco (F) 63

41 Agreement with: Can Share Across Different Affiliated Providers Sharing records across affiliated providers is most prevalent in LA and Chicago % Completely Agree % Total Top 12 Metros 45 New York (A) 39 Los Angeles (B) 55 ACD Philadelphia (C) 43 DC/Virginia (D) 41 Chicago (E) 54 AD San Francisco (F) 46

42 Agreement with Statements Access across unaffiliated providers is low across all metros, but especially in DC and Philadelphia DC, Philadelphia and San Francisco area doctors also report less access across all types (affiliated and non-affiliated) of providers Can share with Unaffiliated Providers Access Across all (Affiliated and Non- Affiliated) Patients Should Have Control over with whom Information Shared % Completely Agree % % % Total Top 12 Metros New York (A) 15 D 18 C 42 Los Angeles (B) 19 D 19 C 47 Philadelphia (C) DC/Virginia (D) Chicago (E) 18 D 25 CDF 48 San Francisco (F)

43 Agreement with Statements Physicians in the New York metro tend to be less comfortable sharing patient information Should Not Have to Be on Same EHR to Access Patient Records Comfortable Allowing Another Provider to View Patients Info in my Record Hospitals/Hea lth Systems Should Not Present Barriers to Sharing Health Info % Completely Agree % % % Total Top 12 Metros New York (A) Los Angeles (B) Philadelphia (C) A 69 DC/Virginia (D) A 75 A Chicago (E) A 68 San Francisco (F) A

44 Major Barriers to Health System Interoperation EHR incompatibility is seen as the largest barrier to interoperation. The next barriers, however, focus on the unwillingness of key players and/or cost involved EHR systems that are not capable of sharing information with other EHR systems because of technical shortcomings or incompatibility 86% EHR vendors unwillingness to share information with competing EHR systems despite being technically capable 63% An unwillingness from hospitals and health systems to share information outside their care facility because of the cost associated with information exchange Costs associated with information sharing 57% 56% An unwillingness from hospitals and health systems to share information outside their care facility because they do not want patients seeking care elsewhere 41% An unwillingness from patients to allow information to be broadly shared across providers and organizations 33% Other 5% None, there are no barriers * 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% *Less than 0.5% Q4. What do you consider to be the major barriers to health system interoperation? For this survey, we ll use the following definition of interoperation...the action of systems like EHRs to exchange and use electronic health information (e.g., meds, test results, notes, etc.) from other systems without special effort. (SELECT ALL THAT APPLY)

45 Top Barriers to Health System Interoperation Technical capability of EHRs is seen as the top barrier to interoperation among doctors in all the top metros EHRs Not Capable of Sharing EHR Vendors Hospitals Unwillingnes Unwillingnes s s Due to Cost Costs Associated with Info Sharing % % % % Total Top 12 Metros New York (A) Los Angeles (B) Philadelphia (C) B DC/Virginia (D) Chicago (E) B San Francisco (F) 91 A

46 Transitions Where Most Notice Lack of Adequate Information Flow Between 40% and 60% of doctors cite all specific listed transitions as areas where they notice lack of information flow. ED and PC/Specialist and Hospital and PC/Specialist top the list Between Emergency Department and Primary Care/Specialist office 59% Between Hospital and Primary Care/Specialist office 58% Between Skilled Nursing Facility or Long-Term Care Provider and Primary Care/Specialist office 50% Between Primary Care/Specialist office and Emergency Department/Hospital Department 49% Between Specialist and Primary Care office 46% Between Primary Care office and Specialist 42% Some Other Transition 9% 0% 10% 20% 30% 40% 50% 60% 70% Q5. At which patient care transitions do you most notice a lack of adequate information flow? (SELECT ALL THAT APPLY)

47 Transitions Where Most Notice Lack Transitional pain points are similar across all metros of Adequate Information Flow ED + Primary/ Specialist Hospital + Primary/ Specialist SNF + Primary/ Specialist Primary/S pec + ED Specialist + Primary Primary + Specialist % % % % % % Total Top 12 Metros New York (A) Los Angeles (B) Philadelphia (C) B 43 DC/Virginia (D) Chicago (E) San Francisco (F)

48 Patient Information Most Often Incomplete, Inaccurate or Unavailable Three out of 4 physicians feel patient medication lists are often not up-to-date. Six in 10 or more cite lab/imaging tests, problem lists and specialist notes as often being missing or incomplete. Medication lists 78% Lab/imaging tests 66% Problem list Specialist/consultant notes 62% 61% Discharge summaries Patient history (medical, family, social) List of providers Immunizations 54% 54% 52% 49% Allergies 34% Patient demographics 17% Other 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Q6. In your experience, which of the following types of patient information is often incomplete, inaccurate, or unavailable when coming from another health care organization? (SELECT ALL THAT APPLY)

49 Patient Information Most Often Incomplete, Inaccurate or Unavailable Lack of information on meds and problem lists are especially prevalent in San Francisco Medication Lists Lab/Imaging Tests Problem List Specialist/ Consultant Notes Discharge Summaries % % % % % Total Top 12 Metros New York (A) Los Angeles (B) AD 56 Philadelphia (C) AB DC/Virginia (D) Chicago (E) AB San Francisco (F) 86 C DE ABE 59 57

50 Patient Information Most Often Incomplete, Inaccurate or Unavailable New York and San Francisco physicians report higher levels of missing allergy information Patient List of Immunizations Demos Patient Allergies History Providers % % % % % Total Top 12 Metros New York (A) D BDE 18 D Los Angeles (B) D Philadelphia (C) D D 14 DC/Virginia (D) Chicago (E) San Francisco (F) BDE 16

51 Proportion of Patients Receiving Care Outside of Health System/Set of Affiliated Providers More than ¾ of doctors in the top 12 metros report at least one-half of their patients obtain care outside their system. Over one-half of doctors report a significant majority of patients do so All or virtually all of my patients receive care from at least one provider not affiliated with my healthcare system/network 21% A significant majority 32% 77% About half 24% A minority 21% None or virtually none; all of my patients are treated within one system (all labs, specialists and hospitals are from the same healthcare system or set of affiliated providers) 2% 0% 5% 10% 15% 20% 25% 30% 35% Q7. Thinking about the patients you treat, how many receive care from doctors or specialists outside of your health system or set of affiliated providers?

52 Proportion of Patients Receiving Care Outside of Health System/Set of Affiliated Providers Although still prevalent, having patients being treated outside their affiliated providers is relatively less of an issue in Chicago, followed by Los Angeles and San Francisco. Majority Half Minority % % % Total Top 12 Metros New York (A) 56 E Los Angeles (B) 53 E AC Philadelphia (C) 53 E 33 BDF 14 DC/Virginia (D) 55 E C Chicago (E) AC San Francisco (F) AC

53 On the whole, doctors give their EHRs low ratings on interoperability. Ratings of EHRs LA physicians rate their EHRs more favorably than those in other metros Incorporates other providers notes, reports, lab results, etc. Allows me to easily send/share files with providers even if use another system Includes information exchange as part of overall service structure % Excellent/Very Good % % % Total Top 12 Metros New York (A) 38 D 24 D 25 DE Los Angeles (B) 49 ACD EF 31 ACDE F Philadelphia (C) DC/Virginia (D) Chicago (E) San Francisco (F) DE

54 Type of Physician/Practice An owner or have a partnership in a physicians group office/practice 31% 37% Part of an IPA (Independent Physician Association), practicing at a physician-owned office/group practice 6% Practicing at a physician office/group practice that is hospital/health system-owned Practicing at a physician office/group practice that is affiliated with a hospital/health system through a clinicallyintegrated network or other model 14% 14% 28% Employed directly by a hospital/health system 24% None of the above 11% 0% 5% 10% 15% 20% 25% 30% 35% Q10a. Are you...? (SELECT ONE RESPONSE ONLY)

55 Number of Physicians in Practice 40% % 150 or more 19% % % % Mean: 56 Median: 12 Q10b. Approximately how many physicians (excluding nurse practitioners or other non-physician providers) are in the practice where you work? (SELECT ONE RESPONSE ONLY)

56 Data fielded by independent research company, EAS Planning