Computing in the Physician's Practice

91
A Survey of Over 750 Physicians Conducted by Harris Interactive Inc. Data collected: October 14, 1999 - December 31, 1999 Revised presentation of findings March 13, 2000 Computing in the Physician’s Practice “40% of physicians use Internet for clinical or medical business use”

description

199 Harris Interactive study of use of computing by physicians--the most comprehensive of its times (and probably to this day)

Transcript of Computing in the Physician's Practice

Page 1: Computing in the Physician's Practice

A Survey of Over 750 Physicians

Conducted by Harris Interactive Inc.Data collected:October 14, 1999 - December 31, 1999

Revised presentation of findingsMarch 13, 2000

Computing in the Physician’s Practice

“40% of physicians use Internet for

clinical or medical business use”

Page 2: Computing in the Physician's Practice

2

Aims of the Study

CPP is the most comprehensive study ever of physicians and information technology--more than 750 physician respondents making it 2 to 3 times the size of a typical physician survey.

Study focuses on four major issues

Physicians’ (and their administrative and clinical staff’s) use of the Internet Physicians’ and their practices staff’s use of computing, the Internet and private

networks for administrative tasks Physicians’ and their practices staffs’ use of computing, the Internet and private

networks for “administrative clinical” tasks Physicians use of computers and the Internet for clinical tasks, and their use of the

“Electronic Medical Record

Subsequent study of “power-users” in field February 2000. Where applicable, trended data from previous Harris surveys are noted.

Page 3: Computing in the Physician's Practice

3

Survey Methods

A random sample of 5,000 physicians was selected from the American Medical Association database including specialists and generalists.

Mail surveys were sent to physicians along with letters describing the survey and offering an incentive in October and November. A reminder postcard was sent in December.

Physicians were given the option of either completing the survey on paper and mailing or faxing it back to Harris, or choosing to do it online. A URL address was included in the invitation that allowed them to access the survey on the Internet. To ensure confidentiality, interviewing was conducted on Harris’ password protected website.

Over 750 physicians responded (769 in data set presented here).

Page 4: Computing in the Physician's Practice

4

Overview of Results

Physicians are very encouraged by the actualities as well as the possibilities of computers--most believe that computers have had a positive impact on medicine already.

The Internet is a big deal for physicians, and it’s not all stock trading and golf tips. They are using it for clinical and business purposes too.

Practice administration is more computerized than is commonly realized, although there is significant room for more automation.

Clinical use of computing is still lagging behind, particularly in the core of the “Electronic Medical Record” but most physicians are optimistic about big changes in the next five years.

Overall, the physician market looks ripe for take off.

Page 5: Computing in the Physician's Practice

Preface:

Practice Issues and Experience with Patient Care “Utilization review,

patient relationship continuity, and time pressure on patient

care are all concerns”

Page 6: Computing in the Physician's Practice

6

Overview of practice issues and experience with patient care

The study starts with some basic metrics about physicians in practice.

Physicians are seeing many more managed care patients than they did just two years ago.

Their biggest problems are lower revenues and more hassle from managed care BUT communications and transactions problems, especially around patient eligibility, formularies, and reporting to third parties, are the next most significant issues.

Utilization review, patient relationship continuity, and time pressure on patient care are all concerns but less severe.

This survey sample has typical physician income characteristics (similar to previous Harris surveys in 1997 and mid-1999).

Page 7: Computing in the Physician's Practice

7

9%

22%

9%

23%

36%

8%

14%

7%

19%

51%

0% 10% 20% 30% 40% 50% 60%

Uninsured

Non-discounted commercial FFS

Fee-for-service Medicaid

Fee-for-service Medicare

Managed care: commercial HMOs, PPOs, (incl. Medicare &Medicaid HMOs)

1997 1999

Since 1997: A big jump in the number of managed care patients

Q.A2 What percentage of your patients are in each of the following insurance categories?

Mean percent of patients in each category

Asked of all physicians (n = 769)

Page 8: Computing in the Physician's Practice

8

Besides managed care, physicians are concerned about administrative costs and systems hassles

Q.A1 Please indicate how much of a problem the following has been for you in your practice.

Percentage of physicians who experienced serious problems with:

40%

44%

49%

59%

60%

69%

79%

84%

31%

40%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Accessing previously recorded patient information

Problems with prescription regimens for patients

Pressure to see more patients than appropriate

Continuity of patient relationships

External review of clinical decisions for purpose of controlling costs

Documentation and reporting to third parties

Complying with pharmaceutical formularies

Communicating with health plans about patient eligibility and referrals

Managed care and/or Medicare increasing practice's administrative costs

Managed care and/or Medicare reducing practice's revenues

Asked of all physicians (n = 769)

Page 9: Computing in the Physician's Practice

9

Practice income: 1997 - 1999Q.F1 Which of the following income categories best describes your last year’s pre-tax income from your medical practice?

SHP1997

SHP1999

CPP1999

305 120 769% % %

$75,000 or less 7 8 6

$75,001 to $100,000 12 12 9

$100,001 to $125,000 14 9 11

$125,001 to $150,000 13 21 11

$150,001 to $175,000 11 13 11

$175,001 to $200,000 9 9 9

$200,001 or over 28 27 26

Decline to answer 6 - 17

Asked of all physicians (n = 769)

Page 10: Computing in the Physician's Practice

10

Geographic setting of practiceQ.F4 How would you describe the geographic setting of your practice? Is it an urban center, a suburb, a small town or a rural location?

SHP1994

SHP1999

CPP1999

2003 336 769% % %

Urban center 43 36 38

Suburb 30 39 34

Small town 18 20 22

Rural 8 5 5

Don’t know/refused 1 - 1

Asked of all physicians (n = 769)

Page 11: Computing in the Physician's Practice

Part One:

Attitudes about Computing and Internet Use

“Over one-third of physicians have

access to the Internet in their clinical work

area”

Page 12: Computing in the Physician's Practice

12

Overview of attitudes about computing, and physicians use of the Internet

Physicians are surprisingly positive about the impact of computers on medicine, although they are more conscious of the problems hindering information technology than they were two years ago.

89% of physicians use the Internet (including email), with the average online physician using it over 6 hours per week.

Most physician Internet use is at home, and most is for personal use BUT 40% is for clinical or medical business use, and the majority of that happens in the practice setting, mostly in their personal office.

Over one third of physicians (and slightly more of their staff) have access to the Internet in their clinical work area.

As with other Internet users, email is the docs’ killer app--50% use it with professional colleagues, but many fewer use it with patients.

Page 13: Computing in the Physician's Practice

13

Physicians have a positive attitude towards computing

Q.A7 Which one of the following statements best reflects how you feel about the use of computers in medicine?

769%

Computers make the practice of medicine easierand improve the quality of care delivered.

57

Computers have done little so far to make thepractice of medicine easier or improve the qualityof care delivered, but will have a significantpositive impact in the next two to five years.

36

Computers have done little so far to make thepractice of medicine easier or improve the qualityof care delivered, and will NOT have a significantpositive impact for at least five more years.

6

Not sure 2

Asked of all physicians (n = 769)

Page 14: Computing in the Physician's Practice

14

Hindrances to information technology use

Q.A8 To what extent is your current use of information technology hindered by each of the following - to a great extent, some extent, or hardly at all?

% Responding “Great/Some Extent”

SHP1997

CPP1999

305 769% %

Lack of capital for adequate investment 53 69

Lack of computer literacy 54 60

The inability to purchase systems designed forreal-world practice environments

52 71

Lack of compatibility between systems acrosshealth care organizations

56 75

The inability to find or afford adequately trainedstaff

45 68

Asked of all physicians (n = 769)

Page 15: Computing in the Physician's Practice

15

Nine in ten physicians are online

89%

50%

38%

34%

51%

83%

0% 20% 40% 60% 80% 100%

Total physicians with Internet access

The administrative staff in my office

Other clinical staff in my clinical work area

Myself, in my clinical work area

Myself, in my personal office area

Myself, at home

% currently accessing Internet in following places:

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Page 16: Computing in the Physician's Practice

16

32%

12%

56%

No Not Sure Yes

No access17%

Have access83%

No access Have access

The vast majority of physicians now have access to the Internet at home . . . most of the rest will soon

Will have access within 18 months

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Physicians saying they have Internet access at home

Page 17: Computing in the Physician's Practice

17

No access50%

Have access50%

No access Have access

52%

12%

37%

No Not Sure Yes

Will have access within 18 months

Half of physicians’ offices have Internet access in their administrative areas . . .

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Physicians saying their office staff has Internet access in their administrative areas

Page 18: Computing in the Physician's Practice

18

No access49%

Have access51%

No access Have access

44%

12%

44%

No Not Sure Yes

. . . and half of physicians have access to the Internet in their personal office area

Will have access within 18 months

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Physicians saying they have Internet access in their personal office area

Page 19: Computing in the Physician's Practice

19

No access66%

Have access34%

No access Have access

61%

12%

28%

No Not Sure Yes

Will have access within 18 months

But only one-third of physicians have Internet access in their clinical work area . . .

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Physicians saying they have Internet access in their clinical work area

Page 20: Computing in the Physician's Practice

20

No access62%

Have access38%

No access Have access

60%

13%

28%

No Not Sure Yes

Will have access within 18 months

. . .although slightly more of their clinical staff have Internet access in their clinical work area

Asked of all physicians (n = 769)

Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

Physicians saying their clinical staff has Internet access in their clinical work areas

Page 21: Computing in the Physician's Practice

21

The average online physician uses the Internet 6 hours per week

Q.B3 In the past week, how many hours did you personally spend using the Internet (or other online services) for all purposes, including business, personal, email, etc.?

1%

13%

45%

31%

10%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Not sure

More than 10 hours

4-10 hours

1-3 hours

None

Hours spent online in past week by physicians with Internet access Mean = 6 hours

Median = 5 hours

Asked of all physicians with Internet access (n = 687)

Page 22: Computing in the Physician's Practice

22

Why are physicians accessing the Internet? It’s mostly personal

Average number of hours on Internet in past week = 6

% of physicians’ Internet use for different functions

Personal use61% Business,

administrative or organizational

issues relating to practice

16%

Specific clinical work relating to individual

patients8%

General clinical information

15%

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following?

Asked of all physicians who used Internet in past week (n = 612)

Page 23: Computing in the Physician's Practice

23

Physicians’ use of the Internet: “What” depends on “Where”

Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

Athome

In mypersonal

officespace

In myclinical

work area Other Total% % % % %

To look for general clinicalinformation, like a Medlinesearch

51 36 11 2 100

Specific clinical work relating toindividual patients (e.g, emailconsultations with colleaguesor patients, prescriptionordering, etc.)

33 46 17 4 100

Business, administrative andorganizational issues related toyour practice

40 45 12 2 100

Personal use 82 14 3 1 100

% of time where physicians used the Internet for the following:

Asked of all physicians who used Internet in past week (n = 612)

Page 24: Computing in the Physician's Practice

24

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

Physicians are on E*trade, ESPN and Match.com, especially at home

Calculated from physicians who used Internet for personal use in the past week (n = 573)

Personal use = 61% of all Internet use

At home50%

Personal office area9%

Clinical work area3%

% of time physicians spend on Internet for personal use in the following locations:

Page 25: Computing in the Physician's Practice

25

Specific clinical work relating to individual patients = 8% of all

Internet use

The little Internet clinical work about individual patients that is done, happens mostly in physicians’ personal

office area

Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219)

Personal office area4%At home

2%

Clinical work area1%

Somewhere else1%

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

% of time physicians spend on Internet for specific clinical work relating to individual patients in the following locations:

Page 26: Computing in the Physician's Practice

26

Both at home and at work, doctors are using the Internet for the business of medicine . . .

Somewhere else1%

Clinical work area2%Personal office

area6%

At home6%

Business, administrative and organizational issues relating

to practice = 16% of all Internet use

Calculated from physicians who used Internet for business, administrative and organizational issues relating to practice in the past week (n = 335)

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

% of time physician spends on Internet for business administrative and organizational issues relating to practice in the following locations:

Page 27: Computing in the Physician's Practice

27

. . .and it’s also used for to look for general clinical information

Clinical work area2% Personal office

area6%

At home8%

Specific clinical work relating to individual patients = 16% of all

Internet use

Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219)

Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet:

% of time physician spends on Internet for specific clinical work relating to individual patients in the following locations:

Page 28: Computing in the Physician's Practice

28

Practice has website

32%

Practice does not

have website68%

Practice has website Practice does not have website

Websites: Not all physicians have them . . .

Q.B5 Does your practice have a website?

Asked of physicians who have Internet access somewhere in their practice (n = 706)

% of physicians with a website

Page 29: Computing in the Physician's Practice

29

Practice has website

32%

Practice does not

have website68%

Practice has website Practice does not have website

66%

3%

31%

No Not Sure Yes

Practice will have web site within 18 months

. . . but many more will get them

Q.B5 Does your practice have a website? Q.B5A If your practice does not currently have a website, do you anticipate getting one within the next 18 months?

Asked of physicians who have Internet access somewhere in their practice (n = 706)

Page 30: Computing in the Physician's Practice

30

Group SizeTotal No group 3-9 10-24 25+769 304 240 80 132% % % % %

Professional colleagues 51 37 50 63 74

Do not use email to communicate withany of these groups

42 52 43 34 21

Your support staff 25 11 23 43 52

Your patients 13 12 10 15 19

Health plans, IPAs or other payers 8 5 8 8 17

Not sure 4 8 3 1 2

Email is common with colleagues, but is rare with patients; both are more frequent in big group practices

Q.D1 Please indicate if you use email to communicate with any of the following:

Asked of all physicians (n = 769)

% of physicians using email with community

Page 31: Computing in the Physician's Practice

31

Reasons physicians may not use email with patients

QD2. Please indicate which of the following is a reason why you might NOT use email for communications between your patients and your office?

769%

My patients haven’t requested the ability to email me 63

Email to patients is not secure enough to use forconfidential information

56

Email from patients will increase my workload with noadditional compensation

50

Email from patients will increase my office staff’sworkload with no additional compensation

46

No computer/email 4

Some other reason 2

Not sure 7

Asked of all physicians (n = 769)

Page 32: Computing in the Physician's Practice

Part Two:

Computers and Networks in Office

“95% of physicians have

computers in their practice”

Page 33: Computing in the Physician's Practice

33

Overview of computers and networks in the office

Only 5% of physicians don’t have computers in their practice, but only larger practices tend to have dedicated network connections.

Internet access is mostly provided by regular ISPs (not WebMD or POL).

Most practices (67%) have internal networks, but less than half have an Intranet, and those are mostly large practices.

Physicians are huge users of cell phones (87%), but only 15% have a handheld device (like a Palm Pilot)--there’s a strong correlation between high Internet use and handheld device use.

Practice management software vendors may be regarded as being the “path to the physician’s desktop” BUT the vast majority of physicians don’t know who their practice’s vendor is!

Page 34: Computing in the Physician's Practice

34

The average physician has 15 computers in their office or practice setting

Q.C1 How many computers are there in your office or practice setting? Include all computers used by administrative and clinical staff.

3%

24%

68%

5%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Not sure

More than 10

Between 1 & 10

No computers

Number of computers in physicians’ office

Mean # of computers = 15

Median # of computers = 5

Asked of all physicians (n = 769)

Page 35: Computing in the Physician's Practice

35

Physicians’ use of different information appliances: The cell phone is stuck to their ear

Q.B6 Please indicate which choice best describes the degree to which you use each of the following devices or technologies:

Asked of all physicians (n = 769)

Physicians using different information appliances

I use this device asan integral part of

my everydaypractice

I use this device,but mostly for

personal activities

I do NOTuse thisdevice Not sure

% % % %

Cellular/Mobile telephone 65 21 13 1

Voice mail 42 17 40 1

Two way pager 35 3 59 3

Laptop computer 16 14 68 2

Handheld personal device,such as a Palm Pilot

10 5 82 2

Page 36: Computing in the Physician's Practice

36

Handheld devices: Despite the Palm Pilot revolution, they are only used by a small minority so far

12%

8%

14%

9%

14%

6%

10%

7%

3%

5%

6%

3%

5%

1%

6+ hours week Internet

<5 hours week Internet

Female

Male

Specialist

PCP

Total

Use handheld device as integral part of practice Use handheld device for mostly personal activities

Asked of all physicians (n = 769)

15%

9%

20%

15%

15%

11%

19%

Q.B6 Please indicate which choice best describes the degree to which you use a handheld device such as a Palm Pilot:

Percentage of physicians using handheld personal device either in practice or personal use

Page 37: Computing in the Physician's Practice

37

Network connections in the office: They’re more hooked into private networks than the Internet

Q.C3 What type of network connection does your office staff use to connect with the outside world?

Group Size

TotalNo

group 3-9 10-24 25+708 260 233 78 126% % % % %

Dedicated line to private network (suchas claims clearing house or hospital)

37 28 35 46 50

Dial-up line via modem to privatenetwork (such as claims clearing houseor hospital)

36 40 41 32 24

Dial-up line via modem to InternetService Provider (ISP)

30 37 32 27 16

Dedicated line to network connecting toan Internet Service Provider (ISP)

24 15 24 42 31

Another type of network connection 4 4 2 4 6

Types of network connections

Asked of physicians have computers in office or practice settings (n=708)

Page 38: Computing in the Physician's Practice

38

Type of connection physicians have for ISPs

Q.C3a Please specify the type of connection your organization has:

171%

T1 or T3 Line 39

Cable Modem 27

ISDN 18

DSL 4

Another type of connection 3

Satellite connection 2

Not sure 10

Asked of physicians who have dedicated line to network connecting to an ISP (n=171)

Page 39: Computing in the Physician's Practice

39

Like the rest of us, physicians’ offices get their Net access through ISPs

Q.B2 Who provides Internet access at your office or clinical workplace?

534%

An Internet Service Provider (ISP) 60

A local hospital or lab, such as Medacom 12

A physician-aimed service, such as WebMD 10

A practice management software vendor 5

Some other provider 5

Access through university 4

No Internet access at office or clinical workplace 2

Not sure 2

Asked of physicians who have Internet service somewhere in their practice (n = 534)

Page 40: Computing in the Physician's Practice

40

Internal networks are common . . .

Q.C6 Does your practice have an internal network, that is, a system that connects the PCs to each other and/or a central server?

708%

Yes 67

No 31

Not sure 2

Asked of physicians who have computer(s) in their office or practice (n = 708)

Page 41: Computing in the Physician's Practice

41

. . . . but only big groups have Intranets

Q.C6a If your office has an internal network, does your practice have an Intranet, that is, a system that allows you to view the contents of the internal network via a web browser such as Internet Explorer or Netscape Navigator?

Group SizeTotal No group 3-9 10-24 25+474 139 163 56 110% % % % %

No 53 71 60 45 25

Yes 45 29 37 52 71

Not sure 3 2 4 4 4

Asked of physicians whose practice has internal network (n = 474)

Page 42: Computing in the Physician's Practice

42

Practice management system software vendors: not the way to the physician’s mind-share?

Q.C5 If you know the name of the vendor who supplies your office’s main practice management system software, please write it below:

Asked of physicians who have computer(s) in their office or practice (n = 708)

Base: Physicians have computer(s) in their office 708%

Not sure/Don’t know 66

Other (Brand quoted by less than 1% ofrespondents)

29

Medical manager 3

Lytec Medical 1

Page 43: Computing in the Physician's Practice

43

Decisions about technology purchases: in smaller practices physicians call the shots

Q.C8 If you currently have a computer (or anticipate getting one in the near future), who makes (or will make) the majority of decisions concerning the purchase of hardware, software and networking systems for your practice?

Group SizeTotal No group 3-9 10-24 25+769 304 240 80 132% % % % %

Myself and/or other physicians 35 51 33 18 11

Myself and/or other physicians inconjunction with office staff and/orclinical staff

26 21 37 33 15

My practice’s non-medical executives,such as the organizations chieftechnology officer

26 12 20 39 58

Office staff and/or clinical staff 5 7 4 5 5

Hired consultants 4 4 5 4 7

Not sure 4 6 2 3 4

Asked of physicians whose practice has internal network (n = 769)

Page 44: Computing in the Physician's Practice

Part Three:

Administrative Use of Computing“Physicians’ practices use

computers for billing information, claims

submission and scheduling”

Page 45: Computing in the Physician's Practice

45

Overview of administrative computer use

Physicians’ practices use computers extensively for a few functions--including billing information, claims submission and scheduling.

Many other available transactions, including several that health plans and vendors have been marketing for some time, are used by less than a third of physicians’ practices.

Even those practices which do use some of the less common functions (such as eligibility or referral authorization) tend to use them for a lower proportion of their patients.

Note: This section uses a complex chart layout. On the left it has a pie chart showing the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone, mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

Page 46: Computing in the Physician's Practice

46

Physicians on their practice’s use of computing for administration: Only billing, claims, and scheduling are ubiquitous

Q.C4 Does your practice use a computer for the following activities?

14%

18%

20%

23%

29%

30%

33%

47%

57%

62%

68%

80%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Admission pre-certification

Looking up provider directories

Receiving earned remittance advice

Referral authorization

Documenting patient encounters for reporting

Receiving electronic payments

Patient eligibility

Submitting claims status inquiries

Looking up billing & CPT codes

Scheduling

Claims submission

Record billing information

Asked of all physicians who have computer in their office or practice setting (n = 708)

Percent physicians responding uses a computer in their practice

Page 47: Computing in the Physician's Practice

47

76% 20%

3%

1%

11-50% 1-10% Do not use >50%

41%

27%

32%

No Not Sure Yes

Plan to use within 18 months

Physicians on their practice’s use of computing for administration: Most practices use computers for recording billing information and

generating patient bills

Q. C4 Does your practice use computers for any of the following functions?

Proportion of patients for which practices are using computers for recording billing information and generating patient bills

Asked of physicians who have computer in their office or practice setting (n = 708)

Page 48: Computing in the Physician's Practice

48

1%

11%

32%56%

11-50% 1-10% Do not use >50%

43%

19%

38%

No Not Sure Yes

Physicians on their practice’s use of computing for administration: Most offices submit the majority of their claims online . . .

Proportion of patients for which practices are using computers to submit claims electronically

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 49: Computing in the Physician's Practice

49

Physicians on their practice’s use of computing for administration:. . . but most claims submission is batch, not real-time

Q.C4a If you currently use a computer to submit claims electronically, are these submitted as they arise or in a batch at the end of the day?

481%

In a batch 75

As they arise 16

Not sure 10

Asked of physicians whose practices submit claims electronically (n = 481)

Page 50: Computing in the Physician's Practice

50

43%

29%

28%

No Not Sure Yes

Proportion of patients for which practices are using for computers for scheduling and other practice administration

Physicians on their practice’s use of computing for administration: Over half use computers for patient scheduling

56%38%

5%

1%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 51: Computing in the Physician's Practice

51

40%

31%

29%

No Not Sure Yes

Proportion which practices are using computer for looking up billing codes, CPT information, Medicare

information, etc.

Physicians on their practice’s use of computing for administration: Over half look up billing codes on a computer

Asked of physicians who have computer in their office or practice setting (n = 708)

38%43%

16%

3%

11-50% 1-10% Do not use >50%

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 52: Computing in the Physician's Practice

52

41%

30%

29%

No Not Sure Yes

Proportion for which practices are using computers to submit claims status inquiries to health plans

Physicians on their practice’s use of computing for administration: Nearly half submit claims status inquiries to health plans online

32% 53%

14%

1%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 53: Computing in the Physician's Practice

53

41%

31%

28%

No Not Sure Yes

Proportion for which practices are using computers to inquire about patient eligibility verification from health plans

Physicians on their practice’s use of computing for administration: Only one third use a computer for inquiring about patient eligibility, but this

should see modest growth

17%67%

13%

3%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 54: Computing in the Physician's Practice

54

45%

36%

19%

No Not Sure Yes

Proportion which practices are using computers to receive electronic payments from health plans, IPAs and payers

Physicians on their practice’s use of computing for administration: Nearly one in three receive electronic payments

17%

69%

12%

2%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 55: Computing in the Physician's Practice

55

47%

34%

19%

No Not Sure Yes

Proportion which practices are using computers to document patient encounters for reporting to health plans or IPAs

Physicians on their practice’s use of computing for administration: Three in ten use a computer for documenting patient encounters to

report to health plans or IPAs

22%

71%6%

1%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 56: Computing in the Physician's Practice

56

40%

36%

24%

No Not Sure Yes

Proportion for which practices use computers to authorize referrals from health plans

Physicians on their practice’s use of computing for administration: Less than one quarter authorize referrals online

10% 77%

9%

4%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 57: Computing in the Physician's Practice

57

44%

34%

22%

No Not Sure Yes

Proportion for which practices are using computers to receive earned remittance advice from health plans, IPAs and payers

Physicians on their practice’s use of computing for administration: One in five receive earned remittance advice from payers

10% 80%

7%

3%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 58: Computing in the Physician's Practice

58

46%

34%

20%

No Not Sure Yes

Proportion for which practices are using computers to look up directories of providers supplied by health plans or IPAs

Physicians on their practice’s use of computing for administration: Fewer than one in five look-up provider directories on a computer

8% 82%

6%

4%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 59: Computing in the Physician's Practice

59

45%

37%

18%

No Not Sure Yes

Proportion for which practices are using computers to pre-certify hospital admissions

Physicians on their practice’s use of computing for administration: Only a tiny minority pre-certify hospital admissions online

6% 87%

5%

2%

11-50% 1-10% Do not use >50%

Asked of physicians who have computer in their office or practice setting (n = 708)

Plan to use within 18 months

Q. C4 Does your practice use computers for any of the following functions?

Page 60: Computing in the Physician's Practice

60

Why is the practice using computers for office functions? Computers provide a better way!

Q.C4b If you currently use a computer for office functions or intend to use one in the next 18 months, what are your main reasons for deciding to use a computer for these functions? (more than one answer permitted)

706%

Software or computer vendor provided cheaper/better solution than previously used

44

Hospital, lab or health plan provided subsidized(or free) technology, or network access

26

Office staff demanded better system to eliminatephone tag, etc.

25

Health plan or other payers required it as part ofcontract

24

HIPAA legislation 5

Easier/ more efficient 4

Some other reason 4

Not sure 18

Practice currently or intends to use computer for various office functions (n=706)

Page 61: Computing in the Physician's Practice

Part Four:

Services for Patients

“Most physicians’ practices provide

very few information services for patients”

Page 62: Computing in the Physician's Practice

62

Overview of services for patients

Most physicians’ practices provide very few information services for patients apart from pamphlets and handouts, and videos.

But significant minorities say they plan to provide computer or Internet-based access to histories, heath risk assessments, etc. within 18 months. With several vendors targeting this type of service free to physicians, we can expect fast growth in this type of service.

Note: In this chart lay-out, on the left the pie chart shows the yes/no. The bar on the right shows the likely activities in 18 months as a fraction of all practices not just those saying no (e.g the bar percentages total the “no’s” not 100%).

Page 63: Computing in the Physician's Practice

63

For patients, most practices only offer information on videos or paper

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

2%

3%

4%

10%

17%

19%

46%

91%

0% 20% 40% 60% 80% 100%

Histories or HRAs over the Internet before visit

Record histories on computer in office

HRAs on a computer in the office

Computer-based information in office

Directions to website

HRAs or histories at home

Informational videos in office

Pamphlets and handouts

Asked of all physicians (n = 769)

Percent physicians offer in their practice setting

Page 64: Computing in the Physician's Practice

64

Does not offer now

9%

Offer now91%

Offer now Does not offer now

7%

2%

1%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Pamphlets and handouts

Almost all physicians offer pamphlets and handouts

Asked of all physicians (n = 769)

Page 65: Computing in the Physician's Practice

65

Does not offer now

54%

Offer now46%

Offer now Does not offer now

42%

3%

9%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Informational videos that can be viewed in the office

Asked of all physicians (n = 769)

Nearly half offer informational videos

Page 66: Computing in the Physician's Practice

66

Does not offer now

81%

Offer now19%

Offer now Does not offer now

60%

5%

16%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Patients have ability to complete histories or health risk assessments at home on paper before they visit the office

Asked of all physicians (n = 769)

Two in five practices offer patients the ability to complete histories or HRAs at home before they visit the office

Page 67: Computing in the Physician's Practice

67

Does not offer now

83%

Offer now17%

Offer now Does not offer now

56%

5%

23%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Directions to pre-selected healthcare websites that can be accessed from home

One in six suggest healthcare websites to patients

Asked of all physicians (n = 769)

Page 68: Computing in the Physician's Practice

68

Does not offer now

90%Offer now

10%

Offer now Does not offer now

66%

5%

19%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Access to computer-based information in office

Asked of all physicians (n = 769)

One in ten offer computer-based information for patients in their offices

Page 69: Computing in the Physician's Practice

69

Does not offer now

96%

Offer now4%

Offer now Does not offer now

72%

6%

18%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Ability to complete health risk assessments on computer in office

Asked of all physicians (n = 769)

Few patients have the ability to complete HRAs on computers in their offices . . .

Page 70: Computing in the Physician's Practice

70

Does not offer now

97%Offer now

3%

Offer now Does not offer now

70%

6%

21%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Ability to complete histories on computer in office

Asked of all physicians (n = 769)

…and fewer offer patients the ability to complete histories on computers in their office

Page 71: Computing in the Physician's Practice

71

Does not offer now

98%

Offer now2%

Offer now Does not offer now

79%

7%

12%

No Not Sure Yes

Plan to offer within 18 months

Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting?

Offer patients ability to complete histories or health risk assessment from home via the Internet before they visit the office

Asked of all physicians (n = 769)

… and none of this is offered over the Net yet!

Page 72: Computing in the Physician's Practice

Part Five:

Practice and Office Use of “Administrative Clinical Computing”

“More than half of practices access

lab test results online”

Page 73: Computing in the Physician's Practice

73

Overview of administrative clinical computing

We define administrative clinical computing as clinical transactions that are usually dealt with by members of the physician’s office or clinical staff.

Despite the efforts to connect physicians offices to clinical networks, the only commonly used computer-based application is receiving lab results.

Substantially more lab results will be received electronically in 18 months time, and there is increased interest in using computers for HCFA E&M coding.

Almost no use of computers for ordering Rx refills thus far.

Note: This section uses a complex chart layout. On the left a pie chart shows the share of transactions done using a computer (i.e. 0%, 1-10% of transactions, 10-50%, or 50%+) as opposed to phone mail or fax. On the right, the bar chart shows whether those practices NOT using computers expect to be doing so in 18 months.

Page 74: Computing in the Physician's Practice

74

Clinical transactions done online in physicians’ practices:

Viewing lab results is the only commonly-used application

6%

7%

8%

9%

11%

52%

0% 10% 20% 30% 40% 50% 60%

Communicating with pharmacies, PBMs & Hlth Plns

Hospital Admissions

Rx refills

Signing discharges

E&M coding

Lab tests/diagnostic results

Asked of all physicians (n = 769)

Percentage of physicians whose practice uses a computer for the following function

Q.E1 Does your practice use computers for any of the following functions?

Page 75: Computing in the Physician's Practice

75

14%6%

33%47%

1-10% 11-50% >50% Do not use

53%

14%

33%

No Not Sure Yes

Plan to use within 18 months

Proportion for which computers are used to access lab tests and/or other diagnostic results

Asked of all physicians (n = 769)

More than half of practices access lab test results online, and more will soon

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 76: Computing in the Physician's Practice

76

56%

19%

25%

No Not sure Yes

Plan to use within 18 months

Proportion for which an automated system is used to verify HCFA E&M coding accuracy

Asked of all physicians (n = 769)

Only one in ten practices use the computer to verify E&M coding accuracy

3%

2%

6%

89%

1-10% 11-50% >50% Do not use

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 77: Computing in the Physician's Practice

77

65%

19%

16%

No Not Sure Yes

Plan to use within 18 monthsProportion of hospital discharge/medical

attestations signed off on computer

Asked of all physicians (n = 769)

Few physicians are in practices using computers to sign off on hospital discharges or Medicare attestations

3%

1%

5%

91%

1-10% 11-50% >50% Do not use

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 78: Computing in the Physician's Practice

78

67%

17%

16%

No Not Sure Yes

Plan to use within 18 monthsProportion for which prescription refills are ordered online

Asked of all physicians (n = 769)

Few practices order prescription refills online

2%2%

4% 92%

1-10% 11-50% >50% Do not use

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 79: Computing in the Physician's Practice

79

64%

18%

18%

No Not Sure Yes

Plan to use within 18 monthsProportion of patients for whom hospital admission

forms are completed online

Asked of all physicians (n = 769)

Hospital admission forms are rarely completed online

2%

1%

4%

93%

1-10% 11-50% >50% Do not use

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 80: Computing in the Physician's Practice

80

64%

18%

17%

No Not Sure Yes

Plan to use within 18 months

Proportion for which computers are used to communicate with pharmacies, pharmacy benefits management companies or health plans

Asked of all physicians (n = 769)

Despite the rhetoric about formularies, few practices communicate online with pharmacies, PBMs or health plans

2%

2%

2%

94%

1-10% 11-50% >50% Do not use

Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

Page 81: Computing in the Physician's Practice

Part Six:

Physician‘s Use of Computing for Clinical Purposes

“Physicians want better access to test results, and easier ways to

generate notes”

Page 82: Computing in the Physician's Practice

82

Overview of clinical computing

We define clinical computing as clinical transactions that are usually dealt with by the physicians themselves.

Paper (and phone and tape) rule in the clinical environment--only 28% of physicians use a computer to access information about a patient, and less than 1 in 3 of them did it for more than half their patients, and only 1 in 5 did it when the patient was present.

Physicians want better access to test results, easier ways to generate notes, and better availability of previous notes.

Clinical notes are all now handwritten or dictated, but change is likely. A substantial minority believes they’ll be using computers, PDAs or voice recognition for taking notes in 18 months, and a large majority believes they will use one of those technologies in 5 years.

Page 83: Computing in the Physician's Practice

83

Limited use of computers to access clinical information

QE2. Do you personally or do other staff in your practice use a computer or handheld device such as a Palm Pilot for any of the following?

I personallyuse one

My staffuses one

Both useone

No oneuses one

Notsure

% % % % %

Receiving numeric lab results like bloodtests

8 11 11 68 2

Communicating clinical information withcolleagues or health plans via email

12 3 7 76 3

Receiving radiological images, EKGs, orother non-numeric diagnostic test results

5 5 5 83 3

Sharing clinical information withcolleagues or health plans via a web siteor private network

8 1 4 84 3

Ordering diagnostic tests 2 7 4 84 3

Checking for formulary compliance and/ordrug interactions

7 3 2 85 3

Receiving and implementing practiceprotocols or guidelines

6 3 2 86 3

Ordering prescriptions and refills 2 2 2 92 3

Asked of all physicians (n = 769)

Page 84: Computing in the Physician's Practice

84

Physicians biggest desires?Immediate access to patients’ results, and a better way to take

notes

Q.A9 Assuming the underlying technologies worked well, which two solutions from the following list would you find most helpful?

Asked of all physicians (n = 769)

769%

Immediate access to lab results, pharmacy records, diagnostictest results, etc.

53

The ability to more easily generate notes (as opposed to usingdictation for later transcription or handwriting)

43

Immediate access to patient notes from previous visits (and thepatient’s visits with other physicians)

35

The ability to record procedure codes for billing purposesdirectly into a computer or hand held device such as a PalmPilot during consults

26

Immediate access to background clinical information, such asjournal articles, during consults

14

Immediate access to protocols and guidelines, from a sourceyou trust, during consults

12

The ability for you to personally generate a referral that youknew would be authorized

7

Immediate access to pharmaceutical formularies (from healthplans or pharmacy benefits managers)

7

Some other solution 2

Not sure 1

Page 85: Computing in the Physician's Practice

85

Physicians use paper to track their work for billing purposes

Q.E4 How do you track your clinical work for billing purposes?

769%

Record billing codes on card or note 54

Record on computer 23

Some other way 18

Billing codes are generated automatically as part ofclinical record taking process

15

Indicate on pre-created bar codes 6

Record on handheld device such as a Palm Pilot 1

Not sure 4

Asked of all physicians (n = 769)

Page 86: Computing in the Physician's Practice

86

Used computer

28%

Did not use computer

72%

Did not use computer Used computer

32%

32%

36%

>50% 11-50% 1-10%

Share of patients used for

Q.E-3 In the past week, did you personally use a computer or handheld device like a Palm Pilot to access clinical information about individual patients? Q.E-A (If Yes,) For what share of patients did you do this?

Overall, one in four physicians is accessing clinical information about specific patients using a computer

Asked of all physicians (n = 769)

Page 87: Computing in the Physician's Practice

87

. . . But those clinical “power users” aren’t doing it while the patient is there

Q.E3B If personally used a computer to access patient clinical information, did you usually do this?

208%

Before you saw the patient 38

After you saw the patient 37

While the patient was present 23

Not sure 3

Asked of physicians who used a computer or handheld device in past week (n = 208)

Page 88: Computing in the Physician's Practice

88

Doctors take their clinical notes after they see the patient

Q.E6 In the past week, when did you finish the bulk of your notes for a typical consultation?

769%

Immediately after the consultation 50

Sometime later in the day 27

During the consultation 21

Not sure 2

Asked of all physicians (n = 769)

Page 89: Computing in the Physician's Practice

89

After 30 years of the “Electronic Medical Record”, clinical notes stay on paper . . .

Q.E5 On your most recent full day of treating patients, what percentage of your clinical notes did you take by each of the following methods?

1%

1%

2%

4%

8%

8%

45%

71%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Use handheld device

Dictate onto audio file

Other

Assistant records notes

Type into a computer

Voice recognition software

Dictate onto tape

Handwrite notes

Asked of all physicians (n = 769)

Percentage who said they used any of the following ways to take clinical notes (multiple answers allowed)

Page 90: Computing in the Physician's Practice

90

17%

20%12%

15%

25%

40%

0%

20%

40%

60%

80%

100%

In 18 months In next 5 years

Voice recognition

Handheld device

Computer

. . . but the majority don’t expect it to stay that way for too long; voice recognition is the great (white coat) hope

Q.E5A If you are mainly taking notes via an assistant, handwriting, and/or dictating onto a tape, do you expect to use a computer, handheld device, or voice recognition software in 18 months?….in five years?

Asked of all physicians who mainly record notes manually or dictate into tape (n = 676)

44%

85%

Page 91: Computing in the Physician's Practice

91

Conclusions

This is the first phase of a detailed look at physician computing, and it yields a few conclusions:

Physicians are using the Internet and are optimistic about the potential of computing. Growth has been VERY fast (x 2 since 1997).

Physicians (and their staff) are frustrated with their current use of computing for administrative transactions, but most are accessing the Internet and the other infrastructure required to start automating more functions.

Clinical computer use is in its infancy, but most physicians are expecting to make big changes in the next 2 to 5 years.