EHR Adoption in the Ambulatory Setting

1. EHR Adoption in the Ambulatory Setting Summary of Findings C. DesRoches, E. Campbell, S. Rao et. al., Electronic Health Record Adoption in the Ambulatory Setting: Findings From a a National Survey of Physicians NEJM (online June 18, 2008; print edition June 26th, 2008) Presented by Sara Rosenbaum Hirsh Professor and Chair, Department of Health Policy The George Washington University School of Public Health and Health Services The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

2. Research Questions • What proportion of U.S. physicians have EHRs available to them? • How satisfied are physicians with EHRs? • What impact, if any, do physicians believe EHRs have on practice? The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

3. Methodology • Define key functions of EHR using evidence-based studies and expert consultation. • Fully functional: recording patient information and demographics, results viewing and management, order entry management including e prescribing, and clinical decision support • Basic: absence of certain order entry and clinical decision support capabilities • Conduct survey (August 2007-March 2008) of representative sample of physicians providing direct ambulatory patient care from the AMA Masterfile: 61% rate of return among 4,484 survey recipients. • Key characteristics considered in relation to EHR use: gender, ethnicity, race, number of years in practice and specialty, practice size, setting, location, and region. Characteristics of responders mirror all eligible physicians. The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

4. Finding: Current Level of Adoption Among Ambulatory Physicians No Functional EHR 83% • 17% purchased system but not yet implemented • 26% intend to purchase within 2 years The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

5. Percentage of Physicians Reporting Positive Impact of EHR, by Activity The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System * Difference between fully functional and basic is significant at p < .05

6. Percentage of Physicians Reporting Positive EHR Impact, by Activity The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System * Difference between fully functional and basic is significant at p < .05

7. Physician Satisfaction with EHRs Percent of physicians very or somewhat satisfied The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

8. Physician Perceived Adoption Barriers: Economic and Practice Percent of physicians reporting a “major barrier” The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

9. Physician Perceived Adoption Barriers: Legal Percent of physicians reporting a “major barrier” The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

10. Physician Perception of Adoption Incentives Percent of physicians reporting incentive would have an impact The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System

11. Conclusions • Basic EHRs in use by 13% of U.S. Physicians, with full functionality for only 4%. • Physicians who use EHRs report high degree of satisfaction in relation to measures of practice improvement and health care quality. Representative nature of adopters suggests potential of EHRs to reach a wide audience. • Serious perceived barriers, most important of which are economic and operational in nature. Legal concerns remain a measurable barrier. • Achieving greater adoption will take a combination of financial, practice, and legal incentives, combined with significant operational support. The George Washington University School of Public Health and Health Services The Institute for Health Policy at MGH/Partners Health System Division of Internal Medicine at the Brigham & Women’s Hospital Clinical and Quality Analysis Group of Partners HealthCare System