Computing in the Physician's Practice
-
Upload
matthew-holt -
Category
Health & Medicine
-
view
1.658 -
download
0
description
Transcript of 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”
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.
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).
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.
Preface:
Practice Issues and Experience with Patient Care “Utilization review,
patient relationship continuity, and time pressure on patient
care are all concerns”
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).
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)
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)
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)
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)
Part One:
Attitudes about Computing and Internet Use
“Over one-third of physicians have
access to the Internet in their clinical work
area”
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.
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)
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)
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?
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
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
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
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
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
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)
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)
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)
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:
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:
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:
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:
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
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)
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
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)
Part Two:
Computers and Networks in Office
“95% of physicians have
computers in their 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!
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)
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
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
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)
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)
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)
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)
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)
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
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)
Part Three:
Administrative Use of Computing“Physicians’ practices use
computers for billing information, claims
submission and scheduling”
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.
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
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)
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?
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)
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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)
Part Four:
Services for Patients
“Most physicians’ practices provide
very few information services for patients”
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%).
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
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)
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
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
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)
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
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 . . .
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
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!
Part Five:
Practice and Office Use of “Administrative Clinical Computing”
“More than half of practices access
lab test results online”
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.
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?
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?
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?
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?
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?
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?
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?
Part Six:
Physician‘s Use of Computing for Clinical Purposes
“Physicians want better access to test results, and easier ways to
generate notes”
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.
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)
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
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)
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)
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)
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)
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)
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%
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.