Jan 18, 2011 - the HITECH Act, even if that means incurring penalties for failing to achieve meaningful use by 2016 ? Fi
January 2011
E-Health Systems: Opportunities and Obstacles By Gienna Shaw
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Foreword Despite Numerous Concerns, Leaders See Value in EHS With government requirements looming and financial incentives dangling, healthcare leaders across the nation are working to come to grips with the e-health systems they have today and what they want those systems to be tomorrow. It’s not an easy task, and with it comes mixed feelings. The proof of this is in the recent E-Health Systems: Opportunities and Obstacles survey conducted by the HealthLeaders Media Intelligence Unit. With respondents representing organizations ranging from small hospitals and midsize health systems to physician organizations, this survey shows significant diversity and disparity in attitudes. For example, while more than half of the healthcare leaders are satisfied with their health information systems’ functionality, less than half are satisfied with their systems’ cost and value. Among other things, the survey also revealed similarities between hospital-based settings and physician practicebased settings in terms of their state of satisfaction and readiness to meet development requirements related to efficient patient care. For example, overall, respondents indicate that the biggest challenge in implementing an EHS is lack of financing or resources (the top choice, selected by 46%), followed by resistance from physicians (24%). But among the concerns related to the technology systems themselves, we see some distinctions. For example, consider the level of dissatisfaction regarding interoperability; for those in a clinic or physician practice setting, 6% are strongly dissatisfied, but in the hospital setting, it’s more than double that at 14%. Similarly, regarding chart review functionality, just 13% are somewhat or strongly dissatisfied in the practice setting, but that jumps to 27% in the hospital setting. For ease of use, dissatisfaction again is lesser in the practice setting (24%) compared to the hospital setting (36%). One thing, however, does seem certain: Despite the variety of concerns expressed, respondents strongly (85%) believe that EHS will improve care coordination at their organizations, and are similarly optimistic (81%) that EHS will improve care coordination industrywide.
Jim Cramer Vice President and CIO Scottsdale Healthcare Scottsdale, AZ
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Table of Contents Foreword
2
Methodology
4
Respondent Profile
5
Analysis
6
Survey Results
10
Time Frame to See Quality of Care Improvements . . . . . . . . . . . . . . . . 10 EHS Implementation Greatest Challenge . . . . . . . . . . . . . . . . . . . . . . . . 10 Benefits of EHS at Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Benefits of EHS Industrywide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Vendors of Hospital-Based EHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Satisfaction with Hospital-Based EHS Elements . . . . . . . . . . . . . . . . . 14 Capabilities of Hospital-Based EHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Vendors of Clinic- or Physician Practice-based EHS . . . . . . . . . . . . . . 15 Satisfaction with Clinic- or Physician Practice-Based EHS Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Capabilities of Clinic- or Physician Practice-Based EHS . . . . . . . . . . . 17 Physician- or Hospital-Based EHS Certification . . . . . . . . . . . . . . . . . . 17 Expect to Achieve Meaningful Use by 2016 . . . . . . . . . . . . . . . . . . . . . . 17 Opting Out of the HITECH Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Participation in Health Information Exchange . . . . . . . . . . . . . . . . . . . . 18 Type of Health Information Exchange . . . . . . . . . . . . . . . . . . . . . . . . . . 18
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Methodology The E-Health Systems: Opportunities and Obstacles study was conducted by the HealthLeaders Media Intelligence Unit. It is part of a series of monthly Thought Leadership studies. In November 2010, an online survey was sent to the HealthLeaders Media Council and select members of the HealthLeaders Media audience. Respondents work in a variety of settings, including hospitals, health systems, physician organizations, health plans, and insurers. A total of 242 completed surveys are included in the analysis. The margin of error for a sample size of 242 is +/- 6.3 percentage points.
Advisors for this Intelligence Report The following healthcare leaders graciously provided guidance and insight in the creation of this report. Jim Cramer Vice President and CIO Scottsdale Healthcare Scottsdale, AZ
John R. Gardner CEO Yuma District Hospital and Clinics Yuma, CO
About The HealthLeaders Media Intelligence Unit The HealthLeaders Media Intelligence Unit, a division of HealthLeaders Media, is the premier source for executive healthcare business research. It provides analysis and forecasts through digital platforms, printed publications, custom reports, white papers, conferences, roundtables, peer networking opportunities, and presentations for senior management.
Upcoming Intelligence Report Topics
Intelligence Report Editor GIENNA SHAW
[email protected]
Intelligence Unit Director ANN MACKAY
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2011 Industry Survey
Publisher MATTHEW CANN
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Senior Director of Sales Northeast/Western Regional Sales Manager PAUL MATTIOLI
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Planned Capital Expenses Accountable Care Organizations
Editorial Director RICK JOHNSON
[email protected] Managing Editor BOB WERTZ
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Media Sales Operations Manager ALEX MULLEN
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Copyright ©2011 HealthLeaders Media, 5115 Maryland Way, Brentwood, TN 37027 • Opinions expressed are not necessarily those of HealthLeaders Media. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Respondent Profile Respondents represent titles from across the various functional areas including senior leaders, clinical leaders, operations leaders, financial leaders, and information leaders. Nearly one-half of the respondents have senior leader titles. They are from a mix of hospitals, physician organizations, health systems, health plans, and insurers.
| Title Base = 289
50
44%
40 30
24%
21%
20 10 0
Senior Leaders
Clinical Leaders
Operations Leaders
Senior Leaders | Administrator, Chief Executive Officer, Chief Financial Officer, Chief Information Officer, Chief Medical Officer, Chief of Staff, Chief Operations Officer, Executive Dir., Partner, Board Member, President, Principal Owner Operations Leaders | Asst. Administrator, Chief Counsel, Dir. of Patient Safety, Dir. of Purchasing, Dir. of Quality, Dir. of Safety, VP/Dir. Compliance, VP/Dir. Human Resources, VP/Dir. Operations/Administration, Chief Compliance Officer, Chief Purchasing Officer Financial Leaders | VP/Dir. Finance, HIM Director, Director of Case Management, Director of Patient Financial Services, Director of RAC, Director of Reimbursement, Director of Revenue Cycle
| Place of Employment Hospital
Physician Org. (MSO, IPA, PHO, Clinic) 28% Health System (IDN/IDS) 21% Health Plan/Insurer (IHMO/PPO/MCO/PBM)
1%
Financial Leaders
Information Leaders
Information Leaders | Chief Medical Information Officer, Chief Technology Officer, VP/Dir. Technology/MIS/IT
| Number of Sites Base = 52 (Health systems)
Base =121 (Hospitals)
50%
5%
Clinical Leaders | Chief of Cardiology, Chief of Neurology, Chief of Oncology, Chief of Orthopedics, Chief of Radiology, Chief Nursing Officer, Dir. of Ambulatory Services, Dir. of Clinical Services, Dir. of Emergency Services, Dir. of Inpatient Services, Dir. of Intensive Care Services, Dir. of Nursing, Dir. of Rehabilitation Services, Service Line Director, Dir. of Surgical/Perioperative Services, Medical Director, VP Clinical Informatics, VP Clinical Quality, VP Clinical Services, VP Medical Affairs (Physician Mgmt/MD), VP Nursing
| Number of Beds
Base = 242
5%
1–50
28%
1–5
25%
51–199
32%
6–20
27%
200–499
30%
21–49
21%
500–999
5%
50+
27%
1,000+
5%
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Analysis
E-Health Systems: Ambivalence and Acceptance Healthcare leaders are making headway in becoming meaningful users of electronic health systems to meet government requirements and earn financial incentives. But that doesn’t mean they’re completely satisfied with their systems. In fact, the mood of respondents in this HealthLeaders Media intelligence report is decidedly ambivalent about some aspects of health information technology, including cost, value, and functionality.
What Healthcare Leaders Are Saying “We are participating in community health information exchange programs but remain wary of regulations, consent issues, and liability. The environment is simply not receptive to taking much HIE risk.” —CIO, midsize health system
“The importance of knowing the patient’s entire story outweighs ‘competition.’ It is also important to better aggregate statistical and demographic information for our area to better address and provide appropriate preventive care and education.” —CNO, midsize hospital
“A strong patient health information exchange is the right thing to do for our community.” —CIO, midsize health system
“Failure is not an option; we must achieve meaningful use if we are to keep our doors open and to remain a viable business.” —VP finance, small hospital
“We must meet meaningful use if we hope to see any of the incentive money to repay for a very expensive program.” —CEO, small hospital
“As a specialty practice, it is more important to us to select the right EHR for our situation than to be forced to use and meet guidelines that are intended for primary care. Therefore, meeting the meaningful use guidelines is not our main focus.” —Administrator, physician practice or clinic
“The penalties [for failing to achieve meaningful use] would close our practice.” —Administrator, physician organization
Overall, healthcare leaders say health information systems will improve quality and efficiency. More than 80% say the government push for electronic health systems will improve quality of care industrywide and 89% say it will improve quality and safety at their own organization. Most hospital and physician leaders strongly (47%) or somewhat (42%) agree that electronic health systems will increase quality and safety at their own organizations. Seventy-one percent say the systems will improve efficiency at their own organizations and 67% say healthcare will become more efficient nationwide. But healthcare leaders are lukewarm when it comes to the capabilities of their systems: About half of hospital and health system leaders are either very satisfied (13%) or somewhat satisfied (41%) with the EMR systems
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Analysis (continued)
they have put in place, and among physician leaders 16% are strongly satisfied and 44% are somewhat satisfied with the overall functionality of their systems, for example.
“We installed our clinic EMR five years ago. It is a continuous work in progress. From the administration’s point of view, we are now at a ‘somewhat satisfied’ point.” —John R. Gardner
“We installed our clinic EMR five years ago. It is a continuous work in progress,” says John R. Gardner, CEO of Yuma (CO) Hospital District and Clinics. “From the administration’s point of view, we are now at a ‘somewhat satisfied’ point.” Among the medical staff, however, opinions range from “it’s horrible” to “it’s wonderful,” he says.
“Some of [the dissatisfaction stems from the] maturity of the software in the industry,” says Jim Cramer, vice president and CIO of Scottsdale (AZ) Healthcare, a three-hospital system, who served as the lead advisor for this report. “The belief is that with more usage all the products and the solutions in the hospitals as well as the solutions within physician office settings will continue to evolve based on more and more clinician input. In some respects there’s no perfect solution. It’s what the organization does with the solution that they select to make it work for them. The leading solutions that are out there will all continue to evolve; as more and more requirements relative to interoperability evolve, the robustness of the products will evolve, as well.”
83%
say the government push for electronic health systems will improve quality of care industrywide.
Interoperability is a common concern among respondents: Less than half of hospital and physician leaders are satisfied with the interoperability of their systems (43% and 40%, respectively). That’s also a barrier to successful health information exchanges, respondents say. “Not all the local medical practices will be on the same EHR system, just as the major hospitals are on different systems,” wrote one respondent, a physician leader.
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Analysis (continued)
“Something needs to be in place to let the systems talk.” Another physician leader respondent put it neatly: “An EMR without interfaces to other data is just a paper chart in the computer.” Cramer agrees that this problem must be addressed. “Part of the core requirements of HIEs from an interoperability standpoint will need to be dealing with the releases of what can be shared and what can’t. And it needs to be part of the common framework,” he says. Despite the variety of concerns about HIEs, most healthcare organizations (67%) are planning to join health information exchanges, although they don’t seem willing to share their data with just any provider just yet. The most popular choice of HIE model is a private regional exchange (32%) followed by private internal exchange among affiliated entities (20%).
Mixed Feelings 45% of health system leaders are satisfied with the cost and value of their systems
48% of physician leaders are satisfied with the cost and value of their systems
54% of hospital leaders are satisfied with the overall functionality of their systems 60% of physician leaders are satisfied with the overall functionality of their systems
71%
agree that e-health systems will increase efficiency at their own organization.
Yuma will join a regional exchange. “The drawback is we are at the mercy of an organization that we don’t have much control over. They can impose unrealistic expectations to make it work,” Gardner says. “From a benefit perspective, we are a remote rural area and the exchange is going to be excellent for patient care as we help patients that see specialists in urban facilities, but rely on us for primary and secondary care.” Healthcare leaders also have mixed feelings about the cost and value of their systems. Less than half of hospital and health system leaders and physician practice leaders are very or somewhat satisfied (45% and 48%, respectively).
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Analysis (continued)
“In some respects there’s no perfect solution. It’s what the organization does with the solution that they select to make it work for them.” —Jim Cramer
“They could be underestimating the ongoing resources and commitment to evolving the products,” Cramer says. “It’s not like you go live and the cost ends. Many times incremental resources are required to continue to make the improvements and changes to processes and putting in new releases. Maybe those were not all fully understood up-front.”
That was the case for Yuma. The basic cost of the system was not an issue because, as a rural health center, the organization received cost-based reimbursement. But, says Gardner, “the ongoing maintenance has been the surprise to us. The cost to modify the system to reflect local business or individual practitioners’ preferences adds up, and then when it is time to upgrade the knowledge base … these customizations do not automatically carry forward, so customization work needs to be repeated.” Leaders will continue to be disappointed in what they’re getting out of their electronic health systems if they’re not fully committed, says Cramer. “If the executive leadership and the physician leadership work together and say, ‘We support this and we’re going to make it work,’ it will work,” he says. Gienna Shaw is senior technology editor for HealthLeaders Media. She may be contacted at
[email protected].
46%
of respondents cited lack of financing or resources as the greatest challenge of implementing e-health systems.
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Survey Results FIGURE 1 | Time Frame to See Quality of Care Improvements hat is a realistic time frame to see industrywide quality of care improve as a result of Q| W the meaningful use regulations?
60
51%
50
38%
40 30 20 10
6%
4%
0
Fewer than 2 years away
2 to 5 years away
6 to 10 years away
More than 10 years away
Base = 242
FIGURE 2 | EHS Implementation Greatest Challenge
Q | Which of the following do you consider to be the greatest challenge of electronic health systems implementation? Lack of financing or resources
Resistance from physicians
Concern about current vendor’s ability to meet meaningful use requirements
24%
9%
Lack of technical expertise Lack of comfort or satisfaction with existing vendor
7%
5% 8%
Other Base = 242
46%
0
10
20
30
40
50
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Survey Results (continued) FIGURE 3 | Benefits of EHS at Organization ow strongly do you agree with the following statements about your organization? Q| H
Net Agree
Strongly Agree (1)
Somewhat Agree (2)
Neither Agree or Disagree (3)
Somewhat Disagree (4)
Strongly Disagree (5)
Electronic health systems will improve quality and safety at my organization
89%
47%
42%
7%
2%
1%
Electronic health systems will improve care coordination at my organization
85%
44%
41%
12%
2%
0%
Electronic health systems will increase efficiency at my organization
71%
38%
33%
13%
12%
4%
Electronic health systems will ensure adequate privacy and security protections for our patients
63%
24%
39%
20%
14%
2%
Electronic health systems will improve patient and family satisfaction and engagement at my organization
60%
21%
39%
26%
13%
1%
Electronic health systems will improve population and public health in our region
51%
20%
31%
33%
13%
2%
Electronic health systems will reduce costs at my organization
44%
16%
28%
25%
21%
9%
Base = 242
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Survey Results (continued) FIGURE 4 | Benefits of EHS Industrywide
Q | How strongly do you agree with the following statements about the industry in general?
Net Agree
Strongly Agree (1)
Somewhat Agree (2)
Neither Agree or Disagree (3)
Somewhat Disagree (4)
Strongly Disagree (5)
Electronic health systems will improve quality and safety industrywide
83%
34%
49%
11%
5%
2%
Electronic health systems will improve care coordination industrywide
81%
34%
47%
13%
5%
1%
Electronic health systems will increase efficiency industrywide
67%
29%
38%
16%
14%
4%
Electronic health systems will improve patient and family satisfaction and engagement industrywide
56%
18%
38%
26%
16%
2%
Electronic health systems will ensure adequate privacy and security protections for personal health industrywide
55%
16%
39%
23%
19%
4%
Electronic health systems will improve population and public health nationwide
54%
19%
35%
33%
10%
3%
Electronic health systems will reduce costs industrywide
43%
14%
29%
21%
23%
12%
Base = 242
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Survey Results (continued) FIGURE 5 | Vendors of Hospital-Based EHS
Q | Which vendor or vendors do you use for your hospital-based electronic health system?
Cerner Corporation
Epic
20%
MediTech
19%
McKesson
Allscripts/Eclipsys
GE Healthcare
Siemens
5%
NextGen Healthcare
5%
5
16%
12%
0
18%
11%
CSI
Other
22%
10
14%
15
20
25
Base = 187 (Among those who currently have a hospital-based electronic health system) Multi Response
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Survey Results (continued) FIGURE 6 | Satisfaction with Hospital-Based EHS Elements onsidering your hospital-based electronic health system, rate your level of Q|C satisfaction with the following elements. Our system does not have this function
Net Satisfied
Strongly Satisfied (1)
Somewhat Satisfied (2)
Neither Satisfied or Dissatisfied (3)
Somewhat Dissatisfied (4)
Strongly Dissatisfied (5)
Overall functionality
54%
13%
41%
14%
21%
11%
1%
System speed, responsiveness, and down time
54%
17%
37%
18%
19%
8%
1%
Ability to share information across internal departments or with other organizations such as medical groups
53%
20%
33%
13%
20%
13%
1%
Chart review functionality
51%
14%
37%
20%
18%
9%
2%
Physician portal
49%
15%
34%
21%
16%
7%
6%
Vendor training and support
48%
18%
30%
16%
20%
15%
1%
Ease of use
46%
11%
35%
19%
23%
12%
1%
Total cost and value
45%
10%
35%
22%
23%
9%
1%
Single sign-on capability
44%
15%
29%
23%
14%
10%
8%
Interoperability
43%
11%
32%
23%
19%
14%
1%
Ability to measure outcomes
40%
11%
29%
24%
20%
12%
4%
Decision support capabilities
36%
8%
28%
27%
18%
12%
6%
Ability to conduct datadriven research studies
32%
11%
21%
29%
19%
13%
6%
Patient portal and patient education capabilities
28%
9%
19%
31%
16%
11%
14%
Base = 187 (Among those who currently have a hospital-based electronic health system) Multi Response
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January 2011 | E-Health Systems: Opportunities and Obstacles
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Survey Results (continued) FIGURE 7 | Capabilities of Hospital-Based EHS
Q | Considering your hospital-based electronic health system, which of the following capabilities does your organization use?
Clinical documentation Picture Archiving and Communications System (PACS)
Physician portal
Computerized physician order entry
Prescription management/e-Prescribing Decision support
Patient disease registry
Patient portal
90%
74%
64%
58%
52%
47%
27%
21%
0
20
40
60
80
100
Base = 187 (Among those who currently have a hospital-based electronic health system) Multi Response
FIGURE 8 | Vendors of Clinic- or Physician Practice-Based EHS
Q | Which vendor or vendors do you use for your clinic- or physician practice-based electronic health system? Allscripts/Eclipsys
Epic
NextGen Healthcare
11%
McKesson
11%
GE Healthcare
10%
Cerner Corporation
10%
eClinicalWorks
21%
16%
7%
MediTech
6%
LSS
Siemens
ChartLogic, Inc.
5%
3%
1%
Other
0
5
10
Base = 178 (Among those who currently have a clinic or physician practice-based EHS)
15
21%
20
25
Multi Response
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page 16
Survey Results (continued) FIGURE 9 | Satisfaction with Clinic- or Physician Practice-Based EHS Elements onsidering your clinic- or physician practice-based electronic health system, rate Q|C your level of satisfaction with the following elements.
Our system does not have this function
Net Satisfied
Strongly Satisfied (1)
Somewhat Satisfied (2)
Neither Satisfied or Dissatisfied (3)
Somewhat Dissatisfied (4)
Strongly Dissatisfied (5)
Overall functionality
60%
16%
44%
17%
18%
3%
2%
Chart review functionality
56%
20%
36%
28%
11%
2%
3%
Ease of use
54%
14%
40%
19%
18%
6%
2%
System speed, responsiveness, and down time
53%
16%
37%
23%
16%
6%
2%
Total cost and value
48%
13%
35%
26%
17%
7%
2%
Single sign-on capability
48%
16%
32%
29%
8%
6%
9%
Ability to share information across internal departments or with other organizations such as medical groups
46%
17%
29%
26%
17%
8%
3%
Vendor training and support
45%
15%
30%
24%
18%
12%
2%
Ability to measure outcomes
45%
12%
33%
25%
17%
9%
4%
Physician portal
45%
15%
30%
31%
10%
3%
11%
Interoperability
40%
11%
29%
30%
21%
6%
2%
Ability to conduct datadriven research studies
38%
10%
28%
27%
20%
8%
7%
Decision support capabilities
38%
11%
27%
33%
16%
6%
8%
Patient portal and patient education capabilities
31%
12%
19%
33%
12%
6%
17%
Base = 178 (Among those who currently have a clinic- or physician practice-based EHS)
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page 17
Survey Results (continued) Figure 10 | Capabilities of Clinic- or Physician Practice-Based EHS onsidering your clinic- or physician practice-based electronic health system, which Q|C of the following capabilities does your organization use?
Clinical documentation
93%
Prescription management/e-Prescribing
69%
Computerized physician order entry
69%
Physician portal
Picture Archiving and Communications System (PACS)
Decision support Patient disease registry
Patient portal
57%
52%
40%
30%
25%
0
20
40
60
80
100
Base = 178 (Among those who currently have a clinic- or physician practice-based EHS) Multi Response
Figure 11 | Physician- or Hospital-Based
EHS Certification
Q | I s your physician- or hospital-based EHS certified by an approved ONC certifying body?
Figure 12 | Expect to Achieve Meaningful Use by 2016 oes your organization expect to Q|D achieve meaningful use by 2016?
100
91%
80 50 40
45%
41%
30
40
20
14%
20
10 0
60
Yes
No
Don’t know
Base = 204 (Among those who currently have a physicianor hospital-based EHS)
0
2% Yes
No
7% Don’t know
Base = 242
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Survey Results (continued) Figure 14 | Participation in Health Information Exchange
Figure 13 | Opting Out of the HITECH Act
ill your organization opt out of Q|W the HITECH Act, even if that means incurring penalties for failing to achieve meaningful use by 2016 ?
80 70 60 50 40 30 20 10 0
re you participating in or do Q|A you plan to participate in a health information exchange?
80 70 60 50 40 30 20 10 0
76%
21% 2% Yes
No
Don’t know
Base = 242
67%
27%
5% Don’t know
No
Yes
Base = 242
Figure 15 | Type of Health Information Exchange hich best describes the type of health information exchange you are participating Q|W in or considering?
A private regional exchange A private internal exchange among affiliated entities A state-run statewide exchange
A private statewide exchange
10%
A state-run regional exchange
A private multistate exchange
20%
18%
9%
3%
A state-run multistate exchange
1%
Other
0
32%
6%
5
10
15
20
25
30
35
Base = 163 (Among those participating or planning to participate in a health information exchange)
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