Electronic Health Records Survey 2012 Report

Transcription

1 Electronic Health Records Survey 2012 Report Prepared by: AAD Survey Research August

2 Table of Contents Executive Summary... 1 Introduction and Methodology... 3 Level of EHR Adoption in Dermatology... 4 Practice Management and EHR Systems at Dermatology Practices... 5 System Providers First EHR at Primary Practice Technology for EHR Systems EHR Financing and Costs Capabilities of EHR System... 7 Patient Health Information Order Entry and Results Management Clinical Decision-Support and Online Patient Accessibility Reporting and Electronic Interfacing Electronic Communications with other Providers EHR System Evaluation and Overall Satisfaction Patient Care and Management General Office Use Impact of EHR Adoption Barriers to Implementation Participation in Incentive Programs Conclusion Appendix A: Statistical Tables Appendix B: Survey Instrument

3 American Academy of Dermatology Electronic Health Records Survey Executive Summary The American Academy of Dermatology s Electronic Health Record (EHR) Survey is a national survey of Academy members designed to collect information on the adoption of electronic health record (EHR) systems in dermatology practices. The 2011 AAD EHR Survey includes measures of adoption level, implementation barriers, EHR evaluation, incentive program participation, and planning resources. The goal of this survey is to provide the Academy with information to guide development of programs and support systems for members management of EHR systems within their dermatology practices. Of the random sample of 4489 members, 582 practicing dermatologists completed the survey. The 582 completed surveys yield a margin of error of less than 4% with 95% confidence. Level of EHR Adoption in Dermatology Practices Slightly more than half of dermatologists (51%) responding to the survey report that their primary practice has acquired an EHR system (with 38% fully implemented and 13% in process). The vast majority (90%) of dermatologists from multispecialty practices and only 36% from solo or dermatology group practices report to have acquired an EHR system. Less than one third (32%) of responding dermatologists indicate no plans to acquire an EHR system. EHR System Evaluation and Overall Satisfaction Epic and Allscripts/Eclipsys are the top 2 providers of EHR systems reported by 18% and 14% of the respondents, respectively. 1 Of those who have a fully implemented EHR system, 70% can easily send electronic scripts, 56% can easily find needed information, and 56% find that documenting patient care is effective. 33% agree that their EHR system can easily upload and archive photos, 29% have useful tools for health maintenance, 26% can effectively track quality measures, and 22% use an EHR that includes anatomic graphs and lesion mapping that meets their needs. 34% reported that they are satisfied with their EHR system and 30% agree that they would pick the same EHR vendor. Approximately half (51%) of EHR users agree that they would not go back to a paper-based practice. Financial Resources for EHR Acquisition More than half (56%) of dermatologists indicate their EHR is a direct purchase by the practice. Over ten percent (11%) indicate their EHR is purchased through a hospital donation/cost-sharing arrangement. One-eighth (12.5%) of dermatologists indicate they have no or a limited choice in EHR selection (of those whose practice has already acquired an EHR system). Technology Specifications for EHR Systems For those who have acquired an EHR, 60% use an in-house client-server model. Most (81%) dermatologists who have acquired an EHR have planned a data backup and disaster recovery process. Use of fax to transmit clinical information to other providers is still predominant. 1 The AAD currently does not specifically endorse or support any specific PMS/EHR vendors. The information presented in this report represents answers provided by survey respondents. 1

4 AAD Electronic Health Records Survey 2012 Executive Summary Barriers to EHR Implementation Of those who have acquired an EHR system, 40% reported that finding a certified dermatologyspecific EHR system that meets their needs was a significant barrier to implementing the EHR. Approximately one third reported that financial, technical, and administrative issues were significant barriers to implementing their EHR system. Approximately one fourth of those with EHR systems reported that skill level and concerns about an obsolete system were significant barriers to implementation. The majority of those who have not yet acquired an EHR system anticipate that all of these issues will be significant barriers in implementing an EHR system in their practices. Participation in Electronic Prescribing and EHR Incentive Programs Participation in the electronic prescribing incentive program increased from 24% of dermatologists reporting to have participated in 2009 to 58% in Two-thirds (67%) indicated that they plan to participate in Of those with an EHR system, 48% report they are registered for the 2011 EHR incentive. Of those who have registered for the EHR incentive, 59% have attested for Meaningful Use and 14% were in the 90 reporting period (and plan on attesting). 2

5 American Academy of Dermatology Electronic Health Records Survey 2012 Report Introduction The American Academy of Dermatology s Electronic Health Record (EHR) Survey is a national survey of Academy members designed to collect information on the nature of and trends of electronic health record (EHR) systems in dermatology practice. The objective of this survey is to provide the Academy with information to guide development of programs and support systems for members management of EHR within their dermatology practices. Methodology Survey Instrument The 2011 AAD Electronic Health Records (EHR) Survey includes the following assessment areas: Level of EHR adoption in dermatology practices EHR and practice management systems specifications and capabilities Financial support for EHR systems EHR system evaluation and overall satisfaction Barriers to EHR implementation Impact of EHR adoption Participation in federally funded incentive programs related to EHR adoption Sample The survey population includes affiliate, associate, and fellow Academy members and excluded international members, known retirees, and those older than 72 years of age. From the 9,148 members meeting the inclusion criteria, a stratified random sample of 4489 was selected to participate in this survey. The sample stratification includes age, gender, and U.S. Census region of the members primary practice site to increase the likelihood that the results would be representative of the members meeting the inclusion/exclusion criteria, the Academy s U.S. membership of practicing dermatologists. Survey Process The EHR survey instrument was administered exclusively online using SNAP online survey research software. The field period for the survey was May 25 th through June 27 th, The initial requests and reminders for member participation were sent via messages. Each contained a link to the survey that was unique for each listed respondent. Reminders were sent by an automated system that independently monitors survey status for respondents. Only those who had not completed the survey were sent reminder messages. Responses are aggregated in reporting to maintain member confidentiality. Survey Respondents Of the random sample of 4,489 members, 595 (13%) dermatologists participated in the survey. Respondents who do not currently see patients or did not answer the question regarding EHR system acquisition status are not included in the analysis. After removing those members from the data set, 582 completed surveys are used in the statistical analysis for this report. The 582 completed surveys yield a margin of error of approximately 3.8% with 95% confidence. Members who did respond to the survey are representative of the survey population of US members of practicing dermatologists. Comparison of the actual respondents to the survey and population from which the sample was selected provides similar proportions based on gender, age, primary practice type (compared to the 2009 AAD Practice Profile Survey), and U.S. Census regions. Hence, the potential for bias in the findings is minimized. 3

6 Level of EHR Adoption in Dermatology AAD Electronic Health Records Survey 2012 Report Based on preliminary 2010 and data from 2009, Hsiao (et al.) 2 conclude that 48% of all ambulatory medical care providers have some form of electronic health records (EHR) or electronic medical records (EMR). Results from this survey indicate that 51% of dermatologists responding have acquired an EHR system for their primary practice. Thus, the adoption of EHR systems in the practice of dermatology is comparable to ambulatory medical care provider EHR adoption. Figure 1 Degree of EHR System Acquisition at Primary Practice Fully implemented EHR system Aquired and implementation in process. Acquired, not yet implemented 5% 8% 38% Plan to acquire within 2 years No plans to acquire 18% 32% 0% 10% 20% 30% 40% As seen in Figure 1, nearly two-fifths (38%) of dermatologists indicate their EHR system is fully implemented. Eight percent have implementation in process and the remaining five percent have acquired but not yet begun the implementation process. Another 18% are planning to acquire an EHR within the next two years. Nearly one-third (32%) of dermatologists indicate they currently have no plans to acquire an EHR system. (See Table 1 of Appendix A.) Figure 2 Fully Implemented EHR System Previously used paper records but converted to EHR 58.6% EHR was in place when joined/started the practice 35% Use both paper records and EHR 6% 0% 15% 30% 45% 60% 75% More than half of dermatologists with an EHR system (59%) indicate that they previous used paper records but have converted to an EHR system (see Table 2). More than one-third (35%) indicate the EHR was in place when they joined or started their primary practice. Less than one-tenth (6%) indicate that they are using dual modes (both paper records and EHR). (See Figure 2) 2 CITATION: Hsiao C-J, Hing E, Socey TC, Cai B. Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates. NCHS Health E-Stat [Internet] Dec 8; Available from: 4

7 Figure 3 Degree of EHR System Implementation by Practice Type Acquired Plan to Acquire No Plans to Acquire Solo 36% 16% 48% Derm Group 36% 29% 35% Multispecialty Academic 90% 94% 6% 4% 4% All Survey Respondents 51% 18% 32% 0% 20% 40% 60% 80% 100% Dermatologists in academic and multispecialty group practices are significantly more likely have an EHR system acquired (implemented, in process, or purchased) than those in solo or group dermatology practices (p<.0001). (See also Table 3 in the Appendix.) As seen in Figure 3, over 90% of dermatologists in multispecialty and academic settings have an EHR System acquired compared with 36% of those in solo or dermatology group practices. (See Table 4.) Figure 4 Use of Practice Management and EHR Systems 60% Practice Mgmt EHR 56% 50% 47% 40% 30% 20% 10% 9% 16% 14% 6% 8% 21% 0% Less than 1 year 1-2 years 2-4 years More than 4 years Of all respondents, nearly two-thirds (64%) have two or more years of experience with a Practice Management System in their primary practice. (See Figure 4.) Of the 264 dermatologists whose system is fully implemented or in process of implementation, two-thirds (68%) reported having two or more years of experience with an EHR system at their primary practice. Practice Management and EHR Systems at Dermatology Practices System Providers Of the 461 respondents who reportedly have a practice management system at their primary practice, Allscripts/Eclipsys and Sage are the top two providers selected by 8.7% and 6.9% of dermatologists, respectively. (See Figure 5.) As seen in Figure 6, Epic and Allscripts/Eclipsys are the most frequently selected providers of EHR systems reported by 18% and 14% of the respondents, respectively. See Table 7 for a complete list of vendors reported by responding dermatologists. 5

8 Figure 5 Provider of the Practice Management System Allscripts/Eclipsys 8.7% Sage 6.9% Cerner Corp. Epic GE Healthcare/Centricity 4.8% 4.3% 5.6% 0% 5% 10% 15% 20% Figure 6 Provider of the Electronic Health Record (EHR) Epic Allscripts/Eclipsys eclinical Works NextGen HealthCare NexTech Cerner Corp. 6.1% 6.1% 5.8% 5.4% 14.2% 18.0% 0% 5% 10% 15% 20% First EHR at Primary Practice For those who have acquired an EHR, one-fifth indicated that this was not the first EHR at their primary practice. (See Figure 7.) Of these 59 respondents, one-fifth reported that the system did not meet their expectations or requirements. Nearly one-seventh (13.6%) indicate that it was a decision made by corporate or leadership and thus may have not been included in the process. (See Figure 8 and Table 9.) Figure 7 First EHR at Primary Practice (% of 295 w/ EHR Acquired) NR 1.4% No 20.0% System/vendor did not meet expectations/requirements Corporate/leadership decision Figure 8 Reasons for Replacement (% of 59 w/ EHR system replaced) 13.6% 20.3% Yes 78.6% Vendor/version no longer provided support Started new/changed practices 6.8% 3.4% Allow for records between hospital & practice 1.7% No reason given 54.2% 0% 20% 40% 60% 6

9 Technology for EHR Systems Dermatologists who have acquired an EHR were asked about the technology used to support the EHR system. Microsoft Windows computer operating system is used by nearly most, which is consistent with the computer hardware (Figure 9) used in the primary practice. As may be seen in Figures 10 and 11, more than half of dermatologists (60%) who have acquired an EHR use a client-server model where the program or EHR system resides on a server for the practice. Data backup and disaster recovery processes exists for four-fifths (81%) of those who have an EHR system. (See also Tables ) Figure 9 Computer Hardware for EHR Systems PC 87.8% Laptop 36.3% Tablet 20.0% ipad 9.5% MAC/Apple Netbook 5.4% 2.7% 0% 20% 40% 60% 80% 100% Figure 10 Software System for Primary Practice Figure 11 Data backup and Disaster Recovery Process Client-server model Web-based ASP 20.0% 60.3% Yes, formal plan Yes, tech firm Not Sure 16.9% 29.5% 51.9% Not sure 17.3% No 1.7% 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% EHR Financing and Costs More than half (56%) of respondents indicate that their EHR was a direct purchase by the practice. Hospital donation or cost sharing arrangements account for 11% of respondents financial support and less than one percent (0.7%) from grant funding. (See Table 17.) The median first year ownership cost (direct and indirect) for EHR systems purchased directly is $50,750. As would be expected, there are significant differences in the first year costs by practice setting. The median first year ownership costs is $43,000 for dermatologists in solo practices, $65,000 for those in dermatology group practices, and $115,000 for those in multispecialty group practices. See Table 18 for details. The median cost per clinician for yearly upgrades and maintenance costs is $5,000 (ranging from $100 to $90,000). (See Table 19.) Capabilities of EHR System The survey asked a series of questions related to the capabilities regarding the ability of the EHR system to capture information related to patient health record, order entry and results management, clinical decision support, online patient accessibility, electronic interfacing and reporting. 7

10 Patient Health Information As seen in Figure 12, over 90% of dermatologists report that their EHR systems have the ability to capture notes (e.g., medical history), patient medication lists, patient general health information, and patient demographics. Seventy-three percent of respondents reported that their EHR has the ability to upload photos, 64% systems capture anatomic graphs and/or lesion mapping, and 50% have the ability to draw on body diagrams and/or photos. (See also Table 20.) Figure 12 Patient Health Information Yes Yes, but not used Not Sure No No response Notes 95% Medications (Rx & OTC) 94% Patient information 93% Patient demographics 87% 4% 5% Photo upload and archiving 60% 13% 6% 20% Anatomic graphs and/or lesion mapping 48% 18% 6% 27% Ability to draw on body diagrams and/or photos 36% 14% 11% 37% 0% 20% 40% 60% 80% 100% Order Entry and Results Management Most respondents report that their EHR systems have order entry management functionality. As seen in Figure 13, the vast majority (90%) report that their EHR systems have electronic prescribing, 73% can place orders for laboratory tests, 66% have access to drug formularies, and 64% can send laboratory test orders electronically. Regarding results management, 80% of respondents report that their EHR system has the ability to view laboratory results that are integrated into the patient s record, and 52% can view summary of care record for each transition of care or referral. However, only 20% of dermatologists report that their EHR system has the ability to view pathology slide images that are integrated into the patient s EHR record. (See also Table 20.) 8

11 Figure 13 Order Entry and Results Management Yes Yes, but not used Not Sure No No response Electronic prescribing 86% 4% 7% Laboratory results integrated into EHR 72% 9% 6% 12% Orders for laboratory tests 60% 13% 6% 20% Access to drug formularies 57% 9% 15% 18% Laboratory test orders sent electronically 49% 15% 10% 26% Summary of care record for each transition of care or referral 47% 5% 21% 26% Pathology slide images integrated into EHR 13% 6% 14% 65% 0% 15% 30% 45% 60% 75% 90% Clinical-Decision Support and Online Patient Accessibility/Notification As seen in Figure 14, 86% of dermatologists report that their EHR systems have the ability to provide warnings of drug interactions and allergies and 60% can highlight out of range test levels. However, only 41% of respondents report that their EHR system has the ability to provide reminders regarding guidelinebased interventions or screenings. (See also Table 21.) Regarding online patient accessibility and notification, 53% of respondents report that their EHR systems have patient-specific education resources and clinical summaries available online. However, less than half (45%) report that patients are able to log into a HIPPA compliant web portal, 44% report that patients are able to send non-urgent messages or questions to practice and 40% can send patient electronic reminders and messages. (See Figure 14 and Table 21.) Figure 14 Clinical Decision Support and Online Patient Accessibility/Notification Yes Yes, but not used Not Sure No No response Provide warning of drug interactions and allergies 77% 3% 9% 9% Highlight out of range test levels 55% 5% 16% 22% Patient-specific education resources & clinical summaries 39% 14% 17% 28% HIPPA compliant web portal for patients 33% 12% 16% 37% Patients able to send non-urgent messages or questions 31% 13% 16% 38% Reminders for guideline-based interventions or screening 31% 10% 26% 31% Send patient electronic reminders and messages 28% 12% 20% 37% 0% 20% 40% 60% 80% 100% 9

12 Reporting and Electronic Interfacing As seen in Figure 15, most dermatologists report that their EHR system has an interface with practice scheduling and/or billing system. Forty percent report that their EHR System is capable of quality reporting to Medicare (PQRS) with approximately one-third being unsure about whether their EHR has this functionality. Only 20% of dermatologist report that their system can perform public heath reporting. However, approximately half (48%) are unsure whether the EHR system can perform this function. (See also Table 23.) Interface with practice scheduling and/or billing system Figure 15 Reporting and Electronic Interfacing Yes Yes, but not used Not sure No NR 74% 9% 10% Quality reporting to Medicare (PQRS) 33% 7% 34% 24% Public health reporting 10% 6% 48% 35% 0% 25% 50% 75% 100% Electronic Communication with Other Providers How a dermatology office electronically communicates with other providers differs significantly by the level of EHR adoption. One-third (34%) of those who have implemented an EHR indicate that they never use an EHR to transmit of key clinical information compared to more than four-fifths (85%) of those dermatologists who have not implemented a system (Figures 16a and 16b below). Dermatologists who implemented an EHR system are more likely (34%) than those who have not implemented a system (19%) to send information through a secure system attachment. Figure 16a Methods to Send and/or Receive info with Others (% of 264 with EHR Implemented) Always/Occasionally Rarely/Never NR Through EHR system 65% 34% Through secure 34% 63% FAX 73% 24% 0% 25% 50% 75% 100% 10

13 Figure 16b Methods to Send and/or Receive info with Others (% of 318 without EHR Not Implemented) Always/Occasionally Rarely/Never NR Through secure 19% 70% 11% FAX 83% 14% 3% 0% 25% 50% 75% 100% Sending or receiving key clinical information by FAX is still a major way to exchange key clinical information. More four-fifths (always 51%; occasionally 31%) of those who have not implemented a system use a fax compared to nearly three-fourths (always 28%; occasionally 44%) of those who have implemented an EHR system. Rarely used methods of communication are hospital-based system (66% never use) and a Health Information Organization (HIO) or State Exchange (81% never use). Other methods used for clinical information transmission provided by respondents include traditional mail/usps (39% of those who indicate other) and telephone (5% of those who indicate other). (See also Table 15.) EHR System Evaluation and Overall Satisfaction Survey participants were asked to evaluate different aspects of their EHR system with regard to patient care and general office use. Patient Care and Management As seen in Figure 17, more than two-thirds (70%) of respondents agree that their EHR system allows easy electronic prescription transmission and more than half (agree that they can easily find information and effectively document patient care. (See also Table 24.) One third of respondents agree that their EHR system can easily upload and archive photos, 29% agree that it provides useful tools for health maintenance, 26% agree that the system effectively tracks quality measures for patient care and 22% agree that their EHR includes anatomic graphs and lesion mapping that meets their needs as a dermatologist. 11

14 Figure 17 Patient Care and Management Agree Neutral Disagree N\A or NR EHR allows easy transmission of e-rx 70% 7% 14% Easily find information needed in EHR 56% 15% 20% 11% Documenting care is effective with EHR. 53% 20% 16% 12% Electronically ordering lab tests is easy w/ehr 38% 12% 19% 31% Allows easiy upload and archive of photos. 33% 14% 31% 22% Provides useful tools for health maintenance 29% 24% 31% 17% Quality measures for patient care are effective 26% 15% 32% 27% Includes anatomic graphs and lesion mapping 22% 14% 46% 18% 0% 20% 40% 60% 80% 100% General Office Use Approximately half (51%) of dermatologists agree that they would not go back to paper based even if it were possible (Table 25). Over 40% of respondents agree that they have received helpful software upgrades, timely technical support, and necessary training from their EHR vendor. Approximately one third of dermatologists report that their EHR system is intuitive and easy to use, are overall satisfied and would pick the same EHR system again. However, 42% of dermatologists disagree that the office productivity improved after implementation and that their system has or will save the practice money. (See Figure 18 and Table 25.) Figure 18 General Office Use Agree Neutral Disagree N/A & NR Would not go back to paper-based, if possible. 51% 12% 25% 12% Receive helpful software upgrades from vendor. 45% 20% 18% 16% Receive timely technical support from vendor. 43% 20% 22% 14% Office staff received necessary training from vendor 43% 22% 19% 16% Overall, satisfied with EHR 33% 20% 34% 12% Overall, EHR is intuitive and easy to use 32% 21% 36% 12% Pick the same vendor if did it all over again 30% 17% 38% 16% Office productivity improved after implementation 25% 17% 42% 16% EHR has/will save money 24% 17% 42% 16% 0% 20% 40% 60% 80% 100% 12

15 Impact of EHR Adoption Staffing level changes might be considered as a proxy for saving money or increased office productivity. However, when asked about staffing levels after EHR implementation, 20% indicate that it is too soon to tell (6%) or they were not sure (14%). Nearly one fourth of dermatologists with an EHR implemented indicate that the staffing levels did not change, but some functional roles did change after completion. (See Figure 19 and Table 26) Figure 19 Staffing Level Changes after Implementation Levels increased No staffing changes Some functional roles changed Levels decreased Too soon to tell No response/not Sure 6.1% 6.1% 17.1% 23.5% 23.1% 24.2% 0% 5% 10% 15% 20% 25% 30% The most difficult aspect in adopting an EHR system was reported to be the actual implementation (staff buy-in and actual in-office use). However, there were statistically significant differences between anticipated (those yet to acquire) and actual most difficult aspect of the implementation. Of those who have yet to acquire an EHR system, 38% reported that the anticipated implementation would be the most difficult compared to 22% of those who actually have an EHR functioning in the practice. For those with a functioning EHR in the practice, the next three most difficult implementation processes are customized templates or forms (20%), training (11%), and selecting the EHR (9%). For those who have yet to begin the EHR acquisition, the next three most difficult processes are selecting the EHR (12%), activating the system including data entry and charting documentation (12%), and training (7%). (See Figure 20.) EHR implementation Customized templates/forms Training Selecting EHR Activating system Figure 20 Most Difficult Process of EHR Implementation Implemented 6% 7% 7% 9% 11% 12% 12% Not Implemented 0% 10% 20% 30% 40% 20% 22% 38% Hence, the differences in process difficulty are dependent on the magnitude of EHR implementation. Both groups select the same issue as most difficult. Proportionally, more dermatologists who have yet to implement their EHR indicate finding a dermatology-specific EHR as a difficult barrier compared to dermatologists who already began the process of implementation. Note that scanning paper charts into the system is rated most difficult by 5% or less of each group (see Table 27 for details). 13

16 Barriers to EHR Implementation Overall, 57% of respondents reported that finding a certified dermatology-specific EHR system that meets their needs as a dermatologist, 51% reported financial (e.g., lack of capital, low ROI) and administrative (e.g., lack of time, compatibility with billing system) issues as major barriers, 45% reported technical issues, 42% reported skill level (of staff), and 39% reported concerns that the obsolete EHR system as major barriers to implementation. (See Figure 21 and Table 29.) Table 33 provides additional comments provided by respondents regarding barriers in implementing an EHR in their practice. Figure 21 Barriers to Implementing an EHR in Primary Practice Major Moderate Minor/None No response Finding Derm-specific EHR 57% 21% 13% 9% Financial 51% 18% 10% 9% Administrative 51% 23% 16% 10% Technical 27% 26% 17% 11% Skill Level 42% 28% 20% 10% Concerns EHR becomes obsolete 40% 28% 23% 9% 0% 20% 40% 60% 80% 100% Significantly fewer dermatologists who have acquired and EHR system reported major barriers than those who have yet to acquire an EHR system (p < ). Between 56-73% of dermatologists who have yet to acquire an EHR reported they anticipate all six aspects to be major barriers. This compares with 24-40% of those who have acquired an EHR system to report major barriers to implementation. (See Figures 22a and 22b and Table for details.) Figure 22a Barriers to Implementing an EHR by Level of Acquisition (% of 295 with EHR Acquired) Finding a certified Derm-specific EHR that meets needs Barrier Moderate Minor/No Barrier NR 40% 25% 19% 16% Financial 34% 21% 30% 15% Administrative 33% 27% 24% 16% Technical 32% 28% 23% 17% Skill Level 29% 32% 23% 16% Concerns that the EHR system will become obsolete 24% 29% 31% 17% 0% 20% 40% 60% 80% 100% 14

17 Finding a certified Derm-specific EHR that meets needs Figure 22b Barriers to Implementing an EHR by Level of Acquisition (% of 287 without EHR Acquired) Financial Barrier Moderate Minor/No Barrier NR 73% 70% 17% 19% 7% 8% Administrative 70% 15% 12% Technical 59% 24% 10% 6% Skill Level Concerns that the EHR system will become obsolete 56% 56% 0% 20% 40% 60% 80% 100% 24% 26% 16% 15% Participation in Incentive Programs Electronic Prescribing The rate of electronic prescribing (e-rx) doubled from 2009 (24%) to 2011 (58%). Based on survey respondents, more than half (58%) may be using e-rx for their patients in 2011 and two-thirds (67%) in 2012 (see Table 34, Table 35, and Table 36). Of the 209 (36%) respondents who indicate they did not participate in the 2011 e-rx incentive, 108 (52%) provided additional information why they did not participate. The top most frequently mentioned reasons for not participating are costs (17 respondents), starting in near future (15 respondents), and software or technology issues (13 respondents). (See Table 37.) Registration in EHR Incentive Program Of the dermatologists who have acquired their EHR, nearly half (48%) reported that they have registered for the 2011 EHR Incentive Program (Figure 23 and Table 39). Of the dermatologists who are not currently registered, one-fifth (20%) are planning to register in Figure 23 Registration in 2011 EHR Incentive Program No plans to register 19% No; but plan to register 20% Yes 48% NR 13% 15

18 Attesting for 2011 Meaningful Use Of the dermatologists who registered for the 2011 EHR incentive, more than one fourth (28%) have attested within the first half of Looking specifically at those who did register, nearly three-fifths (59%) attested for meaningful use (Table 40). However, two-fifths (40%) of dermatologists registered for the incentive had yet to attest for meaningful use. Currently in the 90-day reporting period Less than one-fifth (19%) of those with an EHR system have yet to attest. Of those who are registered but not yet attested, one-third (33%) are in their 90-day attestation and slightly more than half (53%) are not in the 90-day period. (See Figure 24.) Figure 24 Attested for Meaningful Use in 2011 (% of 295 w/ EHR System Acquired) Already Attested 28% In 90 Day Trial Period 33% Not Registered 40% Registered but not attested 19% NR 13% (n=57) Not in Trial Period 53% NR 14% Received 2011 EHR Incentive Payment Of the respondents who are registered and have attested for the 2011 less than one-third (27%) have received their incentive payment (Table 40). Nearly three-fifths (60%) of dermatologists registered and attested for the incentive have yet to receive payment. (See Figure 25.) Figure 25 Registered and Attested - Payment Status Registered & not attested 19% NR 0.3% Recieved EHR payment 27% Not Registered 40% Registered & attested 28% (n=84) No payment recieved 60 % NR 13% NR 13% 16

19 Continue using EHR after the 90-day reporting period AAD Electronic Health Records Survey 2012 Report Four-fifths (82%) of those registered and attested reported that they continued to capture meaningful use data after the 90-day reporting period. Less than one-tenth (8%) of this group reported that they did not continue data capture after use their attestation period. (See Figure 26.) Figure 26 Registered and Continued Use Not Registered 40% Registered & not attested 19% Registered & attested 28% Continue using EHR after 90-day reporting period 82% NR 13% Not continue 8% NR 10% \ Plans to Register for EHR Incentive Program in 2012 There is an increase from the 2011 level (48%), when dermatologists respond about registering for 2012 and beyond (Table 40, Table 41, and Table 42 in the appendix). Looking to the future, only 12% for 2012 and 8.5% for beyond 2012 indicate they would not participate of those who have acquired or are planning to acquire an EHR compared to 40% not registered for an EHR incentive in The proportion of those who are uncertain about registering for the incentive remains steady for 2012 and beyond (23% for those who attested in 2011; 30% for all those who have already acquired or are planning on acquiring an EHR). The reasons for uncertainty are beyond the scope of the current survey but may be of interest in future studies of EHR systems in dermatology. 17

20 Conclusion Overall, dermatology is in line with other specialties in regard to EHR acquisition. Nearly 50% of dermatologists had acquired an EHR system, which is similar to a recent finding by the Centers for Disease Control (CDC) that 55% of physicians had adopted an EHR system 3. The CMS EHR Incentive Program, otherwise known as meaningful use is expected to only speed this adoption process, and the Academy continues to offer helpful resources to practices interested in obtaining the meaningful use incentive at Additionally, the Academy will continue advocating for those dermatologists who choose to not implement an EHR as 48% of solo practitioners in dermatology have no plans to acquire an EHR system. Through advocacy efforts, the Academy continues to stress that no penalties should be assessed on these dermatologists and the choice to adopt an EHR should always be voluntary. On a broader level, the Academy supports incentives that foster the voluntary adoption of affordable and reliable HIT solutions that enable dermatologists to enhance the physician-patient relationship through improved access to timely and safe quality-based dermatologic care 4. In support of this position, the Academy s approach to HIT in general and EHRs in particular has been based on three key elements: 1. educating members on the costs, risks, and benefits of practice automation (at Annual/Academy meetings and practice management courses and through the development and dissemination of practice management resources designed to assist dermatology practices considering EHRs); 2. advocating on behalf of dermatology to ensure that the priorities and needs of the specialty are reflected in ongoing attempts to define, develop, and update functional standards for EHR software systems as well as to advance the dermatology perspective in the still emerging health IT regulatory framework nationwide; 3. engaging with federal policymakers and medical specialty societies to influence proposed federal regulations and incentives governing health IT and participating with other private and publicsector stakeholders on the role dermatologists will play in the emerging HIT and EHR landscape. Future Academy efforts will support updating and enhancing this multi-faceted strategy to deliver value to the specialty as technology, legislative efforts and the regulatory environment continue to evolve. 3 Physician Adoption of Electronic Health Record Systems: United States, 2011; available at 4 AAD Position Statement on Health Information Technology (Approved by the Board of Directors on April 21, 2007). 18

21 Appendix A Statistical Tables 19

22 Table 1 EHR System Acquisition (n=582) Implemented (or in process) n % We have fully implemented our EHR system % Our EHR implementation is in process % Subtotal 264 Acquired, not yet implemented We have acquired an EHR, not implemented yet, and expect to within the next 12 months % We have acquired an EHR, not implemented yet, and expect to within the next 13 to 24 months % Subtotal 31 Not acquired We plan to acquire an EHR in the next 12 months % We plan to acquire an EHR in the next months % We have no plans to acquire an EHR system % Subtotal 287 Total % Table 2 EHR at the current practice n % The EHR was in place when I joined/started the practice % Previously we used paper records, but have converted to an EHR % Currently, we use both paper records and EHR % No response 1 0.4% Total % 20

23 Table 3 EHR System Acquisition by 2 Practice Categories (n = 520) Solo and Group Dermatology Multispecialty Group Acquired and Implemented (or in process) n % n % We have fully implemented our EHR system % % Our EHR implementation is in process % % Acquired, not yet implemented We have acquired an EHR, not implemented yet, and expect to within the next 12 months % 1 1.1% We have acquired an EHR, not implemented yet, and expect to within the next 13 to 24 months % 0. Not acquired We plan to acquire an EHR in the next 12 months % 4 4.2% We plan to acquire an EHR in the next months % 2 2.1% We have no plans to acquire an EHR system % 4 4.2% Total n per group Table 4 EHR System Acquisition by Practice Types Primary practice type Solo Dermatology Multispecialty Academic Hospital/ VA Industry/ Total Degree of EHR acquisition group group Military Corporate n % n % n % n % n % n % n % We have fully implemented our EHR system % % % % 4 100% 3 100% % Our EHR implementation is in process % % % % % We have acquired an EHR, not implemented yet, and expect to % 5.1% 1.1% 6.1% within the next 12 months.) 4.1% We have acquired an EHR, not implemented yet, and expect to % 1.0% 4.1% within the next 13 to 24 months. 1.2% We plan to acquire an EHR in the next 12 months % % 4 4.2% 0 0.0% % We plan to acquire an EHR in the next months % % 2 2.1% 2 4.1% % We have no plans to acquire an EHR system % % 4 4.2% 1 2.0% % 21

24 Table 5 Year of PMS and/or EHR use at practice PMS EHR n % n % Less than 1 year % % 1-2 years % % 2-4 years % % More than 4 years % % No response % 5 1.9% Total % % Table 6 Practice Management System Vendor n % Allscripts/Eclipsys % Sage % Cerner Corp % Epic % GE Healthcare/Centricity % eclinical Works % NexTech % NextGen HealthCare % McKesson % Micro % Encite 7 1.5% emds 5 1.1% Henry Schein 4 0.9% ederm Systems 3 0.7% Clinix 2 0.4% Modernizing Medicine 1 0.2% Others % Unknown/Not Specified % None selected % GE Healthcare/Centricity 0 Practice Fusion 0 Versasuite 0 22

25 Table 7 EHR System Vendors n % Epic % Allscripts/Eclipsys % NextGen HealthCare % eclinical Works % NexTech % Cerner Corporation % Modernizing Medicine % GE Healthcare/Centricity % Micro % Encite 7 2.4% Sage 7 2.4% emds 4 1.4% ederm Systems 2 0.7% McKesson 1 0.3% Clinix 0 Greenway Medical 0 Henry Schein 0 Practice Fusion 0 Versasuite 0 Unknown % OTHER Specified: % Other Not Specified % No EHR selected % Table 8 First EHR System for the Primary Practice (n=295) n % Yes % No 59 20% No response 4 1% Total % 23

26 Table 9 Why this is not the first EHR (n=59) Those who responded that this was not their first EHR system at the primary practice were asked why they purchased a second system. These individually typed responses broadly categorize into the following groupings: Broad Categories n % System or vendor did not meet expectations or user requirements; general dissatisfaction % Corporate or leadership decision % Vendor or version no longer provides support nor available 4 6.8% Started a new practice or changed to a different practice 2 3.4% To allow for records between hospitals and practice % Did not provide a response to why they changed EHR systems % Table 10 Types of Computer Hardware used for EHR (Check all that apply; n= 295) n % PC % Laptop % Tablet % ipad % MAC/Apple % Netbook 8 2.7% Other hardware 4 1.4% ELO Workstations thin client iphone No response % Table 11 Types of Computer Operating Systems for EHR (Check all that apply; n=295) n % Microsoft Windows % Not sure % ios (for ipod, ipad, iphone) % Apple OS X (any version) % Linux/Unix 6 2.0% Android 3 1.0% 24

27 Table 12 Software System for Primary Practice EHR n % Client-server model % Web-based ASP % Not sure % Other 2 0.7% No response 5 1.7% Total % Table 13 Data backup or disaster planning n % Yes, formal documented plan % Yes, have technology firm/consultant on-call % No 5 1.7% Not Sure % No response 6 2.0% Total % Table 14 Sending and Receiving Key Clinical Information Always Occasionally Rarely Never No response (n= 582) n % n % n % n % n % FAX % % % % % Through EHR system % % % % % Through secure system attachment % % % % % Through hospital-based system % % % % % Through Health Information Organization or state 9 1.6% % % % % Other way to send (check % % % % % box)* Other comments coding: USPS/Snail Mail Telephone Transcription Service 1 E-Rx Inter-office mail 1 iphone text message 1 website 1 website portal 1 1 Inter-office mail 1 No comment provided N/A 25

28 Table 15 Sending and Receiving Key Clinical Information (Implemented n=264 ; Always Occasionally Rarely Never No response Not implemented n=318) n % n % n % n % n % Implemented % % % % 3 1.1% EHR system Not Implemented 1 0.3% % % % % Implemented % % % % % FAX Not Implemented % % % % % Implemented Secure % % % % % Not Implemented attachment 9 2.8% % % % % Implemented Hospitalbased % % % % % Not Implemented system 6 1.9% % % % % Implemented HIO or State 6 2.3% 6 2.3% % % % Not Implemented Exchange 3 0.9% 5 1.6% 7 2.2% % % Implemented Other way to 7 2.7% 9 3.4% 8 3.0% % % Not Implemented send % % 2 0.6% % % Table 16 How Primary Practice Connects to Internet n % T1 Cable % Cable through a service % DSL % No internet at primary practice % Not sure % Other 9 1.6% Fiber optic service (FIOS) 4 Cable and dsl 2 Wi-Fi through local server association 1 Dial-up 2 No response 5 0.9% Total % 26

29 Table 17 Primary financial support for EHR (n=295) n % Direct purchase by practice % Hospital donation/cost-sharing arrangement % Lab donation/cost-sharing arrangement % Financing % Lease by option 9 3.1% Applied for and received grant funding 2 0.7% Other % Academic 6 DOD 4 N/A 1 Do not know or Not sure 13 Response expected but not provided 2 No response % Total % Table 18 EHR Total First Year Costs for EHR purchased by the primary practice (Limited to solo, dermatology group, and multispecialty practices; n=139) N N Miss Median Mean Max. Min. 25 th Pctl. 75 th Pctl. Outliers All Respondents $50,750 $105,661 $1,300,000 $1,000 $25,000 $80,000 1 Solo 46 6 $43,000 $48,793 $150,000 $1,000 $20,000 $65,000 0 Group Dermatology $65,000 $82,500 $300,000 $10,000 $35,000 $100,000 0 Multi-Specialty $115,000 $373,833 $1,300,000 $1,000 $30,000 $1,000,000 1 Table 19 Total Yearly Costs per Clinician for EHR purchased by practice (Limited to solo, dermatology group, and multispecialty practices; n=139) N N Miss Median Mean Max. Min. 25th Pctl. 75th Pctl. Outliers All Respondents $5,000 $9,060 $90,000 $100 $2,500 $10,000 1 Solo $4,000 $6,105 $30,000 $250 $1,000 $6,000 0 Group Dermatology $5,000 $13,780 $90,000 $100 $4,500 $18,000 0 Multi-Specialty 9 41 $5,500 $10,637 $35,000 $2,000 $2,450 $16,

30 Table 20 EHR System: Health Information and Data [Patient Records] (n=295) Yes Yes, but not used No Not Sure No response n % n % n % n % n % Notes % 7 2.4% % 3 1.0% Medications taken (Rx and OTC) % 5 1.7% 3 1.% 7 2.4% 3 1.0% Patient information % 7 2.4% 2 0.7% 7 2.4% 4 1.4% Patient demographics % % 8 2.7% % 3 1.0% Photo upload and archiving % % % % 4 1.4% Anatomic graphs and/or lesion mapping % % % % 3 1.0% Ability to draw on body diagrams &/or photos % % % % 5 1.7% Table 21 Order Entry and Results Management (n=295) Yes Yes, but not used No Not Sure No response n % n % n % n % n % Electronic prescribing % % % 3 1.0% 3 1.0% Laboratory results integrated into EHR % % % % 5 1.7% Orders for laboratory tests % % % % 3 1.0% Access to drug formularies % % % % 6 2.0% Laboratory test orders sent electronically % % % % 4 1.4% Summary of care record for each transition of care or referral % % % % 4 1.4% Pathology slide images integrated into EHR % % % % 5 1.7% Table 22 Clinical Decision Support and Online Patient Accessibility (n=295) Yes Yes, but not used No Not Sure No response n % n % n % n % n % Provide warning of drug interactions and allergies % % % % 4 1.4% Highlight out of range test levels % % % % 5 1.7% Patient-specific education resources & clinical summaries % % % % 7 2.4% HIPPA compliant web portal for patients % % % % 6 2.0% Patients able to send non-urgent messages or questions Reminders for guideline-based interventions or screening % % % % 7 2.4% % % % % 7 2.4% Send patient electronic reminders and messages % % % % 7 2.4% 28

31 Interface with practice scheduling and/or billing system AAD Electronic Health Records Survey 2012 Report Table 23 Reporting and Electronic Interfacing (n=295) Yes Yes, but not used No Not Sure No response n % n % n % n % n % % % % % 8 2.7% Quality reporting to Medicare (PQRS) % % % % 4 1.4% Public health reporting % % % % 4 1.4% Table 24 EHR Patient Care and Management (n= 264) This EHR allows me to easily send electronic prescriptions Documenting care is effective with my EHR. I can easily find the information I need in my EHR. Electronically ordering lab tests is easy with my EHR My EHR allows me to easily upload and archive photos. This EHR provides useful tools for health maintenance Quality measures (including PQRS) for patient care are effective This EHR includes anatomic graphs and lesion mapping 5. Strongly agree Strongly disagree Not applicable No response 47% 23% 7% 3% 6% 5% 9% 25% 31% 15% 11% 9% 2% 9% 26% 27% 20% 9% 7% 2% 10% 23% 15% 12% 9% 10% 20% 11% 17% 16% 14% 11% 20% 11% 11% 14% 15% 24% 17% 14% 7% 10% 12% 14% 15% 14% 18% 16% 11% 13% 9% 14% 15% 31% 8% 10% 29

32 Table 25 EHR General Office Evaluation (n= 264) Would not go back to paper-based, if possible. We receive helpful software upgrades from vendor. We receive timely technical support from vendor. Office staff received necessary training from vendor Overall, I am satisfied with the EHR at my primary practice. Overall, the EHR system is intuitive and easy to use. Pick the same vendor if I had to do it all over again. Office productivity improved after implementation Primary practice EHR has/will save money. 5. Strongly agree Strongly disagree Not applicable No response 38% 13% 12% 8% 17% 2% 10% 20% 25% 20% 10% 8% 5% 11% 21% 22% 20% 12% 10% 4% 10% 19% 24% 22% 9% 10% 5% 11% 14% 19% 20% 17% 17% 3% 9% 15% 17% 21% 17% 19% 2% 10% 19% 11% 17% 13% 25% 5% 11% 11% 14% 17% 12% 30% 6% 10% 14% 10% 17% 14% 28% 3% 13% Table 26 Changes in staffing levels after implementation completed (n=264) n % No, but some functional roles changed % Yes, levels increased % No staffing changes % Not sure % No response % Yes, levels decreased % Too soon to tell % Total % 30

33 Table 27 Most Difficult Process in EHR Implementation All Respondents Implemented Not Implemented n % EHR Implementation (staff acceptance, actual inoffice % % % use) Customized templates or forms % % % Selecting the EHR % % % Activating the system (data entry, charting, % % % documentation) Training % % % Maintaining the system (updates, upgrades, % % % technical support) Scanning paper charts into the system % 8 3.0% % Readiness assessment 5 0.9% 3 1.1% 2 0.6% Project planning 5 0.9% 2 0.8% 3 0.9% Contract negotiation 1 0.2% % No response % % % Other % % % Multiple barriers 2 4 No input 7 0 Vendor Issues 3 5 Cost 0 9 Other 5 a 10 b Total % % % a) Other Barriers for Implemented EHR Additional 3-5 minutes time per patient needed for the data input. Constant crashes of the system. Lack of efficiency in visits (added a great deal of time to doctor's work at the end of the day). lack of flexibility to allow free hand drawn body diagrams, learning to type Unreasonable demands and expectations from regulators and medical associations b) Other Barriers for those yet to implement EHR Getting used to the format and the lag time needed to get back to usual pace. switching to a system that is less efficient than dictating seeing patients in numbers before EHR loss of productivity decrease in productivity the interference with patient flow and efficiency It will kill me. lack of motivation to pursue No real government plan, so who knows Meeting "meaningful use" criteria 31