Rhode Island HIT Survey: 2014 Results and Plans

for 2015

January 2015

Survey Objectives

1. To measure presence (structural measures) and use (process measures) of HIT by clinicians caring for Rhode Island patients

2. To capture HIT data for state agencies and other key stakeholders using single instrument (i.e., minimize data collection burden)

• Administered to all Licensed Independent Practitioners (LIPs):• Advanced Practice Registered Nurses (APRNs)• Physicians• Physician Assistants (PAs)

• Electronic survey instrument sent via:• Hard copy mailing (for physicians, with licensure renewal*)• If email available, email notification and up to two reminders

• Analyses limited to LIPs:• Licensed in Rhode Island• In active practice• Located in Rhode Island or an adjacent state (Connecticut or

Massachusetts)*During 2014 survey year.

Methods

1. Electronic Health Records (EHRs): Access to “EHR components,” including functions such as visit notes, lab orders, or prescriptions

2. Basic EHR use: Among those with EHRs, functionality/clinical use relating to documentation and results management

3. Advanced EHR use: Among those with EHRs, functionality/clinical use relating to decision support, external communication, order management, and reporting

4. e-Prescribing: Transmitting prescriptions/medication orders electronically to a pharmacy

Publicly-Reported Measures, 2014

20092010

20112012

20132014

0%

20%

40%

60%

80%

100%

58.1% 57.8%62.9%

55.4%62.3%

68.3%

46.2% 44.0%

PhysiciansAPRNs/PAs

The HIT Survey has a relatively high response rate for a single-wave mailed survey. It is

higher among physicians than APRNs/PAs.

Response rate by year

Physician Results

Overall Trends

Measure

Survey Respondents(N = 2,567)

All Physicians(N = 3,761)

N Score N Score

1. EHRs, n(%) 2,567 2,236 (87.1%) 3,761 2,236 (59.5%)

2. Basic EHR use, mean 2,236 77.0 -- --

3. Advanced EHR use, mean 2,236 62.6 -- --

4. e-prescribing, n(%) 2,349 1,884 (80.2%) 3,543 1,884 (53.2%)

The 2014 results provide a point-estimate of HIT adoption among physicians for the four publicly-

reported measures.

Use of EHRs and e-prescribing, among respondents and all physicians

Measure

Office-Based by Specialty

All Office-Based Physicians (N=1,544)

PCP(N=698)

Non-PCP(N=846)

1. EHRs, n(%) 625 (89.5%) 642 (75.9%) 1,267 (82.1%)

2. Basic EHR use, mean 87.1 70.5 78.7

3. Advanced EHR use, mean 68.3 42.2 55.1

4. e-prescribing, n(%) 590 (85.1%) 576 (73.0%) 1,166 (78.7%)

When looking at office-based physicians by specialty, HIT adoption is highest among office-

based primary care physicians (PCPs).

Respondents’ use of EHRs and e-prescribing, by physician specialty and practice location

1:EHRs

(%)

2:Basic EHR Use

(0-100)

3:Advanced EHR Use

(0-100)

4:e-Prescribing

(%)

0

20

40

60

80

100

67.6%63.6 pts

44.1 pts 41.2%

87.1%

77.0 pts

62.6 pts

80.2%

200920102011201220132014

Since 2009, physicians’ HIT adoption has increased for all four publicly-reported measures. EHR adoption increased by nearly 30% and e-prescribing by 95%.

Survey respondents’ use of EHRs and e-prescribing

Physician Results

Impact of EHRs

Other

Do not have access to EHR outside of practice

Do not use EHR outside of practice

To return patient or family telephone calls

To prepare for the upcoming work day

When covering other physicians' patients

To review labs, imaging, notes or reports

To catch up on documentation

When covering own patients

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

3.6%

12.1%

24.6%

21.0%

29.6%

32.3%

43.6%

49.5%

43.0%

3.6%

9.9%

12.0%

49.0%

49.5%

52.7%

61.6%

64.7%

68.8%

Office-basedHospital-based

(N=1,247)(N=954)

Compared to hospital-based physicians, office-based physicians more frequently report using

their EHR outside of regular work hours.

Percentage of physicians who say “yes,” they use their EHR outside of work hours

Despite agreeing that EHRs improve many aspects of care, fewer than half of hospital-and office-based

physicians agree that EHRs improve job satisfaction.

Percentage of physicians who “agree or strongly agree” that EHRs…

Improves job satisfaction

Improves clinical work flow

Improves communication with outside physicians (hospital-based only)

Improves the care patients receive

Improves ability to do QI work

Improves patient safety

Improves communication among the physicians and staff

Increased the timeliness of receiving test results (hospital-based only)

Improves billing processes (office-based only)

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

48.7%

59.8%

58.6%

68.8%

70.1%

74.5%

72.7%

82.9%

35.4%

51.0%

56.6%

62.0%

66.8%

72.8%

83.4%

Office-basedHospital-based

Improves billing processes (office-based only)

Improves communication among physicians and staff

Improves ability to do QI work

Improves communication with outside physicians (hospital-based only)

Improves job satisfaction

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

77.5%

77.7%

65.4%

63.4%

57.1%

49.0%

51.4%

42.0%

83.4%

82.9%

72.8%

70.2%

65.6%

62.0%

58.6%

54.8%

41.2%20142013

Percentage of physicians who “agree or strongly agree” that EHRs…

Compared to 2013, physicians’ agreement increased for all statements about how EHRs improve care,

except that EHRs improve job satisfaction.

Workload increased

Workload stayed the same

Workload decreased

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

40.5%

47.8%

11.7%

Percentage of all physician respondents who reported an impact of EHRs on take-home workload (N=2,110)

About 40% of physicians say that EHRs increased the amount of work they take home.

Workload increased

Workload stayed the same

Workload decreased

0% 50% 100%

10.1%

32.6%

57.3%

For office-based PCPs, EHRs have increased take-home workload.

Percentage of office-based PCPs who reported an impact of EHRs on take-home workload (N=595)

Physician Results

Public Health

Don't know

No

Yes

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

41.8%

31.7%

26.4%

Approximately one-quarter of office-based physicians are using their EHR for population

health management.

Percentage of physicians using their EHR for population health management (N=1,137)

I am not a decision maker for my practice

Other

Technical assistance

Additional staff members

Financial support

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

49.7%

7.3%

30.1%

33.6%

35.0%

Among office-based physicians not using their EHR for population health management, responses were

relatively evenly distributed about “what it would take” to start: cost, staff, or assistance.

Percentage of physicians who thought it would take the following for them to use their EHR for population health management… (N=1,022) (Select all that apply.)

0%

<30%

30%-60%

>60%

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

56.2%

27.3%

8.1%

8.3%

52.8%

32.5%

9.0%

4.6%

Hospital-basedOffice-based

(N=1,430)(N=778)

% of patients for whom physicians consult the PMP before prescribing

Among physicians who prescribe, fewer than half are consulting the Prescription Monitoring Program (PMP)

before prescribing opioids or benzodiazepines.

Physician Results

CurrentCare

CurrentCare Viewer (N=2,501)

Hospital Alerts (N=2,476)

EHR Integration (N=2,468)

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

26.7%

21.9%

17.6%

Percentage of physicians who are familiar with these CurrentCare services…

Approximately a quarter of all physician respondents are familiar with various components

of the state’s health information exchange, CurrentCare.

>60%

30-60%

<30%

0% - I am able to view or receive data from CurrentCare, but I am not using it

0% - My practice is not yet signed up to view or receive data from CurrentCare

1.6%

2.5%

9.4%

14.0%

72.6%

Percentage of patients for whom physicians view or receive CurrentCare data (N=2,492)

Nearly 75% of physicians are not signed up to view or receive data, highlighting opportunities for engagement.

Among those signed up, about half are using it.

Current Care Viewer

Hospital Alerts

EMR Integration

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

47.4%

36.5%

30.9%

Percentage of PCPs familiar with these CurrentCare services

Office-based PCPs were more familiar with CurrentCare services than non-PCPs.

N=684

N=676

N=670

Physician Results

Meaningful Use

Percentage of physicians who have attested to Meaningful Use

Two-thirds of office-based physicians report that they have attested to Meaningful Use.

Don't know (n=251)

No (n=129)

Yes (n=742)

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

22.3%

11.5%

66.1%

Percentage of physicians who attested to each stage of Meaningful Use in 2014

Medicare Stage 1 is the most common Meaningful Use attestation

Medicaid Stage 2 (n=79)

Medicaid Adoption, Implementation, Upgrade (n=157)

Medicare Stage 2 (n=158)

Medicaid Stage 1 (n=198)

Medicare Stage 1 (n=426)

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

12.9%

25.7%

25.8%

32.4%

69.6%

Percentage of physicians who plan to attest to Meaningful Use in 2014

The vast majority (nearly 90%) of office-based physicians who haven’t yet attested to

Meaningful Use intended to do so in 2014.

Undecided (n=72)

No (n=20)

Yes (n=623)

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

10.1%

2.8%

87.0%

Physician Results

Physician Quality Reporting System (PQRS)

Percentage of office-based physicians using PQRS in 2014 (N=1,422)

About one-third of office-based physicians say they are already using PQRS and plan to

continue in 2014.

Don't know (n=584)

Yes, and plan to continue in 2014 (n=481)

Yes, but plan to discontinue in 2014 (n=7)

No, and have no plans to start (n=254)

No, but plan to start in 2014 (n=94)

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

41.1%

33.8%

0.5%

17.9%

6.6%

Percentage of office-based physicians using the following methods to report PQRS (N=577)

Approximately one-fourth of office-based physicians planning to use PQRS in 2014 will use

their EHR.

Direct Submission Vendor (DSV) (n=26)

Meaningful use/PQRS pilot (n=27)

Registry method (n=40)

Claims method (n=51)

EHR method (n=152)

Don't know (n=281)

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

4.5%

4.7%

6.9%

8.8%

26.3%

48.7%

Percentage of office-based physicians using the following approaches to report PQRS (N=582)

Office-based physicians who know how they plan to report PQRS in 2014 are approximately evenly split between Group Practice and Individual Reporting.

Don’t know (n=157)

Individual (n=199)

Group Practice Reporting Option (GPRO) (n=226)

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

27.0%

34.2%

38.8%

APRN and PA Results

Overall Trends

Measure

Survey Respondents(N = 662)

All APRNs/PAs(N = 1,505)

N Score N Score

1. EHRs, n(%) 662 522 (78.9%) 1,505 522 (34.7%)

2. Basic EHR use, mean 522 72.6 -- --

3. Advanced EHR use, mean 522 58.4 -- --

4. e-prescribing, n(%) 560 394 (70.4%) 1,403 394 (28.1%)

The 2014 results provide a point-estimate of HIT adoption among APRNs and PAs for the four

publicly-reported measures.

Use of EHRs and e-prescribing, among respondents and all APRNs/PAs

2015 Survey

2015 Survey Process

Administered to all Licensed Independent Practitioners (LIPs):• Advanced Practice Registered Nurses (APRNs)• Physicians• Physician Assistants (PAs)

Electronic survey instrument sent via:• Hard copy mailing in April of 2015• If email available, email notification and up to two

remindersAnalyses limited to LIPs:

• Licensed in Rhode Island• In active practice• Located in Rhode Island or an adjacent state (Connecticut

or Massachusetts)

2015 Survey

Goals of 2015 Survey:• Meet the needs of survey stakeholders, including HEALTH,

payers, Rhode Island HIE and provider groups• Reduce the length of the survey• Measure provider participation in value-based payment

programs• Measure provider use of patient engagement tools• Update publicly reported measures to better reflect

current HIT use, programs and state/federal requirements

Discussion Topics

• Updating publicly reported measures o Needs of providers, patients, other stakeholder

groups

• Use of HIT as part of patient engagement efforts and value-based payment programs

o Current and future uses of this technology

• Provider participation in value-based payment programso Provider knowledge and administrative practices

Rebekah Gardner, MD, FACPChair, Physician Reporting WorkgroupRGardner@healthcentricadvisors.org

Samara Viner-Brown, MSChief, Center for Health Data and Analysis

Samara.VinerBrown@health.ri.gov