Physicians in Massachusetts have the highest electronic prescribing rate in the nation, and they have adopted basic electronic health records at twice the rate of the national average, according to a recent study that gives the credit to incentive programs.
The study, conducted by Falls Church, Va.-based CSC and funded by Blue Cross Blue Shield of Massachusetts, interviewed 18,282 Massachusetts physicians.
It revealed that although Massachusetts may be ahead of the curve when compared to the nation, there are still gaps in functionality for both e-prescribing and EHRs.
“The research clearly shows the progress that has been made in the state to increase adoption of clinical information technology,” said Greg LeGrow, director of e-Health Innovation for BCBS of Massachusetts. “We still have a ways to go, but the results are encouraging and demonstrate the impact aligned efforts can have to further the use of technology that improves the quality and affordability of care delivered.”
Erica Drazen, managing partner in Emerging Practices, the applied research arm of CSC’s Global Healthcare Sector, and one of the authors of the study, says Massachusetts is not necessarily ahead of the curve in mandated technology, but rather in incentive programs. She said most of the major health plans in the state are regional, so there is more collaboration.
“They are a little more willing to take risks on new ideas because it is a local experiment,” she said. “There is more of a culture of innovation and collaboration in Massachusetts.”
In 2003, the eRx Collaborative, a joint effort of BCBSMA, Tufts Health Plan, Neighborhood Health Plan, and their technology partners DrFirst and ZixCorp., gave free e-prescribing software to primary care providers in Massachusetts. Because the program targeted primary care providers, they were more likely than non-primary care providers to adopt, says Jason Fortin, senior research analyst, co-author of the study.
“E-prescribing for Massachusetts was a win-win – it helped everyone. When the payer who is getting significant dollar benefits is willing to do this the technology adoption does increase,” says Drazen.
The study suggests that although allergy lists are more commonly available, they are not widely used and may vary among e-prescribing systems. Drazen says for physicians to really take advantage of allergy lists they need to be integrated into their decision-support systems. Allergy information also has to be coded, she says, and right now there is no standard way for coding it for use in decision-support systems.
Fortin says lack of integration is also the reason why physicians are not using disease-management and health-maintenance capabilities.
According to the survey the biggest gap in advanced EHR functionality is the ability to electronically view or be advised of compliance with quality measures.
“Currently the practice is that this information is sent to the provider retrospectively from their payers. They get it all from billing data. It is not captured and responded on from the EMR,” explains Drazen. Providers don’t really have the ability to go through and print out what services are overdue for a patient because the functionality is not necessarily available. “We are still on a model of healthcare that is visit-based,” she says.
“While Massachusetts has a distinct advantage in terms of support from the state government and stakeholder groups, this successful model can be replicated nationwide to create a healthcare infrastructure that significantly improves patient outcomes,” said Deward Watts, president of CSC’s global healthcare sector.
Drazen says what Massachusetts did can be replicated in other states, but thinks the next big wave of adoption will occur when more robust products become available.
