Rhode Island HIT Survey: 2014 Results and Trends. October 2014

Transcription

1 Rhode Island HIT Survey: 2014 Results and Trends October 2014

2 Survey Objectives 1. To measure presence (structural measures) and use (process measures) of HIT by clinicians caring for Rhode Island patients 2. To capture HIT data for state agencies and other key stakeholders using single instrument (i.e., minimize data collection burden)

3 Methods, 2014 Administered to all Licensed Independent Practitioners (LIPs): Advanced Practice Registered Nurses (APRNs) Physicians Physician Assistants (PAs) Electronic survey instrument sent via: Hard copy mailing (for physicians, with licensure renewal) If available, notification and up to two reminders Analyses limited to LIPs: Licensed in Rhode Island In active practice Located in Rhode Island or an adjacent state (Connecticut or Massachusetts)

4 Publicly-Reported Measures, Electronic Health Records (EHRs): Access to EHR components, including functions such as visit notes, lab orders, or prescriptions 2. Basic EHR use: Among those with EHRs, functionality/clinical use relating to documentation and results management 3. Advanced EHR use: Among those with EHRs, functionality/clinical use relating to decision support, external communication, order management, and reporting 4. e-prescribing: Transmitting prescriptions/medication orders electronically to a pharmacy

5 The HIT Survey has a relatively high response rate for a single-wave mailed survey. It is higher among physicians than APRNs/PAs. Response rate by year (administration to APRNs/PAs began in 2013) Physicians 100% APRNs/PAs 80% 60% 58.1% 57.8% 62.9% 55.4% 62.3% 68.3% 46.2% 44.0% 40% 20% 0%

6 Physician Results Overall Trends

7 The 2014 results provide a point-estimate of HIT adoption among physicians for the four publiclyreported measures. Use of EHRs and e-prescribing, among respondents and all physicians Survey Respondents (N = 2,567) All Physicians (N = 3,761) Measure N Score N Score 1. EHRs, n(%) 2,567 2,236 (87.1%) 3,761 2,236 (59.5%) 2. Basic EHR use, mean 2, Advanced EHR use, mean 2, e-prescribing, n(%) 2,349 1,884 (80.2%) 3,543 1,884 (53.2%)

8 When looking at office-based physicians by specialty, HIT adoption is highest among officebased primary care physicians (PCPs). Respondents use of EHRs and e-prescribing, by physician specialty and practice location Measure Office-Based by Specialty PCP Non-PCP (N=698) (N=846) All Office-Based Physicians (N=1,544) 1. EHRs, n(%) 625 (89.5%) 642 (75.9%) 1,267 (82.1%) 2. Basic EHR use, mean Advanced EHR use, mean e-prescribing, n(%) 590 (85.1%) 576 (73.0%) 1,166 (78.7%)

9 Since 2009, physicians HIT adoption has increased for all four publicly-reported measures. EHR adoption increased by nearly 30% and e-prescribing by 95%. Survey respondents use of EHRs and e-prescribing % 87.1% 63.6 pts 77.0 pts 62.6 pts 80.2% pts 41.2% : EHRs (%) 2: Basic EHR Use (0-100) 3: Advanced EHR Use (0-100) 4: e-prescribing (%)

10 Physicians EHR use has increased since 2009, whether you calculate the percentage based on survey respondents or all physicians (including non-respondents). % of physicians who say yes, they have EHR components Survey Respondents All Licensed Physicians 100% 80% 60% 40% 67.6% 39.3% 74.1% 42.8% 81.1% 51.1% 86.2% 88.2% 87.1% 47.7% 55.0% 59.5% 20% 0%

11 Physicians e-prescribing has also increased since 2009, whether you calculate the percentage based on survey respondents or all physicians. 100% % of physicians who say yes, they are e-prescribing Survey Respondents All Licensed Physicians 80% 78.2% 79.9% 80.2% 60% 40% 41.2% 23.9% 49.3% 28.5% 57.5% 36.3% 42.0% 48.2% 53.2% 20% 0%

12 Physician Results Impact of EHRs

13 Compared to hospital-based physicians, officebased physicians more frequently report using their EHR out outside of regular work hours. % of physicians who say yes, they use their EHR outside of work hours (Select all that apply.) To catch up on documentation To review labs, imaging, notes or reports When covering other physicians' patients To prepare for the upcoming work day To return patient or family telephone calls Do not use EHR outside of practice Do not have access to EHR outside of practice Office-based (N=1,247) Hospital-based (N=954) When covering own patients Other 68.8% 43.0% 64.7% 49.5% 61.6% 43.6% 52.7% 32.3% 49.5% 29.6% 49.0% 21.0% 12.0% 24.6% 9.9% 12.1% 3.6% 3.6% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

14 Despite agreeing that EHRs improve many aspects of care, fewer than half of hospital-and office-based physicians agree that EHRs improve job satisfaction. % of physicians who agree or strongly agree that EHRs Improves billing processes (office-based only) 83.4% Increased the timeliness of receiving test results Improves communication among the physicians and staff Improves patient safety Improves ability to do QI work Improves the care patients receive Improves communication with outside physicians Improves clinical work flow Improves job satisfaction 82.9% 72.8% 72.7% 66.8% 74.5% 62.0% 70.1% 56.6% 68.8% 58.6% 51.0% 59.8% 35.4% 48.7% Office-based 0% 20% 40% 60% 80% 100% Hospital-based

15 Compared to 2013, physicians agreement increased for all statements about how EHRs improve care, except that EHRs improve job satisfaction. % of physicians who agree or strongly agree that EHRs Improves billing processes (office-based only) Increased timeliness of receiving test results (hospital- Improves communication among physicians and staff Improves patient safety (2014 only) Improves ability to do QI work Improves care patients receive Improves communication with outside physicians Improves clinical work flow Improves job satisfaction 77.5% 83.4% 77.7% 82.9% 65.4% 72.8% 70.2% 63.4% 65.6% 57.1% 62.0% 49.0% 58.6% 51.4% 54.8% 42.0% 41.2% 0% 20% 40% 60% 80% 100%

16 About 40% of physicians say that EHRs increased the amount of work they take home. % of physicians who said that with EHRs (N=2,110) Did not affect the amount I take home 47.8% Increased the amount I take home 40.5% Decreased the amount I take home 11.7% 0% 50% 100%

17 Physician Results Respondents without EHRs

18 Among physicians without EHRs, office-based physicians are slightly more likely to report e- prescribing. % of physician respondents without EHRs who are e-prescribing (N=300) Office-based 28.2% Hospital-based 23.7% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

19 Among office-based physicians without EHRs, fewer than one in five have plans to implement an EHR within one year. % of office-based physicians without EHRs whose main practice plans to implement an EHR (N=276) No (n=103) 37.3% Yes, within 1 year (n=52) 18.8% Yes, after 1 year (n=21) 7.6% Don't know (n=100) 36.2% 0% 20% 40% 60% 80% 100%

20 Among office-based physicians without EHRs, responses were mixed about what it would take to implement one. Highest agreement related to workflow, cost, and assistance. % of physicians who thought it would take the following for them to implement an EHR (N=227) (Select all that apply.) EHR functionality that supports efficient workflow Financial support Free software Technical assistance Web-based EHR with software that updates automatically Gov't mandate of an EHR with proven, sustainable functionality State Medical Licensure requirement Payment for population-based disease management Other 35.5% 30.4% 24.2% 21.6% 17.2% 14.3% 12.5% 4.0% 22.0% 0% 20% 40% 60% 80% 100%

21 Physician Results Public Health

22 Approximately one-quarter of office-based physicians are using their EHR for population health management. % of physicians using their EHR for population health management (N=1,137) Yes 26.4% No 31.7% Don't know 41.8% 0% 20% 40% 60% 80% 100%

23 Among office-based physicians not using their EHR for population health management, responses were relatively evenly distributed about what it would take to start: cost, staff, or assistance. % of physicians who thought it would take the following for them to use their EHR for population health management (N=1,022) (Select all that apply.) Financial support 35.0% Additional staff members 33.6% Technical assistance 30.1% Other 7.3% I am not a decision maker for my practice 49.7% 0% 20% 40% 60% 80% 100%

24 Among physicians who prescribe, fewer than half are consulting the Prescription Monitoring Program (PMP) before prescribing opioids or benzodiazepines. % of patients for whom physicians consult the PMP before prescribing 0% 56.2% 52.8% <30% 27.3% 32.5% 30%-60% >60% 8.1% 9.0% 8.3% 4.6% 0% 20% 40% 60% 80% 100% Office-based (N=1,430) Hospital-based (N=778)

25 Physician Results CurrentCare

26 Approximately 20-25% of all physician respondents are familiar with various components of the state s health information exchange, CurrentCare. % of physicians who are familiar with these CurrentCare services EHR Integration (N=2,468) 17.6% Hospital Alerts (N=2,476) 21.9% CurrentCare Viewer (N=2,501) 26.7% 0% 20% 40% 60% 80% 100%

27 Nearly 75% of physicians are not signed up to view or receive data, highlighting opportunities for engagement. Among those signed up, about half are using CurrentCare for any percentage of their patients. % of patients for whom physicians view or receive CurrentCare data (N=2,492) 0% - My practice is not yet signed up to view or receive data from CurrentCare 72.6% 0% - I am able to view or receive data from CurrentCare, but I am not using it 14.0% <30% 9.4% 30-60% 2.5% >60% 1.6% 0% 20% 40% 60% 80% 100%

28 Physician Results Meaningful Use

29 Two-thirds of physicians report that they have attested to Meaningful Use. % of physicians who have attested to Meaningful Use Yes (n=742) 66.1% No (n=129) 11.5% Don't know (n=251) 22.3% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

30 Medicare Stage 1 is the most common Meaningful Use attestation, with more than two-thirds of physicians saying they have attested. % of physicians who plan to attest to Meaningful Use in 2014 Medicare Stage 1 (n=426) 69.6% Medicaid Stage 1 (n=198) 32.4% Medicare Stage 2 (n=158) 25.8% Medicaid Adoption, Implementation, Upgrade (n=157) 25.7% Medicaid Stage 2 (n=79) 12.9% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

31 The vast majority (nearly 90%) of physicians who haven t yet attested to Meaningful Use intend to do so in % of physicians who plan to attest to Meaningful Use in 2014 Yes (n=623) 87.0% No (n=20) 2.8% Undecided (n=72) 10.1% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

32 Physician Results Physician Quality Reporting System (PQRS)

33 About one-third of office-based physicians say they are already using PQRS and plan to continue in % of office-based physicians planning to use PQRS in 2014 (N=1,422) No, but plan to start in 2014 (n=94) 6.6% No, and have no plans to start (n=254) 17.9% Yes, but plan to discontinue in 2014 (n=7) 0.5% Yes, and plan to continue in 2014 (n=481) 33.8% Don't know (n=584) 41.1% 0% 20% 40% 60% 80% 100%

34 Approximately one-fourth of office-based physicians planning to use PQRS in 2014 anticipate reporting using their EHR. % of office-based physicians using the following methods to report PQRS (N=577) Don't know (n=281) 48.7% EHR method (n=152) 26.3% Claims method (n=51) Registry method (n=40) Meaningful use/pqrs pilot (n=27) Direct Submission Vendor (DSV) (n=26) 8.8% 6.9% 4.7% 4.5% 0% 20% 40% 60% 80% 100%

35 Office-based physicians who know how they plan to report PQRS in 2014 are approximately evenly split between Group Practice and Individual Reporting. % of office-based physicians using the following approaches to report PQRS (N=582) Group Practice Reporting Option (GPRO) (n=226) 38.8% Individual (n=199) 34.2% Don t know (n=157) 27.0% 0% 20% 40% 60% 80% 100%

36 APRN and PA Results Overall Trends

37 The 2014 results provide a point-estimate of HIT adoption among APRNs and PAs for the four publicly-reported measures. Use of EHRs and e-prescribing, among respondents and all APRNs/PAs Survey Respondents (N = 662) All APRNs/PAs (N = 1,505) Measure N Score N Score 1. EHRs, n(%) (78.9%) 1, (34.7%) 2. Basic EHR use, mean Advanced EHR use, mean e-prescribing, n(%) (70.4%) 1, (28.1%)

38 Rebekah Gardner, MD, FACP Chair, Physician Reporting Workgroup Samara Viner-Brown, MS Chief, Center for Health Data and Analysis