Catherine M. DesRoches, Dr.P.H., Eric G. Campbell, Ph.D., Sowmya R. Rao, Ph.D., Karen Donelan, Sc.D.,
Timothy G. Ferris, M.D., M.P.H., Ashish Jha, M.D., M.P.H., Rainu Kaushal, M.D., M.P.H., Douglas E. Levy, Ph.D., Sara Rosenbaum, J.D., Alexandra E. Shields, Ph.D., and
David Blumenthal, M.D., M.P.P.
Electronic Health Records in Ambulatory Care
– A National Survey of Physicians
Outline & Speakers
Abstract
陳玟妤
Methods
陳柏安、周鈺翔
Results
郭泰源、許茗鈜
Discussion
魏逸昕、賴志豪、章偉恩
Introduction
EHRs have the potential to improve the deliver y of health care services.
Recently, the adoption by physicians range fro m 9 to 29%
Goal:
Gather accurate information on current levels of adoption
Provide survey items that could be used to genera te similar data
Questions addressed in this report…
Outpatient EHRs are available to physicians in office practice?
How physicians are satisfied with such syste m?
The quality of care which these systems can provide to the patients?
Methods
Measure of adoption
Survey sample: 2758(62%) of 4484 eligible resp ondents completed the survey.
Statistical analysis
Results
Survey respondent
Factors associated with availability
Frequency of use, capabilities, effect on pr actice, physician satisfaction…
Barriers to adoption
Facilitators of adoption
Discussions
Cost effects
Previous studies
Challenges
Contribution
EHR in Taiwan
Methods
Survey Development
survey research
health-information technology
health care management and policy
representatives of hospital and physician gr oups and organizations
Developing a Measure of Adoption
Fully functional system
1.Recording patients' clinical and demographic data 2. Viewing and managing results of laboratory tests 3. Imaging, managing order entry
4. Supporting clinical decisions
1. No order-entry capabilities 2. No clinical-decision support
Basic system
000. Practice Characteristics
100. Use of computers in your main practice site
200. Acquisition and Implementation of an EHR system 300. Experience with Electronic Health Records
400. Use of E-mail
500. Barriers to EHR adoption 600. Incentives for EHR adoption
900. Physician and practice characteristics
Survey Sample and Administration
2007 Physician Masterfile of the American Medical Association (AMA)
2758
Physicians 4484 Physicians 5000 Physicians
Statistical Analysis
1.
Evaluation of the association between t he characteristics of physicians and th eir practices with the availability of electronic health records
2.
Association with the availability of el ectronic health records and the positiv e effect of EHR
3.
Satisfaction with EHR
4.
Barriers to and facilitators of adoptio
n
Results
SURVEY RESPONDENTS(I)
Respondents Percent
fully functional ERS
basic system
No using ERS 4%
83%
13%
fully ERS
Integrated non-In- tegrated
Basic ERS
Integrated non-In- tegrated 71%
29%
56%
44%
Reported using integrated system at the hospital where they admit patients
Respondents Percent
fully functional ERS
basic system
No using ERS 4%
83%
13%
No using ERS
Purchased Intended to purchase N.A.
16%
58% 26%
Reported that their practice had purchased but not yet implemented such a system
at the time of the survey.
Respondents said that their practice intended to
purchase an electronic- records system within the
next 2 years.
SURVEY RESPONDENTS(II)
Factors Associated with Availability
In multivariate analyses, having an electronic records system that applying to both individua l physicians and their practices.
The systems are used by physicians who were yo unger, worked in large or primary care practic es, worked in hospitals or medical centers, an d lived in the western region of the United St ates.
The providers served rates of adoption is dif ferent from with less patients who were uninsu red or receiving Medicaid.
Frequency of Use
The Percent of doctor using ERS
fully functional ERS
basic system
No using ERS 4%
13%
83%
97% reported using all the functions at least some of the
time.
99% reported using all the functions at least some of the
time.
Other Capabilities
Physicians with EHRs were asked to report th e extent to which these systems allowed pati ents to do each of the following online:
View and make changes to their medical recor ds and request prescription refills, appoint ments, and referrals.
Enabling patients to request a prescription refill online was a prevalent function for b oth basic systems and fully functional syste ms.
Extent Problems
HE ALT H I NF ORM
AT ION T EC HN OL OGY
IM PLE ME
NT AT ION A SS IS TA NC E
(a)Health Information Technology Extension Program-
To assist health care providers to adopt, implement, and effectively use certified EHR technology that allows for the electronic
exchange and use of health information…
(b) Health Information Technology Regional Extension Centers-
IN GENERAL- The Secretary shall provide assistance for the creation and support of regional centers (in this subsection referred to as
regional centers') to provide technical assistance and disseminate best practices and other information learned from the
54% Finding an EHR to meet needs 44% Concerns of obsolescence
39% Capacity to implement
41% Transition productivity loss
[Reference] Health IT and Patient Safety: ONC Context David R. Hunt, MD, FACS
Chief Medical Officer and Acting Director, OHITA Office of the National Coordinator for HIT
Effect on Practices
Effect on Practices
Physician Satisfaction
Large majority of physicians reported being sati sfied with their electronic-records systems.
Fully ERS more likely to be satisfied with the r eliability of their system than Basic ERS.
Fully ERS
Satisfy non-Sat- 93% isfy
7%
Basic ERS
Satisfy non-Sat- 88% isfy
12%
Barriers to Adoption
The common barriers to adoption among physicians who did not have access to an electronic-records system.
1. Capital costs—66%
2. Not met physicians’ need—55%
3. Uncertainty about ROI—50%
4. System become obsolete—44%
Facilitators of Adoption
The factors that were most frequently cited as fa cilitators of adoption.
1. Financial incentives for the purchase
With ERS—46%
Without ERS—55%
2. Payment for use
With ERS—52%
Without ERS—57%
Discussion
Review
EHR are available in the office setting to o nly a small minority (17%) of U.S. physician s at present.
- 3% basic
-14% fully functional
The effects of group size
Size of the group had a significant influenc e on the adoption of electronic health recor ds
-Large groups with the basic system is th ree
times that of a small groups
-Large groups with the full functional sy stem
is four times that of a small groups
What’s encouraging
The quality of their practice and clinical d ecisions and about their satisfaction with t he system are encouraging
More capable systems offer greater benefits
Bias among early adopters especially greater receptivity to and facility with electronic health records cannot be excluded
Note
The quality and cost effects of electronic h ealth records need to be confirmed by direct studies of clinical outcomes
The overall effect of electronic health reco rds and research needs to clarify the effect s of this technology on our health care syst em
Satisfaction
large majority of respondents reported overa ll satisfaction with their electronic-record s system
Easy to use?
20% with basic systems expressed reservations
Improving the usability of electronic health records may be critical
Compare with other system
Adopting the similar definition
National Ambulatory Medical Care Survey
9.3% in 2006 (NAMCS)
14% in 2007-2008 (This paper)
Enable future researchers to gauge progress in the adoption
Prospect
the potential benefits
low current availability
major challenges
in taking full advantage of electronic health records to realize its health care goals.
The government’s attitude
President Bush
ERS should be widespread by 2014
both of the likely presidential candidates
Medicare cost-containment proposals included i ncentives as a means of spurring greater use.
The cost is high, the resource is uncertain
hundreds of billions of dollars
Benefit of EHR
lower overall national health expenditures
-physicians use computers over 90%
-a variety of interventions
Limitation
response bias
- physicians responded to our survey had a g reater interest than did nonresponders
small number of respondents
-in their diffusion, the respondents with th ese systems are probably different from resp ondents without them.
Contribution
our study informs the debate by providing be nchmark information about the levels of adop tion of electronic health records by U.S.
EHR in Taiwan
EHR in Taiwan(cont.)
推動實施電子病歷子計畫
電子病歷推動現況 ( 統計到 100 年底 )
共 590 家醫院
績效指標 衡量標準 年度目標值
97 98 99 100 醫療院所實
施電子病歷 比例
( 醫院使用電子病歷之家
數/所有醫院數 )*100% - 1% 5% 10%
關卡
1 已宣告實施電子病歷且向衛生局報備 274家 (46%) 關卡
2 已通過電子病歷檢查 208家 (35%)
關卡
3 已通過資訊安全制度 ISO27001:2005 驗證 93 家 (16%) 關卡
4 已通過跨院交換互通查驗 150家 (25%)
Source Information
• From the Institute for Health Policy (C.M.D.
, E.G.C., S.R.R., K.D., D.E.L., A.E.S., D.
B.) and the Massachusetts General Physicians Organization (T.G.F.), Massachusetts General Hospital; and Harvard Medical School (A.J.)
— both in Boston; Weill Cornell Medical Col lege, New York (R.K.); and the Department of Health Policy, George Washington University, Washington, DC (S.R.).
• 行政院衛生署 電子病歷推動專區
http://emr.doh.gov.tw