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EHR ADOPTION IN MICHIGAN AND NATIONWIDEJennifer Horowitz, MA, CPHIMS, FHIMSS
June 6, 2013
JENNIFER HOROWITZ
• Senior Director, Research
• HIMSS Analytics• Began with HIMSS
Analytics in 2001
INDUSTRY TRENDS
• Federal Initiatives» 2009 American Recovery and Reinvestment Act» 2010 Patient Protection and Affordable Care Act» Conversion to ICD-10
• Patient Care Focus» Improved Quality Outcomes» Reduced Medical Errors» Standardized Clinical Care
24TH ANNUAL HIMSS LEADERSHIP SURVEY
BUSINESS ISSUE WITH MOST IMPACT ON HEALTHCARE
Hospital Infrastructure Needs
Staffing Issues
Privacy/Security Issues
Consumer Considerations
Technology Considerations
Shifting Healthcare Landscape
Health Information Exchange
Policy Mandates
Financial Considerations
Healthcare Reform
0%
2%
3%
3%
5%
3%
8%
23%
14%
40%
1%
2%
4%
4%
4%
7%
8%
14%
16%
37%
2013
2012
N = 298
Integration of IT and Medical Devices
Securing Patient Information
Focus on Ambulatory Systems
Healthcare Consumer Issues
Exchange Info with Other Entities
Interoperability
Completing ICD-10 Conversion
Focus On Clinical Systems
Leveraging Information
Optimizing Use of Current Systems
Achieving Meaningful Use
0%
1%
2%
1%
1%
3%
11%
15%
13%
12%
38%
1%
1%
2%
2%
2%
6%
9%
11%
17%
20%
28%
2013
2012
N = 298
TOP IT PRIORITY IN THE NEXT TWO YEARS
Focus on Nursing Systems
Focus on Consumer Technology
Installing/Upgrading Ancillary
Installing/Upgrading CDR
Certification of EHR
Establishing Clinical Protocols
Closed Loop Medication Administration
Creating Continuity of Care Record
Data Warehouse/Clinical Analytics
Installing CPOE
Linking Clinical Systems to Quality Measures
Focus on Physician Systems
Fully Operational EHR in Place
2%
1%
2%
4%
2%
3%
0%
9%
16%
15%
16%
25%
2%
2%
2%
2%
2%
3%
3%
7%
10%
10%
16%
16%
19%
2013
2012Not Applicable
N = 298
PRIMARY CLINICAL IT FOCUS
Ensuring that Data is Secure/Private
Improving Patient Access to Information
Providing Remote Monitoring of Patients
Providing Competitive Advantage
Enabling Remote Access of Data
Sharing Information Externally
Supporting Staff Productivity
Standardizing Clinical Care
Reducing Medical Errors
Improving Quality Outcomes
0%
0%
6%
3%
5%
7%
16%
22%
38%
1%
2%
3%
4%
5%
7%
8%
12%
25%
31%
2013
2012
Not Applicable
N = 298
AREA THAT IT CAN MOST IMPACT PATIENT CARE
HIMSS ANALYTICS® DATABASE
HIMSS ANALYTICS® DATABASE
• Company founded in 2004» Market research arm of HIMSS
• HIMSS Analytics collects information on over 100 IT applications in the healthcare environment
• Data collected by dedicated team of market research associates (MRAs)
• All data is cleansed by our quality team• Data is published on an annual rolling basis
» Data for each hospital is published once per year
HIMSS ANALYTICS EMRAMSM MODEL
• Model established in 2006 to track hospitals’ adoption of EMR technology
• Eight-stage model» Stage 0 – hospitals that don’t have all basic ancillary
applications (lab, pharmacy, radiology)» Stage 7 – hospitals no longer use paper charts to deliver
and manage patient care
• Ambulatory EMRAM Model Introduced in 2012» Stage 0 – paper chart based environment» Stage 7 – organizations do not rely on paper charts to
deliver and manage patient care
Data from HIMSS Analytics® Database © 2012 HIMSS Analytics
0.0% 1.9%
9.1%
16.3%
14.4%
36.3%
10.1%
4.2%
7.8%
0.8%
1.4%
2.2%
25.1%
37.2%
14.0%
19.3%
2007 Final
2013 Q1
Complete EMR, CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP
Physician documentation (structured templates), full CDSS (variance & compliance), full R-PACS
Closed loop medication administration
CPOE, Clinical Decision Support (clinical protocols)
Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology
CDR, Controlled Medical Vocabulary, CDS, may have Document Imaging; HIE capable
Ancillaries - Lab, Rad, Pharmacy - All Installed
All Three Ancillaries Not Installed
N = 5073 N = 5441
HIMSS ANALYTICS EMRAMSM MODEL: MICHIGAN
EMR Adoption ModelSM (EMRAM)
Average Median Min Max
Entire HIMSS Analytics® Database 3.6500 3.4300 0.0000 7.0710
East North Central Region (N=847) 3.9757 3.5260 0.0000 7.0710
Indiana (N=149) 3.9391 3.5400 0.0000 7.0550
Michigan (N=156)) 4.0458 4.1810 0.0050 6.0710
Ohio (N=208) 3.6553 3.4030 0.0000 7.0710
Wisconsin (N=136) 4.3042 4.1845 1.0950 7.0710
East North Central region includes Illinois, Indiana, Michigan, Ohio, and Wisconsin
Source HIMSS Analytics® Database (N= 5,441) First Quarter 2013
HIMSS ANALYTICS EMRAMSM MODEL
EMR Adoption ModelSM (EMRAM)
Average Median Min Max
Vermont (N=14) 4.9561 5.1100 3.4160 6.0710
Delaware (N=9) 4.8592 5.1420 2.6370 7.0470
Rhode Island (N=11) 4.7805 6.0320 0.3870 6.0710
Maine (N=39) 4.6780 4.4040 0.0000 6.0710
Virginia (N=90) 4.5246 4.3825 0.0000 7.0710
Minnesota (N=136) 4.4835 4.3260 0.0660 7.0710
Connecticut (N=33) 4.3865 4.2460 1.0790 6.0710
Wisconsin (N=136) 4.3042 4.1845 1.0950 7.0710
Massachusetts (N=82) 4.2592 4.2820 0.0000 7.0630
Maryland (N=49) 4.1891 3.5420 0.0000 6.0710
Iowa (N=118) 4.0940 4.0270 0.0050 7.0710
Arizona (N=88) 4.0912 3.5060 0.0890 7.0630
Washington (N=96) 4.0712 4.2140 0.0050 6.0710
Illinois (N=198) 4.0592 3.8435 0.0000 7.0710
Michigan (N=156) 4.0458 4.1810 0.0050 6.0710
Source HIMSS Analytics® Database (N= 5,441) First Quarter 2013
EMRAM STAGE 6 HOSPITALS IN MICHIGAN
GETTING ROI OUT OF CLINICAL SYSTEMS - KAISER PERMANENTE
• Kaiser Permanente serves 8.6 million members across nine states. The EMR in use is Epic.
• ROI has been demonstrated across a variety of metrics:» One Kaiser Permanente region saved more than
$120,000 in dictation costs in just one year post implementation
» Reduced the rate of medication errors by 57 percent one hospital site using barcode scanning
» Trimmed by 12 percent outpatient lab utilization two years after the implementation of KP HealthConnect
» 54 percent reduction of archival storage space» Vacated more than 22,000 square feet at 15 medical
facilities when medical records centralized in one region with estimated savings between $0.4 and $3.3 million
GETTING ROI OUT OF CLINICAL SYSTEMS - CITIZENS MEMORIAL
• CMH is a 74-bed hospital with 10 rural health clinics located in Bolivar, MO. The EMR in use is MEDITECH.
• ROI has been demonstrated across a variety of metrics:» Reduction in re-admission rate for home care patients
by 35 percent» Use of in-home tele-management has reduced number
of home care visits by an average of two.» 70 percent reduction in reported medication errors in the
hospital» Elimination of all medical records filming costs» Adjusted Occupied Beds (a measure of in and outpatient
volume), have increased from 101 to 138 and net patient revenues have increased by 23% since in the implementation of Project Infocare.
OVERALL RADIOLOGY PACS INSTALLATIONS
2007 (N=5073)
2008 (N=5168)
2009 (N=5237)
2010 (N=5283)
2011 (N=5339)
2012 (N=5467)
2103 (N=5445)
70.85%
79.18%
84.40%
87.06%
89.89%
89.94%
90.10%
Percent of Hospitals With At Least One Modaility Automated
Source: HIMSS Analytics® Database
Hospitals in Michigan = 89.74%
CPOE AUTOMATION AND PLAN ANALYSIS
2013 (N=156)
2013 (N=5445)
63%
56%
19%
13%
12%
11%
6%
17%
Automated Replacement Purchases Contracted - Not Yet Installed Contracted - Installation In ProcessFirst Time Purchase Not Automated, No Plans to Purchase
Source: HIMSS Analytics® Database
National
Michigan
Adoption in 2007 = 19%
DATA WAREHOUSING/MINING – CLINICALAUTOMATION AND PLAN ANALYSIS
2013 (N=156)
2013 (N=5321)
40%
41%
54%
55%
Automated Replacement Purchases Contracted - Not Yet InstalledContracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase
National
Source: HIMSS Analytics® Database
Michigan
Adoption in 2007 = 16%
DATA WAREHOUSING/MINING – FINANCIAL AUTOMATION AND PLAN ANALYSIS
2013 (N=156)
2013 (N=5318)
58%
51%
38%
46%24%
Automated Replacement Purchases
Source: HIMSS Analytics® Database
National
Michigan
Adoption in 2007 = 22%
PERCENT OF HOSPITALS USING BAR CODE TECHNOLOGY IN THE PHARMACY
Current •National – 72.45%•Michigan – 84.62%
Planned •National – 14.93%•Michigan – 15.39%National N = 5,445
Michigan N = 156
Adoption in 2007 = 9%
PERCENT OF HOSPITALS PARTICIPATING IN INFORMATION EXCHANGE ORGANIZATION
Current •National – 29.53%•Michigan – 35.90%
Planned •National – 23.14%•Michigan – 23.08%National N = 5,445
Michigan N = 156
Adoption in 2007 = 11%
HIE capable, sharing of data between the EMR and community based EHR, business and clinical intelligence
Advanced clinical decision support, proactive care management, structured messaging
Personal health record, online tethered patient portal
CPOE, Use of structured data for accessibility in EMR and internal and external sharing of data
Electronic messaging, computers have replaced the paper chart, clinical documentation and clinical decision support
Beginning of a CDR with orders and results, computers may be at point-of-care, access to results from outside facilities
Desktop access to clinical information, unstructured data, multiple data sources, intra-office/informal messaging
Paper chart based
US Ambulatory EMR Adoption ModelSM
Data from HIMSS Analytics® Database © 2012 HIMSS Analytics N = 18,318
0.96%
4.51%
0.69%
10.06%
27.67%
5.17%
49.75%
1.2%
Q1 2103
AMBULATORY EMR ADOPTIONMICHIGAN
Source: HIMSS Analytics® Database
• National – 65.84%• Michigan – 61.97%
Automated
• National – 8.64%• Michigan – 13.72%
Contracted or Installing
• National – 25.52%• Michigan – 24.31%
Not Automated
National N = 29,129 Michigan N = 1370
Jennifer HorowitzSenior Director, [email protected]