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Ambulatory Electronic Health Records Adoption Trends 2005-2010 Jessica Jacobs September 15, 2010 What does Ambulatory Mean? • Ambulatory providers are physicians who perform the majority of their services outside the hospital – No more than 90% of their services are performed at a hospital • Currently there are 200,0000 physician offices, 515,000 total practicing ambulatory physicians* https://questions.cms.hhs.gov/app/answers/detail/a_id/9844/~/[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based Note: Excludes radiologists, pathologists, anesthesiologists, ER and all other hospital-based physicians In other words… Them Not Them What is an EHR? • An Electronic Health Records (EHR) is “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.” – HIMSS, 2010 • Colloquial Definition – Computer records in a doc’s offices that can talk to pharmacies, has decision support, talks to hospitals, improves quality, decreases costs, and saves the world Adoption Definitions •Patient Demographics •Problem Lists •Clinical Notes •Rx Orders •Lab Results •Imaging Results 6% Full •Any EHR Adoption 21% Basic Any 44% •All Basic Requirements •Medical History/Follow Up •Test Orders •Rx/Test Orders sent Electronically •Drug/Drug Interactions EHR Adoption Rates Accenture, Any (Small Practices) 50.00% xxx, Any (Internal Medicine) 45.00% Kemper, Any (Pediatricians) 40.00% Modern Medicine, Any (PCP) 35.00% NAMCS, Any 30.00% Simon et al, All (Physician Practices) 25.00% SK&A, Any 20.00% DesRoches, Basic (All Physicians) 15.00% NAMCS, Basic Accenture, Full (Small Practices) 10.00% DesRoches, Full 5.00% NAMCS, Full 0.00% 2004 2005 2006 2007 2008 2009 2010 2011 Adoption Definitions •Patient Demographics •Problem Lists •Clinical Notes •Rx Orders •Lab Results •Imaging Results 6% Full •Any EHR Adoption 21% Basic Any 44% •All Basic Requirements •Medical History/Follow Up •Test Orders •Rx/Test Orders sent Electronically •Drug/Drug Interactions HITECH… and Meaningful Use • The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 was a part of ARRA • Allocated funds to spur the adoption of electronic health records - mostly administered through ONC and CMS • Incentive Payments for Meaningful Use are administered through CMS – Medicare: Maximum Incentive = $44k/physician – Medicaid: Maximum Incentive = $63k/physician – Incentives will be paid 2011- 2016, then penalties will begin • Meaningful Use Rules were released July 13, 2010 Basically… EHR Adoption Rates Accenture, Any (Small Practices) 50.00% xxx, Any (Internal Medicine) 45.00% Kemper, Any (Pediatricians) 40.00% Modern Medicine, Any (PCP) 35.00% NAMCS, Any 30.00% Simon et al, All (Physician Practices) 25.00% SK&A, Any 20.00% DesRoches, Basic (All Physicians) 15.00% NAMCS, Basic 10.00% Accenture, Full (Small Practices) DesRoches, Full 5.00% NAMCS, Full 0.00% 2004 2005 2006 2007 2008 2009 2010 2011 Key Take-Aways • The rates of ambulatory adoption have risen significantly over the past five years • Unfortunately that increase in adoption has not translated into “meaningful” adoption • The current rate of meaningful adoption is 6.3%, hopefully new rules and certifications will help increase this percentage