Progress in Health Information Technology 2014 Annual HIT Survey by The American Hospital Association How are Pennsylvania hospitals meeting the Meaningful Use requirements of the Medicare and Medicaid EHR Incentive Programs? April 2015
State E-Health Activities in 2014 Hospitals and health systems across the state are continuing to advance their adoptions of information technology to support their providers with information sharing for high quality care delivery. Clinical quality reporting numbers increased in 2014. The major changes in EHR vendors across the state signify the importance of interoperability, cost constraints, and increased attention to quality indicators. Hospitals have learned the capabilities of EHRs in data sharing with providers and are moving forward or making major changes towards EHR s that will assist them in delivering high quality care to their communities. A transition from measuring quality of performance to delivering high quality performance is currently underway. Findings from this year s AHA HIT Survey demonstrate Pennsylvania hospitals and health systems commitment to progress in the implementation of health information technology across a broad range of functions. The complexity of health care systems and constantly changing certification and meaningful use requirements are forcing most hospitals to make major system changes very quickly. In 2013, seventeen percent (17%) of respondents indicated that they are changing vendors in the next 18 months. In 2014, that number more than doubled to thirty-five percent (35%) of respondents. 2
Computerized Systems for Electronic Clinical Documentation 100% 80% 60% 40% 20% Fully implemented, all units Beg. To implement, 1 unit No resources, consid implement 98% Fully implemented, in at least 1 unit Have resources, implement in next year 6% 8% 4% 32% 50% 0% Patient Demographics Physician Notes 3
Computerized Systems for Electronic Clinical Documentation 100% 80% Fully implemented, all units Fully implemented, in at least 1 unit 14% 13% 60% 40% 83% 85% 20% 0% Nursing Notes Problem Lists 4
Computerized Systems for Electronic Clinical Documentation 100% 80% 60% Fully implemented, all units Beg. To implement, 1 unit 6% 94% Fully implemented, in at least 1 unit Have resources, implement in next year 5% 10% 7% 83% 89% 40% 20% 0% Medication lists Discharge summaries Advanced directives 5
Computerized Systems for Results Viewing 100% 80% Fully implemented, all units Beg. Implement, 1 unit Fully implemented, in at least 1 unit No resources but consid. 2% 5% 5% 6% 6% 10% 60% 40% 99% 99% 94% 93% 87% 79% 20% 0% Lab Reports Radiology Reports Radiology Images Diagnostic Test Results Diagnostic Test Images Consultant Reports 6
Computerized System for Provider Order Entry (CPOE) 100% 80% Fully implemented, all units Fully implemented, in at least 1 unit 7% 6% 7% 6% 6% 60% 40% 90% 92% 92% 88% 92% 20% 0% Lab Tests Radiology Tests Medications Consultation Requests Nursing Orders 7
Computer Systems for Decision Support 100% 80% Fully implemented, all units Fully implemented, in at least 1 unit Beg. Implementation, 1 unit 5% 9% 10% 24% 20% 19% 3% 7% 60% 40% 82% 82% 65% 65% 67% 78% 20% 0% Clinical guidelines Clinical reminders Drug allergy alerts Drug-drug interaction alerts Drug-lab interaction alerts Drug dosing support 8
Computerized System for Barcoding or RFID 100% 80% 60% Fully implemented, all units Have resources, implement next year 18% 19% 74% 75% Fully implemented, in at least 1 unit No resources, consid. Implement 4% 6% 14% 5% 20% 63% 65% 40% 20% 0% Medication administration Patient verification Caregiver verification Pharmacy verification 9
100% 80% 60% 40% 20% 18% 6% 15% 44% Computerized System for Other Functionalities Fully implemented, all units Beg. Implement, 1 unit No resources, consid. Implement 12% 12% 10% 10% 11% 34% 22% Fully implemented, in at least 1 unit Have resources, implement next year Not in place, not consid. 5% 6% 4% 8% 13% 63% 0% Bar code/rfid for supply chain Telehealth Connect Mobile devices 10
Respondents with electronic systems that allow the following: Electronic Clinical Documentation Incorporate lab results for more than 40% of inpatients or ER patients Record patient family health history Record and maintain medication alllergy lists Record smoking status using standard format Vital signs (Ht, Wt, BP, BMI, growth charts) Record preferred language for communication with providers Record time and preliminary cause of death Record race, ethnicity Record gender, D.O.B. 99% 93% 99% 99% 99% 98% 95% 99% 99% 0% 20% 40% 60% 80% 100% 11
Respondents with electronic systems that allow the following: Population Health Management Identify and provide patient-specific education resources 95% Generate lists of patients by condition 97% 0% 20% 40% 60% 80% 100% 12
Respondents with electronic systems that allow the following: Medication Management Electronic prescribing (erx) of discharge meds orders 73% Automatically track meds with an emar 96% Check inpatient prescriptions against an internal formulary 93% Provide an updated meds list at time of discharge 99% Compare a patient's inpatient and preadmissions meds lists 95% 0% 20% 40% 60% 80% 100% 13
Respondents with electronic systems that allow the following: Care Summary Documents Send transition of care summaries to an unaffiliated organization using a different certified EHR vendor 85% Include care teams and plan of care in care summary record 93% Generate summary of care record for trans of care using CCDA format 96% 0% 20% 40% 60% 80% 100% 14
Respondents with electronic systems that allow the following: Automated Quality Reporting Automatically generate physician-specific meaningful use quality measures calculated directly from the electronic health record (EHR) without additional manual processes 80% Automatically generate Medicare Inpatient Quality Reporting program measures for a full Medicare inpatient update 59% Automatically generate hospital-specific meaningful use quality measures by extracting data from an electronic record without additional manual processes 84% 0% 20% 40% 60% 80% 100% 15
Respondents with electronic systems that allow the following: Public Health Reporting & Other Functions Conduct or review a security risk analysis and implement security updates as necessary 94% Implement at least 5 Clinical Decision Support interventions related to 4 or more clinical quality measures 95% Submit electronic syndromic surveillance data to public health agencies per meaningful use standards 89% Submit electronic data on reportable lab results to public health agencies per meaningful use standards 83% Submit electronic data to immunization registries/ information systems per meaningful use standards 95% 0% 20% 40% 60% 80% 100% 16
Patient Engagement Functions Are patients able to do any of the following regarding their medical records? View information from their health/medical record online Download information from their health/medical record 84% 93% Pay bills online Electronically transmit transmission of care/referral to 3rd party Request an amendment to change/update medical record Secure messaging with providers 65% 64% 75% 73% Request refills for prescriptions online Schedule appointments online Submit patient-generated data 43% 42% 41% 0% 20% 40% 60% 80% 100% % of respondents 17
100% Electronic Data Exchange with Hospitals (Check all that apply) 98% % of respondents indicating Yes Inside the System Outside the System 80% 75% 73% 73% 72% 73% 60% 56% 48% 50% 61% 40% 20% 0% Patient demographics Lab results Medication history Radiology reports Clinical care record - Any format 18
Electronic Data Exchange with Ambulatory Providers (Check all that apply) 100% 80% 60% % of respondents indicating Yes 88% 72% 56% 90% 79% Inside the system 62% 91% Outside the system 86% 75% 70% 40% 20% 0% Patient demographics Lab results Medication history Radiology reports Clinical care record - Any format 19
With Patient transitions, how do you routinely send/receive summary of care record? (Check all that apply) 100% 80% 60% 40% 20% % of respondents indicating Yes 88% 78% 57% 31% 69% 47% Send 56% 32% Receive 49% 38% 0% Mail or fax efax Secure messaging (via DIRECT/secure protocol) Provider portal Via health information exchange org/ or other 3rd party 20
When a patient transitions, does hospital routinely electronically send/receive (no efax) summary of care with providers? (Check all that apply) % of respondents indicating Yes 100% Send Receive 80% 60% 60% 46% 46% 40% 20% 25% 24% 29% 15% 14% 0% Other hospitals external Ambulatory Care Providers external Long-term Care Providers (internal or external) Behavioral Health Providers (internal or external) 21
Does EHR integrate any type of clinical information received electronically (not efax) from providers or sources outside your hospital system/org without the need for manual entry? Do not know 2.8% Yes 18.3% % of respondents 8. If yes, does EHR integrate info contained in summary of care records w/out manual entry? 26% No 50.5% Yes but not routinely 28.4% Yes, not routine 12% 8% 1% Yes No Do not know 22
Do providers at your hospital routinely have necessary clinical information available electronically from outside providers or sources when treating a patient that was seen by another health provider/setting? Don't know 7% No response 1% Yes 27% No 65% 23
Are providers at your hospital able to query electronically for a patient s health information from sources outside of your organization or system? No, don't have capability 13% Do not know 4% Yes 44% No 38% 24
When a patient visits your Emergency Department, do you routinely provide electronic notification to the patient s primary care physician? Don't know 3.7% % of respondents 10b. If YES, are electronic notifications provided to primary care physicians, as follows? (Check all that apply) 99% Percent (%) Responding Yes No 31.2% 52% Yes 63.3% Inside of your system Outside of your system 25
What is your level of participation with HIE s or HIO s? Actively exchanging data in at least 1 HIE/HIO 55% HIE/HIO operation but we are not participating 22% HIE/HIO is not operational in area 18% Do not know 3% 0% 20% 40% 60% 80% 100% % of respondents 26
What issues are being experienced sending/receiving patient health info to/from organizations? (Check all that apply) External Providers systems lack capability Providers do not have electronic record system Lack of provider directory Cumbersome workflow to send from system Recipients report info not useful Additional costs to send/receive with external org Difficulty identifying patient between systems 57% 51% 44% 37% 34% 28% 23% We lack capability to receive 15% We lack capability to send We don t typically share data 3% 7% 0% 20% 40% 60% 80% 100% % of respondents 27
Does your IT department currently support an infrastructure for two factor authentication (e.g., tokens or biometrics)? No 44% Don't know 2% Yes 54% 28
Do you possess an EHR system that has been certified as meeting federal requirements for the hospital objectives of Meaningful Use? No 2% Don't know 1% Yes 97% 29
On the whole, how would you describe your EMR/EHR system? Selfdeveloped 2% Primarily 1 vendor 73% Mix of products, vendors 25% 30
Primary Inpatient EMR/EHR System to Pennsylvania Hospitals Top Vendors Inpatient Systems 1 HMS 22.0% 2 Epic 21.1% 3 NextGen 17.4% 4 Cerner 10.1% 5 Siemens 8.3% 6 Allscripts/Eclipsys 6.4% 7 Meditech 3.7% 8 CPSI 2.8% 9 GE 1.8% 9 eclinicalworks 1.8% 9 Vitera/Greenway 1.8% 10 McKesson 0.9% 10 Self-Developed 0.9% 31
Do you use the same primary inpatient EHR/EMR system vendor (noted above) for your primary outpatient EMR/EHR system? No 56.0% Yes 41.3% NA 3.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 32
Vendor systems used to exchange patient health information Top Vendors OUTPATIENT Systems 1 My primary Inpatient EMR 45.0% 2 Surescripts 23.9% 3 Relay Health 11.9% 4 Mirth 10.1% 5 Orion Health 8.3% 6 Medicity 6.4% 7 Do not exchange data 5.5% 8 Clinical Connect 4.6% 8 Secure Exchange Solutions 4.6% 8 MobileMD 4.6% 9 Microsoft 3.7% 10 Alare 2.8% 10 MedAllies 2.8% *Other: Openlink IBM Truven Analytics Care Evolution Certify Data Systems Optom/Axolotl ICA Caradigm DrFirst HSX Iatric Infor KeyHIE Medhost PAR80 33
What changes, if any, are you planning for your EHR system within the next 18 months? (Check all that apply) 50.0% 40.0% 30.0% 36% 35% 29% 20.0% 10.0% 12% 9% 2% 2% 0.0% Significant additional functionalities Major change in vendor Don't know Change from best-of -breed to enterprise No major changes planned Changes from enterprise to best-of-breed Initial deployment 34
Primary Challenges in implementing EMR/EHR system that meets MU federal requirements? (Check all that apply) Ongoing costs of maintaining and upgrading Challenge of meeting all MU in timeframe Upfront capital costs Obtaining physician cooperation 66% 60% 59% 52% Lack adequate IT personnel Limited vendor capacity Security/breaches 32% 38% 42% Uncertainty on certification requirements Obtaining other staff cooperation 24% 22% 0% 20% 40% 60% 80% 100% % of respondents 35
Do you use electronic clinical data from EHR/EMR system to do the following? (Check all that apply) Monitor patient safety Support continuous quality improvement process Dashboard-measure organizational performance Individual provider performance profiles Dashboard-measure unit-level performance Reports for strategic planning Adherence to clinical practice guidelines Identify high risk patients; algorithms/tools Clinicians query the data Identify care gaps for patient populations 76% 75% 70% 69% 64% 62% 55% 51% 48% 47% 0% 20% 40% 60% 80% 100% % of respondents 36
Data Source The AHA s Annual HIT survey was fielded to more than six-thousand hospitals nationwide in Winter 2014. In Pennsylvania, 109 general acute care (GAC) hospitals responded to the survey (69% response rate). Sample is broadly representative of all Pennsylvania-licensed general acute care hospitals. An additional 22 non-acute, specialty, and Veterans Affairs hospitals in Pennsylvania also participated in the survey; however, for the purposes of this analysis, their responses have been excluded. 37
Distribution of Pennsylvania Hospital Respondents Bed Size Ownership Pennsylvania Region N (#) 2014 Respondents Total Acute Hospitals 109 159 Less than 100 30% 33% 101 to 250 38% 38% 251-400 12% 13% 400+ 20% 15% Unaffiliated 26% 26% System-Owned 74% 74% West 35% 38% Central 20% 19% Northeast 17% 18% Southeast 28% 25% TOTAL PA 69% 100% 38
The Hospital & Healthsystem Association of Pennsylvania April 2015