Jessica JacobsSeptember 15, 2010

Ambulatory Electronic Health

Records

Adoption Trends2005-2010

• Ambulatory providers are physicians who perform the majority of their services outside the hospital– No more than 90% of their services are

performed at a hospital

• Currently there are 200,0000 physician offices, 515,000 total practicing ambulatory physicians*

What does Ambulatory Mean?

https://questions.cms.hhs.gov/app/answers/detail/a_id/9844/~/[ehr-incentive-program]-are-physicians-who-practice-in-hospital-basedNote: Excludes radiologists, pathologists, anesthesiologists, ER and all other hospital-based physicians

In other words…

Them Not Them

• An Electronic Health Records (EHR) is “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.” – HIMSS, 2010

• Colloquial Definition – Computer records in a doc’s officesthat can talk to pharmacies, has decision support, talks to hospitals, improves quality, decreases costs, and saves the

world

What is an EHR?

Adoption DefinitionsA

ny • Any EHR

Adoption

Basi

c • Patient Demographics

• Problem Lists

• Clinical Notes

• Rx Orders• Lab Results • Imaging

Results

Full • All Basic

Requirements

• Medical History/Follow Up

• Test Orders• Rx/Test

Orders sent Electronically

• Drug/Drug Interactions

44% 21% 6%

2004 2005 2006 2007 2008 2009 2010 20110.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

EHR Adoption RatesAccenture, Any (Small Practices)

xxx, Any (Internal Medicine)

Kemper, Any (Pediatricians)

Modern Medicine, Any (PCP)

NAMCS, Any

Simon et al, All (Physician Practices)

SK&A, Any

DesRoches, Basic (All Physicians)

NAMCS, Basic

Accenture, Full (Small Practices)

DesRoches, Full

NAMCS, Full

Adoption DefinitionsA

ny • Any EHR

Adoption

Basi

c • Patient Demographics

• Problem Lists

• Clinical Notes

• Rx Orders• Lab Results • Imaging

Results

Full • All Basic

Requirements

• Medical History/Follow Up

• Test Orders• Rx/Test

Orders sent Electronically

• Drug/Drug Interactions

44% 21% 6%

• The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was a part of ARRA

• Allocated funds to spur the adoption of electronic health records - mostly administered through ONC and CMS

• Incentive Payments for Meaningful Use are administered through CMS– Medicare: Maximum Incentive = $44k/physician– Medicaid: Maximum Incentive = $63k/physician– Incentives will be paid 2011- 2016, then penalties will begin

• Meaningful Use Rules were released July 13, 2010

HITECH… and Meaningful Use

Basically…

2004 2005 2006 2007 2008 2009 2010 20110.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

50.00%

EHR Adoption RatesAccenture, Any (Small Practices)

xxx, Any (Internal Medicine)

Kemper, Any (Pediatricians)

Modern Medicine, Any (PCP)

NAMCS, Any

Simon et al, All (Physician Practices)

SK&A, Any

DesRoches, Basic (All Physicians)

NAMCS, Basic

Accenture, Full (Small Practices)

DesRoches, Full

NAMCS, Full

• The rates of ambulatory adoption have risen significantly over the past five years

• Unfortunately that increase in adoption has not translated into “meaningful” adoption

• The current rate of meaningful adoption is 6.3%, hopefully new rules and certifications will help increase this percentage

Key Take-Aways