Overview of Health IT in Massachusetts: Data to Inform and Improve Performance Office of Economic Analysis, Evaluation and Modeling & State HIE Program December 2011
Chartpack Team Office of Economic Analysis, Evaluation and Modeling Vaishali Patel Matt Swain Dustin Charles Emily Hogin Meghan Hufstader State HIE Program Team Claudia Williams & Erica Galvez Evelyn Gallego & Uchenna Okoji Questions? Please contact your project officer with any questions. Health Information Technology 2
Overview of the Data Health Information Technology 3
What is in the Chartpacks? National and state data on: Health information exchange EHR adoption Capacity to exchange Active exchange Adoption of a basic EHR Exchange what types of data? (e-rx, lab data, care summaries) Exchange with who? (physicians, hospitals, pharmacies, labs, patients) Intent to apply for Meaningful Use Health Information Technology 4
Goals of the Chartpacks : A Tool for States Provide a snapshot of current levels of HIE/HIT capacity and activity underway Assess trends over time Help identify gaps as well as areas of strength Health Information Technology 5
Why Chartpacks? Regional extension centers Workforce training Medicare & Medicaid Incentives and penalties State grants for health Information exchange Standards & certification framework Privacy & Security framework Adoption of EHRs Meaningful Use of EHRs Exchange of health information Research to enhance HIT Improved health outcomes ability to study and improve care delivery Increased transparency and efficiency Source: Blumenthal D. Launching HITECH. N Engl J Med. 2010 Jan 4. http://healthcarereform.nejm.org/?p=2669 6
About the Data Sources ONC acquired potential indicators of HIT adoption and use from 3 major sources: National Ambulatory Medical Care Survey (NAMCS) EMR Supplement: The National Center for Health Statistics conducts this survey of physicians who work in ambulatory care settings annually by mail. Starting in 2010, the sample size was increased so we could generate statelevel estimates. American Hospital Association (AHA) survey Health IT Supplement: The American Hospital Association administers this annual survey of hospitals CIOs online and by mail. We report on non-federal acute care hospitals. Surescripts: A leading e-prescription network, Surescripts provides the highest quality representative sample of e-prescribing by providers and pharmacies in the United States. Health Information Technology 7
Current Data Sources Potential Indicators of HIT/HIE Capacity and Activity Data Source EHR adoption Labs erx Care Summary Consumer State Level Estimates NAMCS X X X** X** X AHA (Hospital) X X X X X* Surescripts X X *Generation of State-Level estimate depends upon sample size and response rate. **2011 data only will be available later this year. Health Information Technology 8
ONC s Current Data Sources Provider Surveys Physicians NAMCS Hospitals AHA Time Frame Annually Annually Population Physicians who work in ambulatory care settings CIOs of non-federal acute care hospitals Admin. Mail Online & mail Limitations Possible overestimate of adoption/use rates due to self-reported data & respondent bias 9
E-Prescribing Data Source Surescripts, a leading e- prescription network, provides the highest quality representative sample of e-prescribing in the United States. Data on providers and pharmacies are available quarterly. Market presence may vary in certain territories/states.* Enabled pharmacy Active pharmacy connected to the Surescripts network has processed at least one electronic prescription in the last month. *Please report pharmacies that are on a different network to your project officer 10
Data Strengths and Limitations Source Strengths Limitations NAMCS AHA Oversampling to generate statelevel estimates Administered by NCHS High response rate High response rate Respondent is the hospital CIO Self-reported Non-responder bias Self-reported Non-respondent bias No oversampling Overestimation of HIT adoption Surescripts Geographic scope of more than 92% of all pharmacies nationwide Large sample size Zip code level data Includes both nurse practitioners and physicians Coverage varies by state Denominator not supplied Due to small sample sizes, in some cases we may not be able to generate reliable state-level estimates. When the Relative Standard Error is high, it is considered an unreliable estimate and will be indicated with either an asterisk or the data will not be shown. Health Information Technology 11
NAMCS Chart Packs Health Information Technology 12
National Trends: Physician EHR Adoption 35% 'Basic' EHR Adoption by Office-Based Physicians 30% 30% 25% 25% 20% 20% 21% 20% 21% 15% 17% 15% 14% Overall Primary Care 10% 13% Small Practices ( 10 Physicians) Rural* 5% 0% 2008 2009 2010 Source: NAMCS, 2008-2010 *Rural = Non-Metropolitan Rural estimates not shown for 2008 because >30% relative standard error 13
How does your State Compare to National Estimates? Proportion of Office-Based Physicians that have Adopted a 'Basic' EHR 42% 45% 25% 21% 33% 30% Overall Small Practices ( 10 Physicians) Primary Care National Massachusetts Source: NAMCS, 2010 14
Nationwide: Physician Meaningful Use Intent Overall MU Intent for Office-Based Physicians in the Country MU Intent for Key Physicians MU Intend to Apply in 2011 75% Uncertain 45% Yes 41% Primary Care 50% No 14% Small Practices ( 10 Physicians) 85% 0% 20% 40% 60% 80% 100% Source: NAMCS, 2010 Health Information Technology 15
Physician MU Intent in your State Overall MU Intent for Office-Based Physicians in Massachusetts MU Intent for Key Physicians MU Intend to Apply in 2011 69% Uncertain 44% Yes 46% Primary Care 54% No 10%* Small Practices ( 10 Physicians) 83% 0% 20% 40% 60% 80% 100% Massachusetts Source: NAMCS, 2010 16
National Trends: Physicians Viewing Lab Results Electronically PIN Priority % 70 60 50 40 30 20 10 0 Proportion of Office-Based Physicians with the Capability: View Lab Results Electronically 51 28 23 61 38 23 63 44 19 2008 2009 2010 Overall Capability With EHR Without EHR Source: NAMCS, 2008-2010 EHR defined by those who report having any EHR 17
How does your state compare to national estimates? PIN Priority 71% Office-Based Physicians Capability: Viewing Electronic Lab Results 44% 37% 19% 12% 17% With EHR Without EHR No Capability to Exchange National Massachusetts Source: NAMCS, 2010 EHR defined by those who report having any EHR 18
How does your state compare to national estimates? Office-Based Physicians Capacity: Electronic Lab Test Ordering 57% 55% 37% 41% 8% 3%* With EHR Without EHR No Capability to Exchange National Massachusetts Source: NAMCS, 2010 EHR defined by those who report having any EHR * Indicates unreliable estimate, Relative Standard Error > 0.3 19
Nationwide Comparisons Health Information Technology 20
Statewide Estimates: Physician EHR Adoption Percentile Source: NAMCS, 2010 21
Statewide Estimates: Physician Intent to apply for Meaningful Use MU Percentile Source: NAMCS, 2010 22
Statewide Estimates: Physicians Viewing Lab Results Electronically PIN Priority Percentile Source: NAMCS, 2010 23
Statewide Estimates: Physician Electronic Lab Test Ordering Percentile Source: NAMCS, 2010 24
Measures of eprescribing Health Information Technology 25
Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 How does your State Compare to National Estimates? PIN Priority 100.0 90.0 80.0 70.0 Percent of Retail Community Pharmacies Enabled to e-prescribe and Actively e-prescribing on the Surescripts Network in Massachusetts 89.2 88.2 96.7 96.2 % 60.0 50.0 40.0 30.0 20.0 10.0 0.0 State of the Nation September 2011 Enabled nationwide: 92.4% Active nationwide: 90.9% Enabled in State Active in State Data Source: Surescripts
Surescripts Connectivity: Urban vs. Rural Pharmacies Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Percent of Retail Community Pharmacies Connected to the Surescripts Network in Urban and Rural Counties in Massachusetts 100.0 90.0 80.0 70.0 89.7 100.0 96.7 % 60.0 50.0 40.0 State of the Nation September 2011 30.0 20.0 10.0 28.6 Enabled urban: 93.1% Enabled rural: 90.2% 0.0 Percent Enabled in Urban Counties Percent Enabled in Rural Counties Data Source: Surescripts
Trend in Medication History Requests 1,600,000 Medication History Requests on the Surescripts Network in Massachusetts 1,400,000 1,200,000 1,151,431 1,217,987 1,000,000 800,000 600,000 400,000 200,000 The medication history request variable measures adoption and demand, describing the number of medication histories sought on the Surescripts network. There are 240 million patients with medication history data in the Surescripts database. Their information comes from participating pharmacy benefit managers and pharmacies. 0 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Data Source: Surescripts
AHA Data Health Information Technology 29
% How Does Your State Compare to the National Estimates? 40 30 Adoption of (Basic) EHRs by All Hospitals 34 32 20 10 13 23 16 19 National Massachusetts 0 2008 2009 2010 Data Source: AHA Hospital Survey Health Information Technology 30
% How Does Your State Compare to the National Estimates? 20 Adoption of (Basic) EHRs by Rural Hospitals 14 10 7 10 *Estimate not reliable due to sample size and relative standard error greater than.49 National Massachusetts 0 2008 2009 2010 Data Source: AHA Hospital Survey Health Information Technology 31
% How Does Your State Compare to the National Estimates? 50 Adoption of (Basic) EHRs by Small Hospitals 43 40 30 20 22 17 National Massachusetts 10 0 14 9 10 2008 2009 2010 Data Source: AHA Hospital Survey Health Information Technology 32
Statewide Estimates: Hospital EHR Adoption Percentile Data Source: AHA Hospital Survey Data from 2010 Health Information Technology 33
Meaningful Use Health Information Technology 34
How Does Your State Compare to the National Estimates? Year Hospitals Intend to Apply for Meaningful Use MU National Massachusetts No 15% Do not know 7%* No 11% Do not know 11% 2011 45% 2013+ 3%* 2013+ 8% 2012 21% 2012 24% 2011 55% Data Source: AHA Hospital Survey Data from 2010 *Estimate not reliable due to sample size and relative standard error greater than.49 Health Information Technology 35
Statewide Estimates: Hospitals Intending to Apply for MU in 2011/2012 MU Percentile Data Source: AHA Hospital Survey Data from 2010 Health Information Technology 36
Measures of Lab Exchange Health Information Technology 37
How Does Your State Compare to the National Estimates? % % % of Hospitals Electronically Exchanging Laboratory Reports PIN Priority 100 80 60 40 20 0 Inside Hospital System 72 70 64 60 Data Source: AHA Hospital Survey Data from 2010 67 64 2008 2009 2010 National Massachusetts 100 80 60 40 20 0 Outside Hospital System 23 16 18 17 2* 9 2008 2009 2010 National Massachusetts *Estimate not reliable due to sample size and relative standard error greater than.49 Health Information Technology 38
How Does Your State Compare to the National Estimates? % % of Hospitals Electronically Exchanging Laboratory Reports with Ambulatory Providers Outside Their System PIN Priority 100 80 60 40 20 0 77 67 70 53 55 47 2008 2009 2010 National Massachusetts Data Source: AHA Hospital Survey Data from 2010 Health Information Technology 39
Other Measures of Exchange Health Information Technology 40
How Does Your State Compare to the National Estimates? % % % of Hospitals Electronically Exchanging Radiology Reports MU Inside Hospital System 100 80 70 69 69 60 40 61 63 64 20 0 2008 2009 2010 Data Source: AHA Hospital Survey National Massachusetts 100 80 60 40 20 0 Outside Hospital System 26 23 22 21 2008 7 2009 9 2010 National Massachusetts Health Information Technology 41
How Does Your State Compare to the National Estimates? % % % of Hospitals Electronically Exchanging Medication Histories with Hospitals MU Inside Hospital System 100 80 76 80 83 60 79 79 71 40 20 0 2008 2009 2010 Data Source: AHA Hospital Survey National Massachusetts 100 80 60 40 20 0 Outside Hospital System 28 12 12 12 0* 2008 2009 2010 National Massachusetts 9 *Estimate not reliable due to sample size and relative standard error greater than.49 Health Information Technology 42
How Does Your State Compare to the National Estimates? % % % of Hospitals Electronically Exchanging Care Summaries with Hospitals MU Inside Hospital System 100 80 77 77 75 60 73 73 70 40 20 0 2008 2009 2010 Data Source: AHA Hospital Survey National Massachusetts 100 80 60 40 20 0 Outside Hospital System 26 13 14 14 7 8 2008 2009 2010 National Massachusetts Health Information Technology 43
How Does Your State Compare to the National Estimates? % % of Hospitals Electronically Exchanging Radiology Reports with Ambulatory Providers Outside Their System MU 80 70 60 50 40 30 20 10 0 66 70 69 52 54 45 2008 2009 2010 National Massachusetts Data Source: AHA Hospital Survey Health Information Technology 44
How Does Your State Compare to the National Estimates? % % of Hospitals Electronically Exchanging Medication Histories with Ambulatory Providers Outside Their System MU 50 40 30 20 10 45 43 39 39 34 30 0 2008 2009 2010 National Massachusetts Data Source: AHA Hospital Survey Health Information Technology 45
How Does Your State Compare to the National Estimates? % % of Hospitals Electronically Exchanging Care Summaries with Ambulatory Providers Outside Their System MU 60 50 40 30 20 10 0 56 57 37 44 42 32 2008 2009 2010 National Massachusetts Data Source: AHA Hospital Survey Health Information Technology 46
How Does Your State Compare to the National Estimates? PIN Priority % of Hospitals Electronically Exchanging Key Data with Ambulatory Providers Inside Their System 90 90 MU 73 70 67 67 68 74 National Massachusetts Data Source: AHA Hospital Survey Data from 2010 Lab Reports Rad Reports Med Histories Clinical Care Summaries Health Information Technology 47
How Does Your State Compare to the National Estimates? National % of Hospitals with Capacity to Provide Patients with an Electronic Copy of their Health Information 1 within 3 Business Days MU Yes 36% Mechanism of Sharing No 64% None 22 34 Other 16 21 Massachusetts No 59% Yes 41% USB Secure Messaging Patient Portal PHR 35 46 9 10 20 19 9 9 0 10 20 30 40 50 % Massachusetts National Data Source: AHA Hospital Survey Data from 2010 1 Includes all of the following: Diagnostic test results, problem lists, medication lists, allergies, and discharge summaries 48
Statewide Estimates: Hospitals Sharing Data Electronically with Patients Percentile Data Source: AHA Hospital Survey Data from 2010 49
How Does Your State Compare to the National Estimates? % of Hospitals with Capacity to Send Electronic Reminders to Patients National Massachusetts Yes 29% No 37% No 71% Yes 63% Data Source: AHA Hospital Survey Data from 2010 Health Information Technology 50
Statewide Estimates: Hospitals with Capacity to Send Electronic Reminders to Patients Percentile Data Source: AHA Hospital Survey Data from 2010 51
Statewide Estimates: HIE/HIO available in region Percentile Data Source: AHA Hospital Survey Data from 2010 52
Statewide Estimates: Exchange Capacity/Participating in an HIO Percentile Data Source: AHA Hospital Survey Data from 2010 53
How Does Your State Compare to the National Estimates? % of Hospitals with Exchange Capacity and Participating in an HIO 35 30 29 25 20 10 5 17 32 18 % National 15 24 19 Massachusetts 0 2008 2009 2010 Data Source: AHA Hospital Survey 54
Thank you! Health Information Technology 55