Small Practice Physician EMR Adoption

1. Small Practice Physician EMR Adoption Helga E. Rippen, MD, PhD, MPH Chief Health Information Officer Vice President, Clinical Services Group October 2007 Seminole County Medical Society, Florida

2. Agenda • National Directions • The Physician: EMR Adoption in the Small Physician Practice • Summary Disclaimer: This presentation does not represent the views or policies of any agency in the U.S. government

3. National Directions in HIT Nation-wide interoperable health information infrastructure and electronic health record (EHR) available for most Americans within ten years. President George W. Bush, 2004 • Executive Order: • Vision of developing a nationwide interoperable infrastructure • Incentives for the Use of Health Information Technology • Establishing the Position of the National Health Information Technology Coordinator within the Department of Health and Human Services, Office of the Secretary Leavitt’s 500 Day Plan • Transform Health Care System * • Modernize Medicare and Medicaid * • Advance Medical Research* • Secure the Homeland* • Protect Life, Family and Human Dignity • Improve the Human Condition Around the World * HIT as part of the plan

4. Success Is Dependent on Physician Adoption and Consumer Acceptance What factors are important for small practice physician adoption?

5. Agenda • National Directions in HIT • The Physician: EMR Adoption in the Small Physician Practice • Summary

6. Findings Presented Are Part of a Series of Studies Being Commissioned by the Department of Health and Human Services

7. Most Physicians are Not Using EMRs, Especially in Small Practices • Practices between 1-9 physicians account for over 80% of physicians • In practices larger than 9 physicians, adoption rates are significantly higher • For example (Burt and Sisk, 2005):

8. Many Factors Such as Size, Type of Practice, and Compensation Important to EMR Adoption

9. Specialty and Age are Related to EMR Implementation

10. Adopted EMRs Have Broad Range of Functionalities

11. Literature Review and Synthesis: EMR Definitions and Functionalities • Gans’ survey describes the functionalities physicians have adopted and correlates them to practice size

12. Benefits Identified As Important to Physicians Relate to Patient Quality, Revenue Enhancement and Efficiency

13. Barriers to Adoption Included Lack of Capital, Usability, and Productivity Losses

14. The More Advanced the EMR the Greater the Benefits * Wang et al. (2003)

15. There are Many Components of Cost in Implementing an EMR Miller (2005) – costs in this study are higher than those found in Gans study

16. Net Benefits Are Realized After the First Year in One Study Note: Subtracting the above costs from benefits will not equal the author’s annual net benefit figure because some of the above costs are one-time installation costs and will not recur on an annual basis.

17. Agenda • National Directions in HIT • The Physician: EMR Adoption in the Small Physician Practice • Summary

18. Summary • Federal activities focusing on EHR adoption and consumer empowerment • Many challenges to overcome • There is a return on investment within 1-2 years • Accelerating the adoption of EMRs at the small physician office is critical • Model being developed to understand factors critical to implementation to support policy makers • HCA is moving forward in providing affiliated physicians with options for EMRs

19. Develop Understanding of EMR Functionalities Conduct Internal Preparation Identify and Evaluate Potential Vendors Select Vendor and Negotiate Contract Implementation and Beyond • Gain familiarity with common EMR terms • Explore functionalities defined by IOM, CCHIT and others • Understand functionality levels and associated benefits • Conduct internal assessment to assess baseline • Plan for budget and strategy alignment • Map capabilities to goals and requirements • Consider using assessment tools (e.g., checklists, RFPs) • Research and prioritize vendors based on ratings, compatibility, history with small practices, longevity and other factors • Test-drive top 3-4 choices for hands-on experience • Consult with colleagues and conduct site visits • Contract should explicitly state: type, term, products & services included, current & future costs, vendor role and time commitment and other contingencies • Consider hiring IT consultant or software contracts lawyer • Develop timeline for implementation • Train and troubleshoot before going live • Transition from paper to electronic records • Develop historical data migration plan • The process is not over: the landscape is dynamic, and needs will evolve • Practices should celebrate small victories and foster open communication to share lessons within the practice and the community Overview of EMR Implementation Guidance for Physician Offices

20. Questions? Helga.Rippen@hcahealthcare.com 615 344 8128

21. References • Executive Order: http://www.whitehouse.gov/news/releases/2003/01/20030124.html • ONCHIT web site http://www.hhs.gov/healthit/ • American Health Information Community Potential Breakthroughs, October 7, 2005 http://www.hhs.gov/healthit/breakthrough.html • California Healthcare Foundation Survey http://www.chcf.org/topics/view.cfm?itemID=115694 • Assessing the Economics of EMR Adoption and Successful Implementation in Physician Small Practice Settings http://aspe.hhs.gov/sp/07/adoption/index.htm • Audet AM, Doty MM, Peugh J, Shamasdin J, Zapert K, Schoenbaum S. Information technologies: when will they make it into physicians' black bags? Medscape General Medicine 2004;6(4). (Accessed October 17, 2005, at www.medscape.com/viewarticle/493210) • Burt CW, Sisk JE. Which physicians and practices are using electronic medical records? Health Affairs 2005;24(5):1334-43. • Ford, E. W., Menachemi, N., Phillips, M. T, Predicting the adoption of electronic health records by physicians: when will health care be paperless? in the J Am Med Inform Assoc, 2006 Jan-Feb, vol 13, pp 106-12 • Gans D, Kralewski J, Hammons T, Dowd B. Medical groups' adoption of electronic health records and information systems. Health Affairs 2005;24(5):1323-33 • Miller RH, West C, Brown TM, Sim I, Ganchoff C. The value of electronic health records in solo or small group practices. Health Affairs 2005;24(5):1127-37. • Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. American Journal of Medicine 2003;114:397-403.