The state of HIT adoption and use in ambulatory and hospital settings

Slide Presentation from the AHRQ 2009 Annual Conferenc

On September 15, 2009, Mark Spranca, PhD made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (615 KB) (Plugin Software Help).

Slide 1

The state of HIT adoption and use in ambulatory and hospital settings

Mark Spranca, PhD
Abt Associates
AHRQ Annual Conference
September 15, 2009

Slide 2

Policy Context

• Interest in HIT has never been higher.it is widely viewed as a promising means of generating efficiencies, reducing unnecessary care, preventing errors, improving quality, increasing access, reducing disparities, etc
• To increase adoption and use of HIT, CMS and ONC are working on a plan to reimburse providers who demonstrate "meaningful use" of HIT
• Establishing standardized measures of HIT adoption, use and outcomes can
  • Inform the nation's HIT strategy and broader health reform strategy
  • Help the nation to track progress and revise the strategy

Slide 3

Steps in measure development

Validation > Conceptualization > Operationalization

Slide 4

Steps in estimating adoption and use with survey data

• Weighting and imputation to correct for non-response and missing data
• Coding response options in a consistent, appropriate way
• Getting the denominator right

Slide 5

Overview of measurement focus

Slide 6

Ambulatory Settings

Slide 7

Adoption of EHRs in Ambulatory Settings

Source: Desroches, C.M., E.G. Campbell, S.R. Rao, K. Donelan, T.G. Ferris, A. Jha, R. Kaushal, D.E. Levy, S. Rosenbaum, A.E. Shields, and D. Blumenthal. 2008. Electronic health records in ambulatory settings-a national survey of physicians. N Eng J Med 359 (1): 50-60.
Adoption of EHRs in Ambulatory Settings

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Survey Items Defining the Use of EHRs

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Availability and Use of CDS in Ambulatory Settings

Source: National Survey of Health Record Keeping among Physicians & Group Practices in the United States, 2008

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Availability and Use of CPOE in Ambulatory Settings

Source: National Survey of Health Record Keeping among Physicians & Group Practices in the United States, 2008

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Hospital Inpatient Settings

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Adoption of EHRs in Hospitals

Source: Jha, A.K., C.M. Desroches, E.G. Campbell, K. Donelan, S.R. Rao, T.G. Ferris, A. Shields, S. Rosenbaum, D. Blumenthal, 2009. Use of electronic health records in U.S. hospitals. N Eng J Med 360 (16): 1628-38.

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Survey Items Defining the Use of EHRs

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Adoption of 6 CDS Functions in Hospitals

Source: Hospital EHR Adoption Database (Supplement to the Annual AHA Survey of Hospitals)

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Adoption of CPOE in Hospitals

Source: Hospital EHR Adoption Database (Supplement to the Annual AHA Survey of Hospitals)

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Estimated Reduction in Medication Errors in U.S. Hospitals due to CPOE

Draft results based on Hospital EHR Adoption Database (Supplement to the Annual AHA Survey of Hospitals) and Medication Error Rate Reduction figures from the peer-reviewed literature

Slide 17

Conclusions

• 2008 baseline estimates reveal
  • Lots of room for improvement on adoption of HIT
  • Use of HIT tends to be high where HIT has been adopted
  • Outcomes are largely unknown
• Measurement priorities
  • Continue to measure adoption
  • Shift from use towards "meaningful use"
  • Build foundation for modeling and monitoring outcomes
• Policy recommendations
  • Given gaps in knowledge base, be open to mid-course corrections in HIT strategy
  • Enable and incent provider organizations to learn and generate desired outcomes from use (and non-use) of HIT

Slide 18

Thank you!