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Study of Technology Adoption in California Medical Groups, Ipas, and Community Clinics

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Study of Technology Adoption in California Medical Groups, Ipas, and Community Clinics Study of Technology Adoption in California Medical Groups, IPAs, and Community Clinics May 2002 Prepared for the California HealthCare Foundation by Healthcare Change Institute Acknowledgments The Healthcare Change Institute (HCI) utilized the strength of its faculty, a multi-disciplinary team of academics, consultants, and executives to design and conduct the study and analyze findings. The faculty had considerable experience in managing, studying, and consulting with medical groups and other health care organizations. The faculty also had substantial experience in high technology development and adoption in California medical groups as well as in health systems and medical groups on the east coast who are experienced and advanced in technology adoption. Core HCI study team faculty were: Jeff Oxendine, M.B.A., M.P.H., Founder and Executive Director of HCI at Brigham & Women’s Hospital and Lecturer at Harvard Medical School and Harvard School of Public Health, Principal Investigator; Katherine Kim, M.B.A., M.P.H., former president and CEO of the Communications Technology Cluster LLC, Partner in Health Technology Group LLC, Project Leader and Manager; Judy N. Li, M.B.A., Director of Business Development, SRI International, formerly Stanford Research Institute; Thomas Rundall, Ph.D., Henry J. Kaiser Professor of Organized Health Systems, University of California, Berkeley; and Stephen Shortell, Distinguished Blue Cross of California Professor of Health Policy and Management, University of California, Berkeley. Other HCI faculty who served as collaborators on the project were: Jerry Coil; Jack Silversin, D.M.D., DR.P.H., President of Amicus Consulting, Boston, MA; John Glaser, Ph.D., Chief Information Officer, Partners HealthCare System; Joan Rubano, R.N., Stanford University Medical Center; Dobbe Sangha, M.D., M.P.H., Lead Research Associate; Camila Chavez, Research Associate; and David Monaghan, Research Associate. Margaret Laws, CHCF Director of Policy and Planning, provided guidance to the faculty and participated in the review of the research questions and methodology. Healthcare Change Institute is a nonprofit organization dedicated to assisting health care organizations to more effectively anticipate, implement and achieve the intended results of major change initiatives. HCI was founded in 2000 to provide a greater availability of practical skill development, knowledge, coaching and consulting services to health care organizations regarding change management. Its mission is to improve quality of care and organization performance by increasing the capacity of health care organizations to change. Technology adoption is one of its priority areas of specialized interest along with integration, process improvement and physician practice management. A priority is developing physician, administrative, and nursing leaders and teams, who have greater knowledge, skills and tools to achieve the results of change initiatives. Improving patient care delivery, management effectiveness, and organizational performance are primary goals. In addition to the grant from the California HealthCare Foundation, the HCI has undertaken consulting and research projects at Brigham and Women’s Hospital in Boston and a major health system in Florida. HCI is planning a major conference on change management, sponsored by Siemens Medical Systems, for health system and hospital CEOs and COOs in spring of 2002. We are also collaborating with the Risk Management Foundation, based in Boston, to support initiatives designed to achieve adoption of best practices to improve patient safety and reduce medical errors. HCI was founded by and is housed at the Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, 617-732-7828. Inquiries regarding this project should be addressed to: Jeff Oxendine, Healthcare Change Institute, [email protected], 617-732-7828. Copyright © 2002 California HealthCare Foundation Additional copies of this and other publications can be obtained by calling the CHCF publications line toll-free at 1-888-430-CHCF (2423) or by visiting us online (www.chcf.org). The California HealthCare Foundation, based in Oakland, is an independent philanthropy committed to improving California’s health care delivery and financing systems. Formed in 1996, our goal is to ensure that all Californians have access to affordable, quality health care. CHCF’s work focuses on informing health policy decisions, advancing efficient business practices, improving the quality and efficiency of care delivery, and promoting informed health care and coverage decisions. CHCF commissions research and analysis, publishes and disseminates information, convenes stakeholders, and funds development of programs and models aimed at improving the health care delivery and financing systems. For more information, visit us online (www.chcf.org). 476 Ninth Street Oakland, CA 94607 Tel: 510.238.1040 Fax: 510.238.1388 www.chcf.org Contents Executive Summary.........................................................................................................................5 I. Introduction .............................................................................................................................10 II. Survey and Focus Group Findings..........................................................................................14 III. Recommendations: A Model of Technology Adoption..........................................................24 Appendix A: Survey Instrument ....................................................................................................25 Appendix B: Literature Review as of 10/10/01 .............................................................................36 Executive Summary Study Goal In June of 2001, the California HealthCare Foundation (CHCF) provided funding for Healthcare Change Institute (HCI) to conduct a baseline study of technology adoption in California medical groups and clinics. The primary goal of the study was to identify opportunities for the Foundation and other organizations to facilitate more rapid and effective adoption of innovative technology solutions to improve quality of care and organizational performance in the California health care system. The study was completed December 2001. Methodology To fulfill the study goal, a multidisciplinary team from HCI utilized a written survey, focus groups, and an extensive literature review to obtain insights about technology adoption in medical groups and clinics. “Medical groups” consisted of independent practice associations (IPAs), medical foundations, and integrated medical group practices. “Clinics” consisted of community clinics, rural clinics, and federally qualified health centers. Management service organizations (MSOs) were asked to respond on behalf of a specific medical group or clinic. For purposes of this study, information technology was defined as information systems and data exchange between medical groups and clinics and the key constituents (physicians, patients, payers and hospital/ancillary service providers) involved in the clinical and administrative functions of patient care delivery, financing, and operations. Medical devices and equipment involved in diagnosis and treatment were not part of the scope of this study. Sample and Response The 365 California medical groups and 60 clinics included in a database provided by CHCF were offered the opportunity to complete the survey and participate in a focus group. Study of Technology Adoption in California 5 Medical Groups, IPAs, and Community Clinics Forty-eight medical groups and clinics from throughout California responded to the survey. Twenty-two medical groups, 22 clinics, and 4 MSOs responded. Of these respondents, 5 clinics and 4 medical groups participated in focus groups. Limitations The small intended sample size limited the depth and generalizability of the results, meaningful analysis of issues specific to medical groups and clinics as individual categories and to sub- groups within them. There is potential respondent bias in that the medical groups and clinics that responded may have a greater interest in or problems with technology. Finally, the fact that the study was sponsored by CHCF asking how it could assist organizations may have introduced some bias towards respondents emphasizing financial need. However, many medical groups and clinics are encountering significant financial challenges that limit their resources and ability to invest in technology. Research Questions and Findings The survey, focus groups, and literature reviews were designed to address five key research questions. The most significant findings related to each research question are summarized below. Research Question #1: How are California medical groups and clinics currently using information technology in the delivery of care and administration? Overall, medical groups and clinics participating in this study had very limited use of information technology to communicate and exchange information with any of their key constituents. Systems for administrative functions were far more prevalent than clinical systems. Electronic claims submission and email were the most commonly implemented systems across all constituent groups. However, respondents indicated a high level of dissatisfaction with these systems’ abilities to meet functional requirements and user needs. Clinical systems such as electronic medical record (EMR) and disease management systems seem to be high priorities for medical groups and
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