HIMSS 2012: Women in Health IT

Women in Health IT

Perficient Healthcare asked men and women at HIMSS 2012 comment on what unique qualities women bring to Health IT. Their answers are in the video below. The closing song sums up my reasoning :-)

 

Also, be sure to check out this post on The Top 5 Women in Health IT by Katie Matlack. Some interesting choices...

Proposed Rules for Stage 2 Meaningful Use

Stage 2 Meaningful Use Has Arrived finally

We have known that the proposed rules for stage 2 meaningful use under the EHR Incentive Program were on their way. I had hoped that they would be released on Febraury 17, 2012, which was the third anniversary of the passage of the HITECH Act. Sadly, we did not get to read them prior to HIMSS. Nor did we get to read them prior to many of the learning sessions on stage 2 meaningful use scheduled at HIMSS the first two days. But, finally they are here (and sadly not even in time for Farzad Mostashari's keynote address as some had predicted). This will certainly be a major topic of conversation after the HIMSS conference (along with clouds, mobile and collaboration). There are two rules pertaining to stage 2 meaningful use: Medicare and Medicaid Electronic Health Record Incentive Program--Stage 2; and the New and Revised Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology which is not yet published. I will be posting some deeper analysis coming weeks on each of the rules once I have had some time to actually read them in more detail and the S&C rule is published.

Stage 2 Meaningful Use

First, let's look at the NPRM for Stage 2 meaningful use. The final rule for the Medicare and Medicaid EHR Incentive Programs, which was published in the Federal Register on July 28, 2010, specifies that CMS will expand on the criteria for meaningful use established for Stage 1 to advance the use of certified EHR technology by eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs). This proposed rule would establish the requirements for Stage 2. As stated in the July 28 final rule, "Our goals for the Stage 2 meaningful use criteria, consistent with other provisions of Medicare and Medicaid law, expand upon the Stage 1 criteria to encourage the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible, such as the electronic transmission of orders entered using computerized provider order entry (CPOE) and the electronic transmission of diagnostic test results."

One of the significant changes is in the timing for implementation of stage 2 meaningful use. This change was expected and will become official under the final rule expected this summer. Under the current requirements, eligible doctors and hospitals that began participating in the Medicare EHR Incentive Programs in 2011 would have had to meet new standards for the program in 2013. If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption the rule allows doctors and hospitals to adopt health IT in 2011, without meeting the new standards until 2014. The proposed rule would move all menu set items to core measures, and many of the percentages are increased, and some new menu objectives added.

Other significant aspects of the rule are around improving care transitions and patient engagement, including health information exchange and interoperability of EHRs. The requirement that patients have electronic access to their information is proposed to become that patients have used the capability to access and download their information and have communication preferences stated, as well as a requirement that 10% patients get reminders for preventive, follow-up care. Patients will have the right to view and download (on demand) relevant information contained in the longitudinal record, which has been updated within 4 days of the information being available to the practice. Patients should be able to filter or organize information by date, encounter, etc. Patient engagement will be critical to allow patients to share accountability for their care and obtain better health. There is also a new requirement for Eligible Hospitals (EH)s that 80% of patients offered the ability to view and download via a web-based portal, within 36 hours of discharge, relevant information contained in the record about EH inpatient encounters. It will be required that data are available in human-readable and structured forms. (A web portal as defined as online access to health information. Therefore all web portals defined as such are subject to HIPPA rules and regulations.)

The requirement that a summary of care record must be transmitted between providers at transitions in care is ramped up and using paper is no longer an option. Secure messaging is a requirement, and there is a standards and certification requirement that Direct Project protocols are enabled in the EHR. The health information exchange requirement goes from merely performing one test to the ability to connect to at least three external providers in the primary referral network (but outside delivery system that uses the same EHR) or establish an ongoing bidirectional connection to at least one health information exchange organization. Sharing health data among providers is necessary to be accountable for care and the health of a patient population. The requirements for quality reporting in meaningful use are increasing at the same time that new reimbursement models are tied to performance. Quality reporting will eventually need to be in real time so that gaps in care can be avoided, rather than simply reported.

Medicare and Medicaid Programs; Electronic Health Record Incentive Program-- Stage 2

Stage 2 Standards and Certification Criteria

In order to successfully meet the requirements for meaningful use, hospitals and EPs must meet Stage 2 objectives and measures using “Certified EHR Technology.” Certified EHR Technology is defined as an EHR (either a Complete EHR or combination of EHR Modules) that has been certified against all applicable certification criteria adopted by ONC for a given payment year. With the delay of Stage 2 Meaningful Use implementation, this allows additional time for EHR vendors to design, develop and release new functionality, which was also cited as one of the reasons behind the recommended delay.

Below is the NPRM on Standards, Implementation Specifications, and Certification Criteria for stage 2 meaningful use. The final rule that established the initial set of standards, implementation specifications, and certification criteria was published in the Federal Register on July 28, 2010. The initial set represented the first round of an incremental approach to adopting future sets of standards, implementation specifications, and certification criteria to enhance electronic health record (EHR) interoperability, functionality, and utility. Under the authority provided by section 3004 of the Public Health Service Act (PHSA), this notice of proposed rulemaking would propose that the Secretary adopt revisions to the initial set as well as new standards, implementation specifications and certification criteria. The proposed new and revised standards, implementation specifications, and certification criteria would establish the technical capabilities that certified EHR technology would need to include to support meaningful use under the CMS Medicare and Medicaid EHR Incentive Programs.

The ONC has created a new certification called Certified EHR Technology that will replace current certification. This will begin at the implementation of Stage 2 Meaningful Use in 2014 (they are creatively calling this the 2014 edition). There will be two types of certification: a Base EHR and a Core EHR. Some of the baseline capabilities of a Base EHR are history and problem list, clinical decision support, CPOE, capture quality data and data query. privacy and security, and health information exchange.

One of the requirements is the View and Download for patients certification criterion which combines several previous certification requirements:
Enable a user to provide patients with the ability to view and download their longitudinal health information online, and to electronically transmit this information directly to patients. Also, enable users to track transmission events and when information is viewed and downloaded. Information must include, at a minimum, diagnostic test results, problem list, medication list, medication allergy list, procedures, clinical summaries and discharge instructions, and be provided in:
(i) Human readable format;
(ii) The standard (and applicable implementation specifications) specified in the new single standard and implementation guide and with data elements using applicable standards;
(iii) Track the number of patient online accesses (view and download) or transmission events.

Electronic access via online access is intended to include an online portal and/or PHR directly tied to the EHR or a third party patient portal and or PHR that is connected to the EHR. The third party solution (PHR and/or patient portal) may be directly connected to that EHR or through an HIE connection that offers electronic patient access. Similarly, the intention here is that the EHR needs to demonstrate one of these options for certification (not all of them). There is also the criteria that secure messaging is enabled that would allow a user to electronically send a secure message to a patient; and also receive a secure message from a patient. As mentioned previously Direct Project protocols must be enabled, which shows a continued emphasis on promoting these standards.

Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technolog...

Patient Centered Medical Home and ACOs: The EHR is necessary but not sufficient

Check out this brilliant presentation below from Charles DeShazer, M.D. at the Accountable Care & HIT Strategies Fall Summit 2011. He is a board-certified Internal Medicine physician executive with over 20 years of management experience in Medical Informatics, quality improvement, medical management and care delivery redesign. In his current role as VP, Quality, Medical Informatics and Transformation for the Dean Health System (DHS), he is responsible for development and execution of their vision for transformation through leveraging technology and process redesign to become a national leader in care delivery quality, efficiency and service. This objective includes implementing a patient-centered medical home model, leveraging their system-wide EHR to achieve meaningful use objectives, supporting their development of an Accountable Care Organization (ACO), creating tools and infrastructure for quality and performance measurement, management and reporting and implementing patient-centered technologies such as Personal Health Records (PHRs) and telehealth systems. Dr. DeShazer is an Institute for Healthcare Improvement (IHI) certified Improvement Advisor. He has experience in several improvement and change management methodologies including Lean and Six Sigma. He received his medical degree from the University of Illinois at Chicago and completed his internship and residency in Internal Medicine at the University of Illinois Hospital, Chicago, IL.

In this presentation he provides some understanding of the health IT implications for new emerging care models. Health IT not only closes critical gaps in how care is delivered but will be essential to enabling higher levels of competitive performance. The EHR is essential but must be optimized and integrated into a complete HIT “ecosystem” and transformed culture to deliver on its promise.

• Impact of current and expected government initiatives 
• HIT requirements for the PCMH and ACOs 
• Best practices for managing the data lifecycle 
• Understand “Big Data” analytics 
• Key strategies and tactics to implement the necessary HIT infrastructure

Playing Games with Federal Regulations

Most people expected the Stage 2 Meaningful Use rules to be published on Friday, February 17th but that did not happen. Now the expectation is that it will be released in conjunction with the Joint CMS-ONC Session at the HIMSS conference on Wednesday, February 22, from 9:45 AM - 10:45 AM. If this is done in a calculated way then I am very disappointed. As Histallk said in today's post:

"It looks as though the particulars about Meaningful Use Stage 2 will be released in the ONC meetings scheduled for Wednesday morning. That is damned annoying: you know they’ve been finished for some time, so holding them back just to crow about them at HIMSS is unfortunate. Why couldn’t ONC have released them last week to give people time to study the proposed rules so they could discuss them intelligently this week? ONC is going to hijack all of the topics and issues being discussed at the conference by people who have spent a lot of time and money to be here and turn it into a test of who can make an Excel worksheet the fastest. That’s a shame. It’s not like the government doesn’t already hog more than its share of the healthcare IT spotlight."

Actually we know pretty well what the Stage 2 Meaningful Use rules are going to look like. It is really the Stage 2 Standards, Implementation Specifications, and Certification Criteria that we don't have a truly clear picture about (and being at HIMSS, the greatest health IT vendor orgy ever that is a pretty significant bit of news). I really hope that the rules are not released Wednesday morning. It will not speak well to the integrity of the process and certainly does not allow for open and honest discussion on the proposed rules...

By the way Nate Osit made me chuckle this morning with his tweet proposing that maybe they will have copies of the rules under everyone's seats during the ONC session:

@Cascadia @Farzad_ONC @ahier It would be very dramatic if MU Stage 2 was released during his talk! Perhaps put a copy under ppls seats?
— Nate Osit (@NateOsit) February 21, 2012

Quantifying Myself With Fitbit

There are lot of chances to win prizes in Las Vegas, Nevada at the 2012 Annual HIMSS Conference. One of these will require me to track my walking .Practice Fusion, the free (ad supported) web based EHR, and Fitbit are sposnoring a contest between myself and Don Fluckinger. We will be competing for the most number of steps taken on Tuesday, February 21 for a chance to win a charitable donation of $500 made by Practice Fusion in our name through Givewell.org. We are also taking side bets on who reaches 30,000 steps first on Tuesday. That is a LOT of walking, but as past HIMSS conferences have shown, there is a bit of walking ahead of us.

With the Fitbit Ultra your information is wirelessly uploaded  to the web so you can gain deeper insight into your daily or monthly fitness and sleep levels with free online graphs and charts. Fitbit offers free iPhone and Android apps so you can track your progress and log food, work-outs and more on the go. It also has a pressure altimeter, so it can determine when you're climbing stairs or hills. This is my first foray into self-tracking, and I am very interested in seeing if or how my behavior changes. Fred Trotter in "The Rise of the Programmable Self" postulated the following formula: Quantifying your changes + motivational hacks = programmable self. As I'm wandering around Las Vegas I'll be pondering how I can use these tools in interesting ways to make positive changes.

You have the chance to win a Fitbit yourself at HIMSS with a value of $99.00. Here are the contest rules: On Tuesday February 21, tweet your response to “Who will win the Fitbit challenge? Don or Brian?” using hashtags #fitbit #HIMSS12 and @PracticeFusion. One participant will be randomly selected to win on Tuesday. No matter who wins, everyone is a winner with $500 going to Givewell.org and a raising of the awareness of self monitoring. Below is a promotional video that describes the Fitbit and may prompt you to send a tweet :-)

 

Survey Finds that Consumers Value Electronic Health Records - But Worries Persist About Breaches of Data

"Making IT Meaningful: How Consumers Value and Trust Health IT" Is Unprecedented Consumer Survey on Health IT

As more and more consumers see their doctors using electronic health records (EHRs), trust in doctors is high and patients have confidence that health information technology (health IT) can improve the quality and coordination of care.  Those with online access to their own medical records are especially supportive of health IT.  But consumers have persistent concerns that data breaches will occur.

Making IT Meaningful

The federal government is providing incentives for the use of health IT right now, investing tens of billions of dollars in its adoption.  Health IT is a foundation for health reform and for many of the new models of care now being developed or tested.  At this key moment as health IT is being rolled out, the National Partnership for Women & Families commissioned an unprecedented study to examine consumer views on health IT with research directed by Alan Westin, Ph.D., professor emeritus at Columbia University.  It was conducted by Harris Interactive.
"We fielded this survey now, in the early stages of the transformation to EHRs, to assess consumer views and to measure whether the ways doctors and hospitals are using them is what patients want and need," said Christine Bechtel, vice president at the National Partnership. Bechtel also represents patients and families on the federal Health IT Policy Committee.  "For health IT to deliver on its promise, consumers must support it.  If they don't, we will see political pressure for repeal and the promise will be squandered.  What we found is encouraging, but there are still potential landmines ahead."
"This survey draws attention to a critical, but sometimes overlooked, facet of health information technology – patients and their families need to be at the center of efforts to modernize health care's information infrastructure," said Dr. Farzad Mostashari, National Coordinator for Health IT, U.S. Department of Health and Human Services.
Making IT Meaningful: How Consumers Value and Trust Health IT takes an unprecedented look at consumer confidence in health IT.  Survey respondents had an ongoing relationship with a care provider and knew whether that provider uses an electronic or paper record system.  Among the findings:

• Regardless of the type of record their physician uses, patients see value in EHRs.  When asked if an EHR is or would be useful for seven key elements of care – such as making sure doctors have timely access to relevant information, and helping patients communicate directly with providers – 88 to 97 percent of those whose doctors use EHRs, and 80 to 97 percent of those whose doctors use paper medical records, said EHRs would be useful.  
• Just six percent of respondents whose doctors use EHRs are unsatisfied with the medical record system their doctors are using.
• Three in four EHR respondents whose doctors use paper records said it would be valuable if their doctors adopted EHRs.
• The one in four respondents who have online access to their medical records (26 percent) were even more supportive of health IT than those who do not, particularly when it comes to the ways in which EHRs benefit them personally.  They were also more trusting of doctors to protect their privacy.
• Overwhelming majorities of respondents, regardless of record system, trust their doctors to protect the privacy of their health information.
• Consumers rated EHRs higher than paper records when it comes to giving patients confidence their information is safe, complying with privacy laws, giving patients more control over their health information, earning their trust, and seeing a record of who has accessed their information.
• There are concerns about data breaches and current privacy laws.  Three in five respondents whose doctors use EHRs (59 percent) agree that widespread adoption of EHRs will lead to even more personal information being lost or stolen, as do 66 percent of respondents whose doctors use paper records.  Similarly, more than half of those whose doctors use EHRs (51 percent) and 53 percent of those whose doctors use paper records agree that the privacy of personal medical records and personal health information is not currently well protected by federal and state laws and organizational practices.
• Those with paper records today who are most worried about their privacy in this survey were men, those with a college education, respondents ages 35 to 46, and those living in the east and west.

An oversample of Hispanic adults found that those whose doctors use EHRs were significantly more likely than others to see them as valuable in helping them personally in some important ways, such as maintaining a healthy lifestyle, understanding their health conditions and keeping up with their medications.  At the same time, they were more likely both to report having experienced a data breach and to worry that more widespread adoption of EHRs will lead to even more such breaches.
"The survey shows that patients see tremendous value in the power of electronic health records to improve the way care is delivered by facilitating better communication and helping them become active partners in their own care.  Its findings offer important messages about how to build, implement and use health IT systems in ways that are meaningful and beneficial to patients and their families," Mostashari said.
"At the same time, patients are also saying the success of advanced information technology rests on a foundation of trust that must be vigilantly protected," he added.  "Encouraging the adoption and meaningful use of electronic health records is important, but the ultimate goal should be to leverage information technology in ways that lead to higher quality care, more coordinated care, and care that is truly patient-centered."
"At a time when America's taxpayers have made such a large investment in the implementation of health IT, we have an obligation to use their dollars wisely and get this right," the National Partnership's Bechtel said.  "Amplifying the voices of consumers is key to success.  This survey gives consumers a voice."
The survey was conducted from August 3 to August 22, 2011.  The respondent pool was 1,961 adults.  It was funded by the Commonwealth Fund, Merck & Co., Inc., WellPoint, Inc. and the California HealthCare Foundation.  It is intended to serve as a baseline for longitudinal tracking, and the survey instrument has been made available for public use.
The survey report includes a series of policy recommendations in the areas of consumer education, and functional and privacy requirements for a variety of federal programs.
NOTE: The new survey is available at www.NationalPartnership.org/HIT. As a leader of the Consumer Partnership for eHealth, the National Partnership published a Consumer Platform for Health IT last year; it is available here.
The National Partnership is a non-profit, non-partisan organization dedicated to promoting access to quality health care, fairness in the workplace, and policies that help women and men meet the dual demands of work and family.  More information is available at www.NationalPartnership.org.

SOURCE National Partnership for Women & Families

Proposed 2013 ONC Budget

From the President's proposed FY 2013 Budget for the Department of Health and Human Services

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

(dollars in millions)
2013
2011		2012	2013	+/-2012
Budget Authority ................................................................................................	42	16	26	+10
PHS Evaluation Funds ................................................................	19	45	40	-5
Total, Program Level	61	61	66	+5
FTE ................................................................................................	147	172	191	+19

The Office of the National Coordinator for Health Information Technology is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.

The FY 2013 Budget request for the Office of the National Coordinator for Health Information Technology (ONC) is $66 million, $5 million above FY 2012. The Budget provides resources to continue supporting, and further advance, the progress that ONC has achieved in creating a nationwide health information technology (health IT) infrastructure in response to the mandates set forth in the Health Information Technology for Economic and Clinical Health (HITECH) Act. In addition, ONC will continue efforts to accelerate the adoption of health IT and help physicians achieve meaningful use of electronic health records (EHRs). The Budget also includes resources for ONC to serve as the Federal health IT leader.

ONC and the Centers for Medicare & Medicaid Services (CMS) are working closely together to register eligible professionals and hospitals to qualify for incentive payments from Medicare and Medicaid which are designed to encourage providers to adopt and meaningfully use EHRs. With incentive payments beginning in January 2011, ONC and CMS estimate 80,000 providers will have achieved meaningful use and received payments by the end of FY 2012.

More Than100,000 Providers Working with Regional Extension Centers


The ONC Health IT Regional Extension Centers (RECs) has made great strides towards the program’s goal to assist 100,000 providers adopt and demonstrate meaningful use of EHRs by FY 2014. To date, over 130,000 providers have registered to work with an REC.In asignificantmilestone,roughlyone-third of all primary care providers and more than two-thirds of all rural providers in the country are now working with ONC grantees.The providers working with RECs are a diverse group. Among them, half are from small private practices or small practice consortia, and over 20 percent are affiliated with critical access hospitals, rural health clinics, and other practices in medically underserved areas. In addition, 11percent of providers are in public hospitals and 18 percent are in community health centers.As of January 2012, nearly 60,000 REC-assisted providers had implemented EHRs with e-prescribing and quality reporting capabilities and over 5,000 of theseprovidershave achieved meaningful use.The RECs will continue toassist these providers with adopting and meaningfully using EHRs in their practices.

ADOPTION

Reducing barriers to the adoption and meaningful use of EHRs is essential to improving the quality and efficiency of our health care system. The FY 2013 Budget includes $7.8 million, an increase of $2 million, to allow ONC to work with health care organizations and community organizations to share best practices to encourage adoption and meaningful use of health IT. In addition, this funding will support Regional Extension Centers to leverage their relationship with providers to support other HHS priority programs, such as the National Quality Strategy.

STANDARDS AND INTEROPERABILITY

The Budget includes $12 million for standards and interoperability work, which enables health information to be captured and exchanged among health IT systems, whether small physician practices or large hospital systems. Through these activities, ONC supports the:

Creation of a life-cycle of standards and implementation specifications for health IT;Identification of existing or development of new standards, services descriptions, and implementations;

Development and maintenance of certification criteria and certification process;Coordination of federal participation in health information exchange. ONC also supports the Virtual Lifetime Electronic Record (VLER) project, a Presidential priority which is creating a unified electronic record for military personnel and veterans. Combined, these standards and interoperability activities enable ONC’s efforts to promote adoption and meaningful use of EHRs; facilitate electronic health information exchange to improve health care quality and delivery; and, enable consumers to play a more central role in directing their care through the use of technology.

PRIVACY AND SECURITY

Privacy and security are critical to provider and consumer trust in electronic health information and participation in health information exchange. The Budget includes $5 million to assure that policies and practices are in place to keep health information private and secure in a rapidly changing environment. Key efforts include the evaluation and policy development of privacy and security protections for electronic health information in the evolving nationwide network. ONC will continue to coordinate the development and implementation of these policies with other federal partners as well as with the states, the territories, and foreign countries. To facilitate the private and secure implementation of EHR technology and Health Information Exchanges, ONC, in conjunction with other federal partners, will continue to identify good privacy and security practices and to develop and disseminate appropriate educational materials to health care providers and other stakeholders. ONC will also continue to explore security issues arising from patient-centered health care, such as secure electronic communications with patients.

HHS Promoting the Adoption and Meaningful Use of EHRs
ONC continues to partner with other federal agencies to encourage health care providers and hospitals to make thetransition frompaper records to certified EHRs in order to improve health care and control costs. Within HHS,CMS has supported this goal by the implementation of EHR Incentive programs.

• As of December31,2011, Medicare has made approximately $275 million in incentive payments toover 15,800 providers and over $1.1billion to more than 600 hospitals.
• As of early January2012,43states had launched State Medicaid Electronic Health Record Incentive Programs.
• Over $295 million in Medicaid incentive payments have been made to more than 15,100 professionals and over $850 million had been made to over 1,000 hospitals.CMS and ONC expect even more providers and hospitals to take advantage of the program in the future.

EHR Adoption Grows Over 5 Percent in 6 Months

SK&A’s updated “Physician Office Usage of Electronic Health Records Software” report revealed a significant growth in EHR software adoption during 2011. Findings of the report, which were finalized in January 2012, show overall growth in the EHR implementation, as government initiative deadlines get closer.

SK&A was awarded a contract by the U.S. Department of Health and Human Services (HHS), Office of the National Coordinator for Health IT (ONC), to provide ongoing survey information about the adoption, usage and planned usage of electronic health records (EHR) by physicians in U.S. medical offices. The SK&A OneKey database of 251,000 medical offices and over 700,000 physicians is delivered to ONC quarterly.

SK&A's Research Center in Irvine, Calif., conducts telephone interviews with office managers and physicians in all 50 states and the District of Columbia. Every month, the researchers survey and verify information at more than 40,000 sites. Medical offices are asked about their intent to purchase an EHR and about their timeframe, decision factors (such as price and functionality), and awareness of government incentives for adopting EHR technology.

Physician Office Usage of Electronic Healthcare Records Software

	January 2012		July 2011
Overall U.S. Office Response	Yes %	No %	Yes %	No %
	45.6%	54.4%	40.4%	59.6%
By Number of Physicians at Site	Yes %	No %	Yes %	No %
1 physician	36.9%	63.1%	30.8%	69.2%
2 physicians	47.1%	52.9%	41.6%	58.4%
3 to 5 physicians	54.9%	45.1%	51.0%	49.0%
6 to 10 physicians	64.9%	35.1%	63.0%	37.0%
11 to 25 physicians	74.0%	26.0%	71.6%	28.4%
26 or more physicians	77.2%	22.8%	75.5%	24.5%
By Number of Exam Rooms at Site	Yes %	No %	Yes %	No %
1 room	31.2%	68.8%	28.2%	71.8%
2 rooms	34.0%	66.0%	28.5%	71.5%
3 rooms	38.8%	61.2%	32.9%	67.1%
4 rooms	43.4%	56.6%	37.6%	62.4%
5 rooms	47.1%	52.9%	42.0%	58.0%
6 to 10 rooms	54.1%	45.9%	49.7%	50.3%
11 or more rooms	66.6%	33.4%	64.1%	35.9%
By Average Daily Patient Volume	Yes %	No %	Yes %	No %
1 to 50 patients	41.2%	58.8%	36%	64%
51 to 75 patients	54.2%	45.8%	50%	50%
76 to 100 patients	60.6%	39.4%	57.7%	42.3%
101+ patients	68.4%	31.6%	66.1%	33.9%
By Application	Yes %	No %	Yes %	No %
Electronics notes	33.1%	66.9%	31.9%	68.1%
Electronic prescribing	31.1%	68.9%	29.9%	70.1%
Electronic labs/xrays	31.9%	68.1%	30.7%	69.3%
All of the above	26.4%	73.6%	25.2%	74.8%
By Site Ownership	Yes%	No%	Yes %	No %
Hospital owned	59.5%	40.5%	60.4%	39.6%
Nonhospital owned	43.2%	56.8%	38.9%	61.1%
Health system owned	64.2%	35.8%	63.5%	36.5%
Nonhealth system owned	43.1%	56.9%	38.5%	61.5%

By Region	Yes %	No %	Yes %	No %
North	47.7%	52.3%	42.4%	57.6%
South	47.3%	52.7%	41.6%	58.4%
East	41.7%	58.3%	37.3%	62.7%
West	45.7%	54.3%	40.5%	59.5%

By Practice Specialty	Yes %	No %	By Practice Specialty	Yes %	No %
Top 5 specialties	January 2012		Top 5 Specialties	July 2011
Dialysis	68.4%	31.6%	Dialysis	64.9%	35.1%
Pathology	66.2%	33.8%	Pathology	61.8%	38.2%
Nuclear Medicine	64.2%	35.8%	Nuclear Medicine	60.6%	39.4%
Radiology	62.8%	37.2%	Aerospace Medicine	59.7%	40.3%
Genetic Specialist	60.5%	39.5%	Radiology	58.8%	41.2%
Bottom 5 Specialties			Bottom 5 Specialties
Plastic Surgery	31.0%	69.0%	Psychiatric	25.7%	74.3%
Psychiatric	29.2%	70.8%	Other Specialty	25.7%	74.3%
Bariatrician	28.2%	71.8%	Bariatrician	25.2%	74.8%
Psychiatry	25.0%	75.0%	Holistic Medicine	17.0%	83.0%
Holistic Medicine	18.7%	81.3%	Psychiatry	16.7%	83.3%

By State	Yes %	No %	By State	Yes %	No %
Top 5 States	January 2012		Top 5 States	July 2011
Minnesota	65.2%	34.8%	Minnesota	61.8%	38.2%
Utah	62.7%	37.3%	Utah	57.6%	42.4%
North Dakota	59.9%	40.1%	Massachusetts	52.9%	47.1%
Oregon	57.3%	42.7%	Oregon	52.8%	47.2%
South Dakota	57.2%	42.8%	North Dakota	52.1%	47.9%
Bottom 5 States			Bottom 5 States
California	40.1%	59.9%	Maryland	36.1%	63.9%
New York	40.0%	60.0%	Rhode Island	35.6%	64.4%
Maryland	40.0%	60.0%	Louisiana	34.5%	65.5%
Louisiana	36.6%	63.4%	California	33.3%	66.7%
New Jersey	34.6%	65.4%	New Jersey	30.0%	70.0%

Source: SK&A, A Cegedim Company, Jan 24, 2012 Based on telephone survey of 240,281 U.S. medical sites


Editor's Note: For a copy of the summary findings for publication, please contact Jack Schember, SK&A Vice President of Marketing, at 800-752-5478, ext. 1259.