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CH i R -AZHQ

CH i R -AZHQ. Center for Health Information & Research. Fall 2013 Stakeholder Meeting. agenda. Welcome/Introductions Status of CHiR – Bill Riley & Tameka Sama existing program what’s new & improved Project Updates/Results - Bill Johnson trauma registry

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CH i R -AZHQ

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  1. CHiR-AZHQ Center for Health Information & Research Fall 2013 Stakeholder Meeting

  2. agenda • Welcome/Introductions • Status of CHiR– Bill Riley & Tameka Sama • existing program • what’s new & improved • Project Updates/Results - Bill Johnson • trauma registry • physician, use, exchange & evaluation of EMRs • Q & A • Remarks

  3. welcome & introductions • Name • Position • Organization • Brief statement of affiliation with CHiR • Interests going forward

  4. status of

  5. what hasn’t changed • AZ Board of Regents research center • Multidisciplinary • Neutral source of information • Community resource & tool • HIPAA compliant environment

  6. data sharing partnership principles • Voluntary participation • Business Associate Agreements • Covered entities retain ownership of data • Flexible data submission formats • Covered entities authorize data uses/disclosures • Patients never identified in research output without individual consent

  7. Administrative claims data (ED, inpatient, trauma, outpatient/office visits) Banner Health System Dignity Health: Arizona John C. Lincoln Health Network Maricopa Integrated Health System Mountain Park Health Center Phoenix Children’s Hospital Scottsdale Healthcare Administrative claims data (ED, inpatient, outpatient, office visits) data sources Hospital discharge data (ED & inpatient) State Vital Records (birth/death certificate info) Health Care Workforce Licensing & Survey data Sonora Quest Labs • AZ Medical Board / AZ Board of Osteopathic Examiners • AZ State Board of Nursing • AZ State Board of Pharmacy

  8. data repositories Health Care Workforce Licensing data demographics, education, certifications Survey data Questions differ across licensing cycles Current physician questions: HIT Current nursing/pharmacy questions: Employment status/setting/role Physician surveys optional with licensing applications; Nursing & pharmacy surveys required • Individual level health encounter data on millions of Arizona residents • Geographically-based • Sub-repositories • Data sharing partnerships • Tracks patients across health care systems and over time

  9. what’s new, improved & under development?

  10. vision & objectives Vision Goals Develop new business strategy Expand data architecture Incorporate clinical data (EMR/EHR) Increase available services CHNA, etc. Advance data sharing partnerships • To provide comprehensive health care information for Arizona.

  11. health professional workforce • Practicing Physicians (in state only) • MD -13,508 • DO – 1,700 • Active Nurses • RN = 74,637 • LPN = 10,525 • NP = 4,336 • Pharmacy • Pharmacists – 6,179 • Technicians – 15,984 15,208 Total 126,869 89,498 22,163 Source: http://www.azmd.gov/MediaCenter/MediaFactSheet.aspxhttp://www.azdo.gov/MediaCenter/FactSheet.aspx; Daily Arizona Nursing Statistics, http://www.azbn.gov/; Arizona State Board of Pharmacy 2011-2012 Annual Report, http://www.azpharmacy.gov/pdfs/2012%20annual%20report.pdf.

  12. licensed health care organizations Total 2,903

  13. service opportunities

  14. services we provide

  15. community health needs assessments • Useful for strategic planning, community benefit planning, grant proposals, and federal reporting (IRS). • Uses data at the city and/or county level for specified zip codes • Streamlined Basic Information Report • community demographics • community health care facilities & resources • community health needs (ED/IP use, insurance coverage, injuries, deaths) • primary and chronic disease needs (asthma, heart disease, diabetes, stroke, cancer incidence) • other health issues (behavioral health, risk factors, births) • Data Sources: state hospital discharge data and birth/death records, publicly available data

  16. data requests • Various requests for data from: • university researchers & students • community researchers • providers • insurers • others • Customizable from simple counts of a particular condition to more complex data sets for analysis with multiple variables from multiple sources. • All HIPAA rules and business associate rules apply • Standardized processing fees

  17. health outcomes studies • Most studied area • Defined as “research that seeks to understand the end result of health care delivery.” • Our goal: assist the health sector in reviewing the impact of health care services and improving the quality of care provided to consumers. • multi business associate collaborations

  18. health workforce • Longitudinal data systems to track the physician, physician assistant, nursing and pharmacy workforce in AZ. • Combines survey questions with license applications. • Analyzes and forecasts the supply and demand for these health professionals • Analyzes the impact of health information technology. • Model developed to assist in policy decisions that address workforce needs assessments and relate these to the available training programs in AZ.

  19. current projects& results

  20. AHCCCS/ASETHIE Cooperative Agreement ProgramSeptember 2013

  21. Physician Adoption & Ranking of Electronic Medical Records2007-2013Highlights William G. Johnson, PhDProfessor of Biomedical InformaticsFounder, CHiRGevork HarootunianSenior Statistical Programmer, CHiR Center for Health Information & Research

  22. Acknowledgements I would like to gratefully acknowledge the contributions of Tom Betlach, the Director of AHCCCS; Lorie Mayer, HIT Director, AHCCCS; Jenna Jones, the Executive Director of Arizona Board of Osteopathic Examiners in Medicine and Surgery and Lisa Wynn, the Executive Director of the Arizona Medical Board. The results to be presented today would not have been possible without their dedicated cooperation.

  23. Data Collection Methods • Data collection on physicians began in 1991. (Extended to nurses and pharmacists in 2007.) • Survey data are merged with licensing applications. • Scope of the survey limited by reliance on paper forms until adoption of electronic survey in March, 2012. • Data are collected for in-state and out-of-state physicians. The current report is restricted to in-state physicians. • Physicians with active licenses who are retired, semi-retired or on leave are excluded from the study.

  24. Data Collection March 2012 – April 2013 Source: Arizona Medical Board (AMB), Arizona Board of Osteopathic Examiners (ABOE) Survey and Administrative Data, 2012-2013. Note: Physicians who responded to the survey as retired or semi-retired/on leave were excluded.

  25. Utilization of Electronic Medical Records Center for Health Information & Research

  26. Electronic Medical Records • In 2012-2013, approximately 61% of Arizona physicians who responded to the survey used some type of electronic medical record (EMR) • In 2009-2011, approximately 52% of physicians used EMRs • In the 2007-2009 approximately 45% of physicians used EMRs

  27. Methods of Storing Medical Records 2012-2013 vs. 2007-2009 & 2009-2011 Source: AMB, ABOE Survey Data, 2007-2009; 2009-2011; 2012-2013. Note: 2007-2009, Respondents who did not identify a method of storing medical records (missing): 390 for 2007-2009 and 2,567 for 2012-2013. *Data on “EMR alone or in combination” is not mutually exclusive from other categories.

  28. The Persistence of Paper • Paper records alone declined from 46% to 12% • BUT • Paper & scanned images combined with EMR tripled • Problem of gradual conversion of files • Problem of lack of HIEs so practices with EMRs sharing data on paper/scanned images

  29. EMR Rates by Type of Practice, 2012-2013 (N = 5,323) Source: AMB, ABOE Survey Data, 2012-2013. Note: Rates = % of physicians within each practice type. 1,196 respondents were missing type of practice.

  30. Trends in the Target Population of Physicians without EMRs by County, 2012-2013 vs. 2007-2009 Source: AMB, ABOE Survey Data, 2012–2013.

  31. Summary 2007-2013 • Sources of growth • Incentives/penalties designed to induce increases in use of EMRs • As older physicians retire they are replaced by cohorts trained in use of EMRs (see med school rates) • Decrease in percentage of physicians in solo practice

  32. Utilization of EMR Functions Center for Health Information & Research

  33. Summary Utilization of EMR Functions

  34. The Exchange Problem • Most but not all physicians use the functions included in their EMRs but relatively few who use the functions also exchange the information with others. • Patient care summary is used by approximately 91% of physicians but only 33% of the physicians exchange the information. • The comparable percentages for prescriptions are 89% using the function and 48% exchanging the information. • Public health information: 76% utilization and 31% exchange.

  35. HIE: the next frontier in HIT • EMR use is not universal but the upward trend is well established • Problem: most of the benefits of EMRs require exchanges among organizations • Lack of HIEs and failure of many attempts show need for solutions • HINAZ continues to expand

  36. EMR Software Use and Physician Rankings by Brand Center for Health Information & Research

  37. EMR Use by Vendor ≥ 70 Users Source: AMB, ABOE Survey Data, 2012–2013. Note: The “Other” vendor includes all vendors contracted with government hospitals/clinics. 2,820 physicians did not respond to the survey question on vendor name.

  38. EMR Use by Vendor < 70 Users Source: AMB, ABOE Survey Data, 2012–2013. Note: 2,820 physicians did not respond to the survey question on vendor name.

  39. EMR Users Rankings of All Vendors: (1=awful: 5=outstanding) Source: AMB, ABOE Survey Data, 2012–2013. Note: Physicians practicing in government settings have been excluded from these results.

  40. Summary of Rankings • Despite widespread complaints about EMRs, average ratings are either neutral (3.0) or slightly positive (3.3) • Rankings by vendor generally cluster around the overall means with some notable exceptions

  41. Summary Ranking of Weighted Means by Vendor (N = 4,599)

  42. Summary Ranking of Weighted Means by Vendor (N = 4,599) (cont.) Source: AMB, ABOE Survey Data, 2012–2013. Note: Physicians practicing in government settings have been excluded from these results.

  43. Conclusion • Percentage of physicians with EMRs is higher than national studies suggest, but much of the difference is due to difference in sample characteristics. • Use of EMRs is generally limited to intra-office use with little electronic exchange of EMR data. • Biggest obstacle is the absence of networks for the exchange of EMR data • Variance among counties is very large with some rural counties having utilization rates higher than Maricopa and Pima. • Many topics in the full report have been omitted from this presentation

  44. Next Steps • Current licensing renewal cycle ends in April 2014 • Report on findings 2007-2014 • Create new survey questions to be operational in April 2014 (suggestions welcome) • Avoid asking same questions of same respondents • Emphasize the effects of EMRs on practice • Emphasize the nature of exchanging EMR information & barriers to exchange • Create some separate decision trees for AHCCCS providers

  45. Revising the Survey • Organize a set of meetings to solicit suggestions for the issues to be addressed by the revised survey (October-November 2013) • Draft the new survey and circulate among interested parties for comments (December 2013) • January –March 2014 Software development & testing in cooperation with the licensing boards • April 2014: implement the new survey • YOU ARE ALL INVITED TO PARTICIPATE IN THE DEVELOPMENT PROCESS (sign up sheet is being circulated)

  46. database development and health outcomes study Collaborative effort with the 8 Level 1 Trauma Centers and the Arizona Burn Center to: Collect and merge trauma data into a repository to be used for reference and research as needed for: • comparing processes and outcomes • establishing benchmarks • improving trauma care • meeting the certification requirements of the American College of Surgeons. Trauma Registry Sponsor: Arizona Biomedical Research Commission 2010-2014

  47. Trauma 1 Registry: Falls Mortality William G. Johnson, PhDProfessor of Biomedical InformaticsFounder, CHiRGevork HarootunianSenior Statistical Programmer, CHiR Center for Health Information & Research

  48. Acknowledgements I would like to gratefully acknowledge the contributions of the participating organizations: AZTRACC, ABRC, John C. Lincoln, St. Joesph’s, MIHS, and Scottsdale Trauma. I would also like to specifically acknowledge the contributions of Tracey Sotelo, Executive Director of ABRC, Alicia Mangram, Medical Director of Trauma Services/Critical Care, JCL; James Dzandu, Trauma Research Manager, JCL; Michael Corneille, Trauma Medical Director of Research, JCL and Melissa Moyer, Trauma Registrar, JCL. The Trauma 1 project would not have been possible without their dedicated cooperation.

  49. Overview • Data collected from JCL, Scottsdale, St. Joseph’s, and MIHS trauma centers from 2008-2011. • Patients 60+ with ground level falls are identified and merged across to the ADHS Discharge and Vital Stats datasets. • Trauma level data, demographic data, previous medical history, and death records will be utilized to examine factors associated with mortality after falls. • Relationship of underlying cause of death with fall. • Nature of the cause of fall: mechanical or medical. • Predictive factors for mortality.

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