Electronic Health Records in Ambulatory Care

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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

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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

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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

(4)

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?

(5)

Methods

Measure of adoption

Survey sample: 2758(62%) of 4484 eligible resp ondents completed the survey.

Statistical analysis

(6)

Results

Survey respondent

Factors associated with availability

Frequency of use, capabilities, effect on pr actice, physician satisfaction…

Barriers to adoption

Facilitators of adoption

(7)

Discussions

Cost effects

Previous studies

Challenges

Contribution

EHR in Taiwan

(8)

Methods

(9)

Survey Development

survey research

health-information technology

health care management and policy

representatives of hospital and physician gr oups and organizations

(10)

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

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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

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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

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Results

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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

(16)

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)

(17)

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.

(18)
(19)
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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.

(21)

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.

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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

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Effect on Practices

(24)

Effect on Practices

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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%

(26)

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%

(27)

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%

(28)

Discussion

(29)

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

(30)

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

(31)

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

(32)

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

(33)

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

(34)

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

(35)

Prospect 

the potential benefits

low current availability

major challenges

in taking full advantage of electronic health records to realize its health care goals.

(36)

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

(37)

Benefit of EHR

lower overall national health expenditures

-physicians use computers over 90%

-a variety of interventions

(38)

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.

(39)

Contribution

our study informs the debate by providing be nchmark information about the levels of adop tion of electronic health records by U.S.

(40)

EHR in Taiwan

(41)

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%)

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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

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Thanks for your

attentio

n

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References

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