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Wednesday, March 19, 2014

Mapping EHR penetration, 2013

From NCHS Data Brief 143, January 2014, Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013 (pdf).

I took these data, dropped them into Excel, quickly sorted and stratified them into 10% rank strata, with NJ at the low end and ND on the high end. sort of a "bar graph" just using data columns.

Click the image to enlarge.
Not exactly a "bell curve" distribution, 'eh? Though, the median (46.9%, MT, FL) is not very far from the mean (48.2%).

From the Data Brief:
In 2013, the National Ambulatory Medical Care Survey (NAMCS) EHR Survey showed that about 78% of office-based physicians used any EHR system. Since 2006 (first year for which data are available), the percentage of physicians who reported having an EHR system that met the criteria for a basic system increased 336%—from 11% in 2006 to 48% in 2013.
Adoption of a basic EHR system varied greatly by state. Adoption ranged from 21% in New Jersey to 83% in North Dakota.

To qualify for the Stage 2 meaningful use incentive in 2014, eligible physicians must meet all 17 of the Stage 2 Core objectives for meaningful use and 3 of the 6 Menu Set objectives, using certified EHR systems (3). In this report, estimates of physicians’ readiness to meet meaningful use measures were limited to 14 of the 17 computerized capabilities that support the Stage 2 Core objectives.

In 2013, 69% of physicians reported intending to participate (having already applied or intending to apply) in the Medicare or Medicaid EHR Incentive Programs. However, only 13% of all physicians reported that they intended to participate in the EHR Incentive Programs and had an EHR system with the capabilities to support 14 of the 17 Stage 2 Core Set objectives for meaningful use. This may be an overestimate of the percentage meeting the Stage 2 requirements, because some physicians with systems supporting the 14 core objectives examined in this report may have a system that does not support the remaining 3 objectives, or 3 of the 6 Menu Set objectives required for payment.

From 2010 through 2013, physician adoption of 7 of the 17 capabilities required for Stage 2 Core objectives for meaningful use increased significantly. Computerized capabilities to send prescriptions to the pharmacy electronically and to provide warnings of drug interactions or contraindications had the largest increases.
Doesn't bode particularly well for Stage 2. These percentages are for "basic EHRs."

to wit,
Micky Tripathi: Providers must 'strike a balance' with MU, other programs
March 20, 2014 | By Marla Durben Hirsch
For providers transitioning from Stage 1 to Stage 2 of Meaningful Use, 2014 will be a challenging year. Many must assess the costs and benefits of the federal incentive program, and whether they should even continue to participate.

Micky Tripathi ... is founding president and CEO of the Massachusetts eHealth Collaborative, a nonprofit geared toward helping providers exchange health information, and also serves as chair of the information exchange workgroup, a sub-committee of the Health IT Policy Committee in the Office of the National Coordinator for Health IT. In an exclusive interview with FierceEMR, Tripathi shares his insights on Meaningful Use and the looming provider conundrum.

FierceEMR: Why is 2014 such a difficult year for providers?

Tripathi: The Meaningful Use Stage 2 requirements are going up in substantial ways at the time of a perfect storm of obligations: ICD-10, the Affordable Care Act, HIPAA compliance, penalties for breaches, changes in the reimbursement models and hospital readmission penalties.

Also, the Stage 2 requirements didn't give the vendor community time to develop the systems, so they're not yet fully available. The number of products certified for Stage 2 are well below the figures from Stage 1. Some vendors have announced that they will not be able to meet Stage 2. Now some providers, especially smaller ones, have to switch vendors. It wouldn't surprise me to see providers just drop out of the program because they can't afford to buy a new system...
"Perfect storm," hmmm... where have we heard that before?

"[P]hysicians remain unhappy with how EHRs work, despite the fact that we're already several years into the Meaningful Use program. The report reveals that the same problems that have always plagued the physicians still exist: poor usability; time consuming data entry that could be performed by clerks or scribes; unreliable data; interference with patient interaction; less fulfilling work content; and lack of effective data sharing.

Moreover, this is the year that the more stringent Stage 2 requirements kick in, and many physicians are being left stranded by vendors who have not yet upgraded their systems to the 2014 edition of certification, or have decided not to try..."


My daily stop at The Incidental Economist put me onto this book.

"For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We’ve left out of our tally the most impactful expenditures countries make to improve the health of their populations—investments in social services.

In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care,” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.

Offering a unique and clarifying perspective on the problems the Affordable Care Act won’t solve, this book also points a new way forward."
We'll see. Kindle download to ensue shortly.


Got the book and have begun my study. Interesting snip:
Despite the strong evidence about social determinants of health, attention devoted to improving health in the United States has been directed largely at reforming the health care industry. Reform efforts have sought to enhance insurance coverage and access to medical care, redesign physician and hospital payment schemes, and improve the quality of medical care. Although it is too early to evaluate the full impact of the Patient Protection and Affordable Care Act (known colloquially as Obamacare), this reform focuses largely on providing access to health care to previously uninsured groups, with little attention on the social determinants of health. Improving access will have positive effects, but by itself is unlikely to address fundamental causes of the American paradox of high costs and poor outcomes. Extensive literature suggests that health care has relatively less impact on health than these social determinants of health, begging the question of whether past health care reforms have been too narrow to have an effect. (Kindle Locations 394-402).
Yeah. Recall my January 21st post When it comes to health, your zip code matters more than your genetic code.”

While I've begun reading the book from the beginning, I did conduct an immediate search for any discussions of Health IT.

Not much there.
Even for primary care physicians, who are meant to be the main portal for patients seeking health care, making a full investment in collecting a patient’s history and assessing current lifestyle can be difficult. The most recent evidence suggests that the average time a patient spends with the physician at a primary care visit is less than 15 minutes, and nearly half of a primary care physician’s time is spent on documentation and follow-up, outside the examination room without the patient present. The stresses have created what author and consultant Dr. Ian Morrison, president emeritus of the Institute for the Future, termed “hamster medicine” in a 2000 paper in the BMJ— the experience of constant running and never catching up. Gone are the days (for the most part) of house calls. Most doctor’s offices are open an average of thirty to forty hours a week, and host practices of approximately 2,500 patients. On the basis of recommendations from national clinical care guidelines for preventive services and chronic disease management, sufficiently addressing the needs of this size practice would require 21.7 working hours per day. Although electronic means of communicating and retaining medical data were designed to save clinicians time, physicians do not view this as time saving, as this obstetrician (ID 31) said of her current-day practice:
The electronic medical record allows me to document more, and that information is helpful. But it definitely does not save any time; it probably takes longer now. But we have more data, too. Still, there are too many alerts. It is so noisy. There is an alert for everything, and you get numb to it. If you stopped [to pay attention to] everything, it would really take forever, so sometimes you just click right by them.
That's pretty much it.

More to come...

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