Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State...

Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State Coordinator for HIT

Project Team: Andy Coburn

Cathy McGuire

Martha Elbaum Williamson

Al Leighton

Deb Thayer

Stuart Bratesman

June 17, 2010

Public Health and Health Policy Muskie School, USM

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Overview

• Project Background– Purpose and Timeframe(s)– Strengths & Limitations

• Survey Methods– Ambulatory Practices– Dental Practices– Acute Care Hospitals

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Overview

• Results to Date – Report follows outline for “as is” assessment– Frequencies for each survey provide additional detail

(Appendixes A – C)– Analysis compares data to criteria outlined in draft rule

• Discussion – Determine any necessary additional analyses for SMHP (e.g.

estimated # of eligible professionals, analysis by adoption)– Determine next steps for additional follow-up to increase survey

participation among groups surveyed – Discuss next steps to set approach for next phase of work of

interest to OSC and OMS

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Project Background

Purpose• To develop data collection instruments, administer them, and

analyze resulting data to inform an “as is” environmental assessment of the status of HIT among providers who are potentially eligible for incentive payments for HIT adoption and use.

• To develop data collection instruments, administer them, and analyze the resulting data to inform statewide HIT efforts being led by Maine’s Office of the State Coordinator for HIT.

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Project Background

April May June July AugustAmbulatory Practice Survey Survey DevelopmentSurvey LaunchFollow-UpData Cleaning And AnalysisHospital SurveySurvey DevelopmentSurvey LaunchFollow-UpData Cleaning And AnalysisDental Practice SurveySurvey DevelopmentSurvey LaunchFollow-Up Data Cleaning And AnalysisReportingInitial FrequenciesPopulated SMHP OutlineData Cleaning and AnalysisAnalysis to OMS/OSCDraft ReportDeliver to OMS/OSCScope Data Collection for Statewide HIT ProjectReview existing InformationMeet with Key StakeholdersOutline Scope and Methods

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Survey Methods

Overall• Develop Survey Tools • Develop Survey Samples• Develop Methods

Limitations• Timeframe (web-based survey)• Available Contact Information• Lack of Provider-to-Site-to-Organization Mapping

Strengths• Data is timely• Instrument reflects current understanding of draft rules

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Survey Methods

Ambulatory Practices• Response rate – 41 percent

• Denominator/Population– Practice lists compiled from several sources– 1546 practices included in lists– 155 duplicates identified– 65 found to be ineligible (as practices)– 15 practices on list had closed– 1311 remaining practices in denominator

• Practices responding - 538

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Survey Methods

Dental Practices• Response rate – 34 percent

• Denominator/Population– Practice lists compiled from OMS – 220 practices on list and used as denominator

• Practices responding - 75

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Survey Methods

Acute Care Hospitals• Response rate – 75 percent

• Denominator/Population– Practice lists compiled from OMS – 40 hospitals on list used as denominator

• Hospitals responding – 30

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Results to DateOverall

HIT Adoption among Maine Providers

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Results to DateAmbulatory Practice Survey

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• Among 418 practices responding– 46% Do not have an EHR– 4% Have purchased or begun installation– 6% Installed in some areas – 44% Installed and in use in all or nearly all areas

• Practices with EHR– Most practices use CCHIT certified systems– 70% reported completing installation in 2008 or earlier– 26% reported completing installation more recently (2009 or

2010)

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• EHR Adoption by Practice Size

– 68% of 102 large practices (6 or more providers)

– 60% of 124 medium size practices (3 to 5 providers)

– 32% of 180 small practices (1 or 2 providers)

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EHR Adoption by Practice Type

– 38% of 190 specialty practices

– 60% of 215 primary care practices

– Note: Multi-specialty groups are included with specialists and may include primary care providers

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– EHR adoption ranges from 13% of 8 responding practices in Piscataquis County to 82% of 11 responding practices in Lincoln County

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Practices with EHRs • Practices reported using their EHR systems for a variety of

purposes:

– Order entry(82% have CPOE systems/modules)

– Decision support during patient encounter (a majority or near majority use the EHR routinely for a number of clinical decision supports)

– File insurance claims

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Results to DateAmbulatory PracticesMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with

EHRCPOE 80 percent of all orders 69% meet criteria

Drug-drug, drug allergy, drug formulary checking All capabilities enabled 35% drug-drug34% Drug-allergyFormulary 18% (at point of prescribing)

Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems

84% meet criteria

Generate and transmit e-Rx At least 75 percent permissible Rx transmitted electronically

60% meet criteria

Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none.

89 % meet criteria for medications92% meet criteria for allergies

Record demographics 80 percent of patients seen have gender, race, DOB, ethnicity, preferred language, insurance recorded.

Age, DDOB, Gender 97% meetRace 57% meetEthnicity 48% meetLang. 46% meetInsurance 95% meet

Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20

BP-83% meetBMI-63% meetChart growth-57%

Record smoking status 80 percent of patients over 13 seen 62% meet criteria (tobacco use)

Incorporate test results into EHR 50 percent of results expressed as a number or positive/negative. Generate at least one report

74% meet criteria

Generate list of patients with specific conditions Generate at least one report 88% meet criteria

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Meaningful Use Requirement Criteria for Eligible Professionals Status among respondents with EHR

Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically

55% using EHR17% using EHR and paper chart

Send reminders for preventive/follow-up care Send reminders for preventive/follow-up care to 50 percent of patients age 50+

51% meet criteria14% send reminders, but for fewer than 50%

Check insurance eligibility Check eligibility electronically for 80 percent patients seen

39% meet criteria(30% check for fewer than 80% of patients)

Submit claims electronically File 80 percent of claims electronically 84% meet criteriaProvide patients with their health information on request

80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies

29% usually provide within 48 hours of request (electronic copy) 59% do not have or do not know if they have this capability.

Provide access to clinical summaries Clinical summaries provided for 80 percent of office visits

28% meet19% provide for fewer than 80% of visits

Provide timely access to new results 10 percent of all patients seen receive access to lab results, problem list, medication and allergy lists within 96 hours of provider receipt

9% meet (electronic access)

Exchange meaningful clinical information with care team

One test of capability to exchange key clinical information

A small percentage of practices routinely exchange electronic data with other providers, hospitals and other care settings

Perform medication reconciliation Provide at least 80 percent of encounters and care transitions

46% meet criteria(17% for fewer than 80% of encounters and transitions; 37% do not or are not sure)

Provide summary record at transitions in care and referrals

Provide at least 80 percent of encounters and care transitions in care and referral

43% meet criteria(6% for fewer than 80% of transitions or referrals; 51% do not or are not sure)

Information to immunization registries submitted electronically

Capability to submit data to immunization registries and submission where required and accepted (Stage 1-at least one test of electronic submission capability)

4% report sending electronic data to immunization registries electronically

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Intent to Apply for Incentives

• 35% Not Sure• 14% Not Applying• 36% Applying for Both (Medicaid and Medicare)• 7% Applying for Medicaid only

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Practices without EHRs – Intent to Implement EHRs• 30% have no plans to implement an EHR in 1-5 years• 13% planning to implement in 4-5 years• 40% planning to implement in 1-2 years• 17% will implement within 1 year

Practices without EHRs- Functional Capacities• 95% do not have CPOE (3% have, but don’t use)• 78% do not have e-Rx systems

Barriers to Implementation • 67% cite cost as a significant barrier• 45% cite cost to maintain as a significant barrier

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Results to DateDental Practice Survey

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Results to DateDental Practice Survey

Respondents• 47% General Dentistry / Solo Practice • 11% Specialty Dentistry / Solo Practice• 16% General Dentistry / Group Practice• 9% Specialty Dentistry / Group Practice• 17% Community Dental Clinic

Use of Paper Charts• 20% Entirely paperless• 24% PMS/EDR is most complete source of patient information• 20% Some paper, some electronic records• 35% Primarily paper, some electronic records

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Results to DateHospital Survey

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• Among 30 hospitals responding– 3% Do not have an EHR– 17% Installed in some areas – 80% Installed and in use in all or nearly all areas

• Hospitals with EHR– 80% reported completing installation in 2006 or earlier– 20% reported completing installation more recently (2007 -

2009)

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• Clinical Staff Using EHR Routinely– 3% < 25%– 3% 25-50%– 28% 51-90%– 66% >91%

• Providers Using EHR Routinely – 14% < 25%– 14% 25-50%– 41% 51-90%– 31% >91%

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Results to DateHospital SurveyMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with

EHRCPOE 10 percent of all orders Lab orders – 70% meet criteria

Radiology – 70% meet criteria Medications– 66% meet criteriaConsultation–39% meet criteriaNursing – 76% meet criteria

Drug-drug, drug allergy, drug formulary checking All capabilities enabled 47% drug-drug47% Drug-allergyFormulary 20% (at point of prescribing)

Maintain up-to-date problem list 80 percent of patients have at least one entry or indication of no problems

Maintain active medication and allergy list 80 percent of patients seen have at least one entry or indication of none

86 % meet criteria for medications92% meet criteria for allergies

Record demographics 80 percent of patients admitted have gender, race, DOB, ethnicity, preferred language, insurance recorded, and cause of death recorded

Name address contact info. 100% meetGender and DOB 100% meetRace and ethnicity 86% meetPreferred language 81%meetInsurance 100% meetCause of death 56% meet

Record vital signs 80 percent of patients 2+ years have BP and BMI; growth chart for ages 2-20

Height, weight, BP - 82% meet criteriaCalculate display BMI - 68% meet criteriaGrowth chart - 43% meet criteria

Incorporate test results into EHR 50 percent of results expressed as a number or positive/negative

Of respondents with EHR providing data: Lab. Reports – 100% meet criteria Radiology reports– 100% meetRadiology images – 100% meetDiagnostic test results – 77%Diagnostic test images – 32%

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Results to DateHospital SurveyMeaningful Use Requirement Criteria for Eligible Professionals Status among respondents with EHR

Report quality measures to CMS and the States For 2011, capture required data electronically and provide aggregate numerator and denominator by attestation, for 2012 and later, submit electronically

To outside Organization 15% using EHR only 74% using EHR and paper chartTo Public health agencies 63% (electronically submit)

Check insurance eligibility Check eligibility electronically for 80 percent patients admitted

79% meet criteria7% check, but for <80%

Submit claims electronically File 80 percent of claims electronically 96% meet criteria

Provide patients with their health information on request

80 percent of patients who make the request receive it within 48 hours; test results, problem list, med list, allergies, discharge summary, procedures

18% meet criteria25% provide information but to <80%57% Do not provide patients (does your current system provide electronic copy?)

Provide patients with discharge information 80 percent of patients who request it, receive electronic copy of discharge instructions Medication list – 82% meet

Exchange meaningful clinical information with care team

One test of capability to exchange key clinical information (cannot share EHR)

96% (EHR not specified)

Perform medication reconciliation Provide at least 80 percent of encounters and care transitions

Nine of the 15 hospitals reporting data on this item meet criteria

Provide summary record at transitions in care and referrals

Provide summary care record at 80 percent of transitions in care and referral

7% meet criteria 18% provide, but for less than 80% percent of transitions/referrals

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Year of First Medicaid Application• 40% 2011• 40% 2012• 4% 2013• 16% Not Sure

Most Challenging Meaningful Use Criteria Cited:•Generate the numerator and denominator data for quality reporting directly from EHR, Perform medication reconciliation across settings of care (12 hospitals), •Exchange clinical information with other providers (10), •implement CPOE at the specified level of sophistication (9), •Implement clinical decisions support rules, give patients access to their data in electronic form (6), and•Generate problem lists using codified data sets (6). 29

Discussion

– Determine any necessary additional analyses for SMHP (e.g. estimated # of eligible professionals, analysis by adoption)

– Determine next steps for additional follow-up to increase survey participation among groups surveyed

– Discuss next steps to set approach for next phase of work for of interest to OSC and OMS

– Other discussion topics??????

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Questions?

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Maine Health Information Technology (HIT)Status Report for MaineCare and Office of the State...

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