Electronic health records 040913

EXECUTIVE INSIGHTS MARKETS

Electronic Health Records

2013 1

Contents 1. Overview of Electronic Health Record and Meaningful Use ..............................................................3 1.1 Electronic Health Record .............................................................................................................. 3 1.2

Meaningful Use ............................................................................................................................. 3

2. Potential Benefits of EHR ................................................................................................................5 3. Barriers to Implementing an EHR System ........................................................................................6 4. Current Adoption of EHR in the US ..................................................................................................7 4.1 Adoption of EMR/EHR Systems by Office-based Physicians Has Increased ................................. 7 4.2

Hospital Adoption of EHR Systems Has More than Tripled since 2009 ........................................ 9

2

1. Overview of Electronic Health Record and Meaningful Use 1.1

Electronic Health Record

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.

While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond the standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.

EHRs can: •

Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results

•

Allow access to evidence-based tools that providers can use to make decisions about a patient’s care

•

Automate and streamline provider workflow

Differentiating Electronic Health Records from Electronic Medical Records An Electronic Medical Record (EMR) contains the standard medical and clinical data gathered in one provider’s office. Electronic Health Records (EHRs) go beyond the data collected in the provider’s office and include a more comprehensive patient history.

For example, EHRs are designed to contain and share information from all providers involved in a patient’s care. EHR data can be created, managed, and consulted by authorized providers and staff from across more than one health care organization.

Unlike EMRs, EHRs also allow a patient’s health record to move with him/her - to other health care providers, specialists, hospitals, nursing homes, and even across states.

1.2

Meaningful Use

Meaningful use is the set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides the Department of Health & Human Services (HHS) with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange.

Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.

3

Stages of Meaningful Use To achieve meaningful use and other objectives, eligible providers and hospitals must adopt the certified EHR technology These meaningful use objectives and measures will evolve in three stages over the next five years:

Stage 1

Stage 2

Stage 3

2011-2012

2014

2016

Data capture and sharing

Advance clinical processes

Improved outcomes

Electronically capturing health information in a standardized format

More rigorous health information exchange (HIE)

Improving quality, safety, and efficiency, leading to improved health outcomes

Using that information to track key clinical conditions

Increased requirements for eprescribing and incorporating lab results

Decision support for national high-priority conditions

Communicating that information for care coordination processes

Electronic transmission of patient care summaries across multiple settings

Patient access to selfmanagement tools

Initiating reporting of clinical quality measures and public health information

More patient-controlled data

Access to comprehensive patient data through patient-centered HIE

Using information to engage patients and their families in their care

Improving population health

4

2. Potential Benefits of EHR EHR systems offer the potential to improve care quality and patient safety by enhancing both the quantity and quality of information available to providers for decision making. An EHR system's ability to capture detailed clinical information in a highly structured manner can enable analysis for quality assessment, identification of areas for improvement, and the design of decision support tools like allergy alerts, medication alerts, and other prompts.

EHR can improve patient care by: •

Making information readily available An organization will have immediate electronic access to person- and population-level information, which will help in avoiding duplication of tests, reducing delays in treatment, and informing patients to take better decisions. It has been estimated that 1 in 7 patients have been unnecessarily hospitalized when medical records were not available.

•

Increased quality of care EHRs can help providers increase quality of care through automated population management tools. The power to automate population management, clinical protocols and outreach programs helps providers provide safer, more efficient and more effective care. Tools like a clinical event manager aid providers in monitoring best practice guidelines and clinical protocols, which can be customized by disease state or wellness indicators.

•

Increased patient engagement and patient satisfaction Some EHR solutions provide tools to increase patient engagement and patient satisfaction, which helps improve both clinical outcomes and practice performance. Patient portals, which are offered by select EHR vendors, allow patients to update demographic information, request refills, set appointments and ask a nurse a question. Quality EHR systems also improve patient satisfaction by providing patient education tools and allowing providers to automatically generate email appointment reminders.

•

Increased efficiency and productivity EHR solutions can help expedite physician workflow, increase automation, and improve practice operations, prompting quick and seamless completion of routine tasks. The result is more efficient patient care and higher revenue. An EHR solution that is fully accessible via mobile devices like iPad also helps increase physician speed, resulting in increased productivity.

•

Creating an opportunity for financial incentives Eligible providers (EPs) have the opportunity to earn incentives for the adoption and meaningful use of the EHR technology through either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program. They may earn up to USD44,000 through the Medicare EHR Incentive Program (with an additional 10% bonus for EPs in HPSAs), or up to USD63,750 through the Medicaid EHR Incentive Program. In addition, EPs may also get incentives for e-prescribing with the EHR technology through the CMS eRx Incentive Program.

5

3. Barriers to Implementing an EHR System Despite the many advantages of a more uniform approach to documenting medical care and coordinating care when patients see several specialists, the EHR system is not foolproof Some of the major barriers to implementing EHRs are: •

Difficulty in adding older records to an EHR system Organizations normally pick a start date before implementing their new EHR system, which starts recording the patient data from that particular date and needs manual incorporation of older paper medical records of the patient. Even if, older documents are scanned, they are sometimes hard to read. Also, the process of developing electronic health records requires a plan for the long-term preservation and storage of these records. The required length of storage of an individual electronic health record will depend on national and state regulations, which are subject to change over time. This, in turn, will further complicate the current state of implementation.

•

Privacy There have always been privacy issues with regard to the healthcare system as who has access to medical records. Although, the Federal government has set guidelines that all healthcare organizations will have to comply with in regard to electronic health transactions, there are concerns as to the adequacy of implementation of these standards.

•

Start-up and software maintenance costs At a time when healthcare organizations need to reduce their costs, allocating capital to information systems is still a challenge. There is a high startup cost when transforming a pen and paper system to EHR. Some physicians do not see EHR benefiting their practice in the short run and drag their feet in implementing the system.

Furthermore, software technology advances at a rapid pace. Most software systems require frequent updates, often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only the budget but also workflow. Physicians desire modular upgrades and ability to continually customize, without large-scale reimplementation.

Training employees to use an EHR system is costly, just as training them to use any other hospital system. New employees, permanent or temporary, will also require training as they are hired.

6

4. Current Adoption of EHR in the US 4.1

Adoption of EMR/EHR Systems by Office-based Physicians Has Increased

Some of the key observations included are: •

Use of EMR/EHR system among office-based physicians increased to 72% in the preliminary 2012 estimates from 18% in 2001, a 26% increase over the 2011 estimate (57%)

•

About 40% physicians reported having a system that met the criteria for a basic system, a 17% increase over the 2011 estimate (34%)

•

In 2012, 66% office-based physicians reported that they planned to apply, or already had applied, for "meaningful use" incentives

•

In 2012, 66% of physicians intended to participate [i.e., already applied (41%) or intended to apply (25%)] in the Medicare or Medicaid incentive program

•

The proportion of physicians intending to participate rose to 66% in 2012 from 52% in 2011

Percentage of office-based physicians with EMR/EHR systems: United States, 2001–2010 and preliminary 2011–2012 80 71.8 Perrcent of physicians

60

57.0 48.3

51.0

42.0

40

39.6

34.8 20.8

17.3

20 18.2

33.9

29.2

27.9

23.9

21.8 16.9

17.3

10.5

11.8

0 2001

2002

2003

2004

2005

2006

Any EMR/EHR system

2007

2008

2009

2010

2011

2012

Basic System

Source: CDC/NCHS, National Ambulatory Medical Care Survey, 2001–2012.

7

•

In 2012, the percentage of physicians using any EMR/EHR system varied by state, ranging from 54% in New Jersey to 89% in Massachusetts

•

Compared with the national average (72%), the percentage of physicians using any EMR/EHR system was lower in 4 states (Connecticut, Illinois, Louisiana, and New Jersey) and higher in 11 states (Arizona, Delaware, Hawaii, Iowa, Massachusetts, Minnesota, North Carolina, North Dakota, South Dakota, Utah and Wisconsin)

•

The percentage of physicians who had systems meeting the criteria for a basic system, by state and the District of Columbia, ranged from 22% in the District of Columbia to 71% in Wisconsin

•

The percentage of physicians who had systems meeting the criteria for a basic system was lower in the District of Columbia and six states (Connecticut, Georgia, Kentucky, Louisiana, Maryland, and New Jersey) and higher in seven states (Iowa, Massachusetts, Minnesota, North Dakota, South Dakota, Utah and Wisconsin) compared with the national average (40%)

Percentage of office-based physicians intending to participate in meaningful use incentive programs, by state: United States, preliminary 2012

Source: CDC/NCHS, National Ambulatory Medical Care Survey, 2001–2012

8

4.2

Hospital Adoption of EHR Systems Has More than Tripled since 2009

Some of the key observations included are: •

Hospital adoption of at least a Basic EHR system more than tripled since 2009, increasing to 44% in 2012 from 12% in 2009. This represents a 61% increase from the previous year and a more than three-fold increase in EHR adoption since 2009

•

The percentage of hospitals possessing a certified EHR technology increased by 18% between 2011 and 2012, rising to 85% from 72%

•

In addition to growth in overall EHR adoption, hospital adoption of advanced functionality has increased significantly. Hospital adoption of comprehensive EHR systems has increased more than six-fold in just three years

Percentage of non-federal acute care hospitals with adoption of at least a Basic EHR system and possession of a certified EHR: 2008-2012 90 85.2 80 71.9

Perrcent of Hospitals

70 60 50

44.4

40 30

27.6

20 10

9.4

12.2

15.6

0 2008

2009 Basic EHR System

2010

2011

2012

Certified EHR

Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement

9

•

State rates of hospital adoption of at least a Basic EHR system ranged from 21% to 71% (Table 1). o

South Dakota (71%), Rhode Island (69%), and Colorado (68%) had the highest percentage of hospitals with adoption of at least a Basic EHR system

o

New Hampshire (21%), New Mexico (26%), and Kansas (26%) had the lowest percentage of hospitals with adoption of at least a Basic EHR system

•

Hospital adoption of at least a Basic EHR system was significantly higher than the national average in 12 states (Colorado, Illinois, Indiana, Maryland, Massachusetts, Michigan, Minnesota, Ohio, Rhode Island, South Dakota, Virginia, and Wisconsin)

•

Hospital adoption of at least a Basic EHR system was significantly lower than the national average in 11 states (Alabama, Kansas, Kentucky, Maine, Montana, New Hampshire, New Mexico, Oklahoma, South Carolina, Tennessee, and Texas)

•

Hospital adoption of Comprehensive EHR systems has increased six-fold since 2009, rising to 17% in 2012

•

From 2009 to 2012, hospital adoption of at least a Basic EHR without Clinician Notes more than tripled, increasing to 56% from 16%

State percentage of non-federal acute care hospitals with adoption of at least a Basic EHR system compared with the national average (44.4%): 2012

Source: ONC/AHA, AHA Annual Survey Information Technology Supplement

10