1. Rhode Island HIT Survey: 2014 Results and Plans for 2015 January 2015

2. Survey Objectives 1.To measure presence (structural measures) and use (process measures) of HIT by clinicians caring for Rhode Island patients 2.To capture HIT data for state agencies and other key stakeholders using single instrument (i.e., minimize data collection burden)

3. Administered to all Licensed Independent Practitioners (LIPs): Advanced Practice Registered Nurses (APRNs) Physicians Physician Assistants (PAs) Electronic survey instrument sent via: Hard copy mailing (for physicians, with licensure renewal*) If email available, email notification and up to two reminders Analyses limited to LIPs: Licensed in Rhode Island In active practice Located in Rhode Island or an adjacent state (Connecticut or Massachusetts) *During 2014 survey year. Methods

4. 1.Electronic Health Records (EHRs): Access to “EHR components,” including functions such as visit notes, lab orders, or prescriptions 2.Basic EHR use: Among those with EHRs, functionality/clinical use relating to documentation and results management 3.Advanced EHR use: Among those with EHRs, functionality/clinical use relating to decision support, external communication, order management, and reporting 4.e-Prescribing: Transmitting prescriptions/medication orders electronically to a pharmacy Publicly-Reported Measures, 2014

5. The HIT Survey has a relatively high response rate for a single-wave mailed survey. It is higher among physicians than APRNs/PAs. Response rate by year

6. Physician Results Overall Trends

7. Measure Survey Respondents (N = 2,567) All Physicians (N = 3,761) NScoreN 1. EHRs, n(%)2,5672,236 (87.1%) 3,7612,236 (59.5%) 2. Basic EHR use, mean2,23677.0-- 3. Advanced EHR use, mean2,23662.6-- 4. e-prescribing, n(%)2,349 1,884 (80.2%)3,5431,884 (53.2%) The 2014 results provide a point-estimate of HIT adoption among physicians for the four publicly- reported measures. Use of EHRs and e-prescribing, among respondents and all physicians

8. Measure Office-Based by Specialty All Office-Based Physicians (N=1,544) PCP (N=698) Non-PCP (N=846) 1. EHRs, n(%)625 (89.5%)642 (75.9%)1,267 (82.1%) 2. Basic EHR use, mean87.170.578.7 3. Advanced EHR use, mean68.342.255.1 4. e-prescribing, n(%)590 (85.1%)576 (73.0%)1,166 (78.7%) When looking at office-based physicians by specialty, HIT adoption is highest among office- based primary care physicians (PCPs). Respondents’ use of EHRs and e-prescribing, by physician specialty and practice location

9. Since 2009, physicians’ HIT adoption has increased for all four publicly-reported measures. EHR adoption increased by nearly 30% and e-prescribing by 95%. Survey respondents’ use of EHRs and e-prescribing

10. Physician Results Impact of EHRs

11. (N=1,247) (N=954) Compared to hospital-based physicians, office- based physicians more frequently report using their EHR outside of regular work hours. Percentage of physicians who say “yes,” they use their EHR outside of work hours

12. Despite agreeing that EHRs improve many aspects of care, fewer than half of hospital-and office-based physicians agree that EHRs improve job satisfaction. Percentage of physicians who “agree or strongly agree” that EHRs…

13. Compared to 2013, physicians’ agreement increased for all statements about how EHRs improve care, except that EHRs improve job satisfaction.

14. Percentage of all physician respondents who reported an impact of EHRs on take-home workload (N=2,110) About 40% of physicians say that EHRs increased the amount of work they take home.

15. For office-based PCPs, EHRs have increased take- home workload. Percentage of office-based PCPs who reported an impact of EHRs on take-home workload (N=595)

16. Physician Results Public Health

17. Approximately one-quarter of office-based physicians are using their EHR for population health management. Percentage of physicians using their EHR for population health management (N=1,137)

18. Among office-based physicians not using their EHR for population health management, responses were relatively evenly distributed about “what it would take” to start: cost, staff, or assistance. Percentage of physicians who thought it would take the following for them to use their EHR for population health management… (N=1,022) (Select all that apply.)

19. (N=1,430) (N=778) % of patients for whom physicians consult the PMP before prescribing Among physicians who prescribe, fewer than half are consulting the Prescription Monitoring Program (PMP) before prescribing opioids or benzodiazepines.

20. Physician Results CurrentCare

21. Percentage of physicians who are familiar with these CurrentCare services… Approximately a quarter of all physician respondents are familiar with various components of the state’s health information exchange, CurrentCare.

22. Percentage of patients for whom physicians view or receive CurrentCare data (N=2,492) Nearly 75% of physicians are not signed up to view or receive data, highlighting opportunities for engagement. Among those signed up, about half are using it.

23. Office-based PCPs were more familiar with CurrentCare services than non-PCPs. N=684 N=676 N=670

24. Physician Results Meaningful Use

25. Percentage of physicians who have attested to Meaningful Use Two-thirds of office-based physicians report that they have attested to Meaningful Use.

26. Percentage of physicians who attested to each stage of Meaningful Use in 2014 Medicare Stage 1 is the most common Meaningful Use attestation

27. Percentage of physicians who plan to attest to Meaningful Use in 2014 The vast majority (nearly 90%) of office-based physicians who haven’t yet attested to Meaningful Use intended to do so in 2014.

28. Physician Results Physician Quality Reporting System (PQRS)

29. Percentage of office-based physicians using PQRS in 2014 (N=1,422) About one-third of office-based physicians say they are already using PQRS and plan to continue in 2014.

30. Percentage of office-based physicians using the following methods to report PQRS (N=577) Approximately one-fourth of office-based physicians planning to use PQRS in 2014 will use their EHR.

31. Percentage of office-based physicians using the following approaches to report PQRS (N=582) Office-based physicians who know how they plan to report PQRS in 2014 are approximately evenly split between Group Practice and Individual Reporting.

32. APRN and PA Results Overall Trends

33. Measure Survey Respondents (N = 662) All APRNs/PAs (N = 1,505) NScoreN 1. EHRs, n(%)662522 (78.9%) 1,505 522 (34.7%) 2. Basic EHR use, mean52272.6-- 3. Advanced EHR use, mean52258.4-- 4. e-prescribing, n(%)560 394 (70.4%)1,403394 (28.1%) The 2014 results provide a point-estimate of HIT adoption among APRNs and PAs for the four publicly-reported measures. Use of EHRs and e-prescribing, among respondents and all APRNs/PAs

34. 2015 Survey

35. 2015 Survey Process Administered to all Licensed Independent Practitioners (LIPs): Advanced Practice Registered Nurses (APRNs) Physicians Physician Assistants (PAs) Electronic survey instrument sent via: Hard copy mailing in April of 2015 If email available, email notification and up to two reminders Analyses limited to LIPs: Licensed in Rhode Island In active practice Located in Rhode Island or an adjacent state (Connecticut or Massachusetts)

36. 2015 Survey Goals of 2015 Survey: Meet the needs of survey stakeholders, including HEALTH, payers, Rhode Island HIE and provider groups Reduce the length of the survey Measure provider participation in value-based payment programs Measure provider use of patient engagement tools Update publicly reported measures to better reflect current HIT use, programs and state/federal requirements

37. Discussion Topics Updating publicly reported measures o Needs of providers, patients, other stakeholder groups Use of HIT as part of patient engagement efforts and value-based payment programs o Current and future uses of this technology Provider participation in value-based payment programs o Provider knowledge and administrative practices

38. Rebekah Gardner, MD, FACP Chair, Physician Reporting Workgroup RGardner@healthcentricadvisors.org Samara Viner-Brown, MS Chief, Center for Health Data and Analysis Samara.VinerBrown@health.ri.gov