The State of Health Information Technology and Health Information Exchange in New Hampshire

SURVEY RESULTS

May 27, 2016 Table 10 edited September 10, 2016

Prepared for: New Hampshire Department of Health and Human Services, Office of Medicaid Business and Policy

By: Institute for Health Policy and Practice at the University of New Hampshire

Lead Authors: Sarah M. Eck, PhD Patrick B. Miller, MPH

Research Assistance: Tracy Keirns Elizabeth Trivett

Table of Contents 1.0 Executive Summary ...... 4 1.1 Purpose ...... 4 1.2 Study Population ...... 4 1.3 Findings Summary ...... 5 2.0 Methodology ...... 10 2.1 Provider Database Development ...... 10 2.2 Survey Instrument Development ...... 11 2.3 Fielding the Survey ...... 11 2.4 Analysis ...... 11 4.0 Results: Electronic Health Records (EHR) and EHR Incentive Programs ...... 18 4.1 EHR Systems Overview ...... 18 4.2 Medicare and Medicaid EHR Incentive Programs ...... 22 4.3 CEHRT Technology, Vendor Brands, and EHR Consolidation Plans ...... 38 4.4 EHR Capabilities and Meeting Specific Meaningful Use Objectives ...... 47 4.5 Health Information Exchange Capabilities ...... 60 5.0 Results: Broadband, Payment Arrangements, Security, and Future State ...... 67 5.1 Broadband ...... 67 5.2 Security ...... 69 5.3 Payment Arrangements ...... 70 5.4 Health Information Technology (HIT) and Health Information Exchange (HIE) Future State ...... 75 5.4.1. Desired and Future States of HIT (Q64) ...... 75 5.4.2 Current and Future States of HIE (Q65) ...... 78 6.0 Appendices ...... 81 6.1 Appendix A: Index of Tables and Figures ...... 81 6.2 Appendix B: Survey Instrument ...... 83

[Remainder of Page Left Intentionally Blank] The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

1.0 Executive Summary 1.1 Purpose This web-based survey was conducted on behalf of the New Hampshire Department of Health and Human Services (NH DHHS) Office of Medicaid Business and Policy (OMBP) to understand the current New Hampshire landscape of health provider implementation and use of health information technology (HIT) and health information exchange (HIE). A similar survey was conducted in 2012. This current survey is intended to support planning needs [e.g., internal NH DHHS, 1115 Delivery System Reform Incentive Payment Program (DSRIP) Waiver, State Innovation Models Initiative (SIM), and regulatory reporting requirements from the Centers for Medicare and Medicaid Services (CMS)]. 1.2 Study Population The study population consisted of 15 provider types:
Community Mental Health Center
Dentist, General
Dentist, Pediatric
Federally Qualified Health Center
Freestanding Urgent Care Center
Home Health and Hospice Agency
Hospital, Critical Access
Hospital, New Hampshire Hospital
Hospital, Non-Critical Access
Hospital, Rehabilitation
Nursing Home and Skilled Nursing Facility
Nursing Home, County
Nursing Home, Glencliff Home
Practice, Other (denotes primary, and specialty, care practices not owned by a hospital)
Rural Health Clinic

4

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

1.3 Findings Summary
Survey Response Rates. The response rates by provider type varied considerably. Of the 720 surveys administered, 266 (37%) of organizations responded. The Community Mental Health Centers (CMHCs) and New Hampshire Hospital (NHH) had the highest response rates of 100% each. In descending order, the next highest response rates were the Federally Qualified Health Centers (FQHCs) with a 91% response rate (n=10); county nursing homes with a 70% response rate (n=7); rehabilitation hospitals with a 67% response rate (n=2); home health and hospice agencies with a 54% response rate (n=21); and critical access hospitals (CAHs) also with a 54% response rate (n=7). While neither of the two, non-hospital owned Rural Health Clinics (RHCs) responded, additional RHCs were included in the responses of multiple hospitals. There is one, Vermont-based FQHC with a New Hampshire site which was also included in the survey.

Survey Respondents. In descending order, the most frequently used titles by survey respondents to identify themselves included: “Practice Manager or Office Manager” (30%; n=80); “Chief Executive Officer or Executive Director” (18%; n=48); “Administrator” (17%; n=46); “Other” (13%; n=33); “Chief Information Officer or Director of Information Technology” (11%; n=29); and “Owner” (9%; n=24).

Number of Electronic Health Record (EHR) Systems. The majority of respondents reported using one EHR system (70%; n=186) while 10% (n=25) of respondents use two EHR systems. Of the 266 respondents, 21% (n=55) do not have an EHR system in place. Of those without any EHR system (n=55), dentists comprised the largest percentage (78%; n=43) followed by other practices (primary and specialty care practices not owned by a hospital) (15%; n=8).

Organizations Attesting for Medicare EHR Incentive Program Prior to 2015. Seventy-four percent (74%) (n=137) of organizations did not attest for the Medicare EHR Incentive Program prior to the 2015 program year while 26% (n=47) indicated that their organizations had attested for the Medicare EHR Incentive Program. All (100%; n=7) of CAHs; 100% (n=8) of non-CAHs; 75% (n=21) of independent practices; 40% (n=4) of FQHCs; and 30% (n=3) of CMHCs reported attesting for the Medicare EHR Incentive Program prior to 2015. Lower rates were shown for county nursing homes (14%; n=1); home health and hospice agencies (6%; n=1); and general dentists (3%; n=2). There were multiple reasons that organizations did not attest for Medicare EHR Incentive Program. Thirteen percent (n=7) did not know how to attest; 13% (n=7) did not meet eligibility requirements; 8% (n=4) cited lack of staffing; 6% (n=3) cited lack of ONC-certified technology; and the remaining 65% (n=34) cited “other.”

Organization Plans to Attest for Medicare EHR Incentive Program for 2015 and/or 2016 Program Years. More than half (51%; n=100) of responding organizations indicated that they do not intend to attest for the Medicare EHR Incentive Program for the 2015 and/or

5

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

2016 program years. However, 18% (n=35) of organizations plan to attest for the Medicare EHR Incentive Program for the 2015 and/or 2016 program years while 31% (n=62) indicated that they are unsure about plans to attest.

Organizations with Eligible Professionals (EPs) Plans to Attest for Medicare EHR Incentive Program for 2015 and/or 2016 Program Years. Thirty-three percent (33%) (n=32) of organizations have EPs that plan to attest for the Medicare EHR Incentive Program for the 2015/2016 program years. Twenty-seven (27%; n=26) of responding organizations indicated that they are unsure whether EPs in their organizations will attest for the Medicare EHR Incentive Program while most organizations (40%; n=38) do not plan to have EPs attest for the Medicare EHR Incentive Program in the 2015 and/or 2016 program years.

Organizations Attesting for Medicaid EHR Incentive Program Prior to 2015. Seventy -seven percent (77%) (n=134) of responding organizations did not attest for the Medicaid EHR Incentive Program prior to 2015. Notably, 93% (n=63) of dentists did not attest prior to 2015; of these, 68% (n=42) are Medicaid-enrolled dentists. A quarter (25%; n=34) of respondents cited not knowing how to attest; 20% (n=20) stated that they did not meet eligibility requirements; and 33% (n=44) cited “other” reasons including the “arduous process”; “not being aware of it”; and “not a Medicaid provider.”

Organizations With EPs Attesting for Medicaid EHR Incentive Program Prior to 2015. Sixty-five percent (65%) (n=60) of 93 respondents reported that EPs in their respective organizations did not attest for the Medicaid EHR Incentive Program prior to the 2015 program year. The highest attestation rates are attributed to 90% of FQHCs (n=9); 70% of CMHCs (n=7); and 57% of CAHs (n=4). There are a multitude of reasons that organizations reported that their EPs did not attest for the Medicaid EHR Incentive Program. Besides “other” (46%; n=24), “did not meet eligibility requirements” (25%; n=13) was the highest reason across all provider types followed by “do not/did not understand how to attest” (15%; n=8), and “lack of staffing” (12%; n=6).

Organization Plans to Attest for Medicaid EHR Incentive Program for 2015 and/or 2016 Program Years. Approximately half (49%, n=91) of reporting organizations do not intend to attest for the Medicaid EHR Incentive Program for the 2015 and/or 2016 program years. However, 80% (n=8) of FQHC respondents, 75% (n=6) of non-CAH respondents, and 50% (n=5) of CM HC respondents plan to attest during this time period.

Organizations With EPs Plans to Attest for Medicaid EHR Incentive Program for 2015 and/or 2016 Program Years. There are organizations with EPs that intend to attest to the Medicaid EHR Incentive Program in the 2015 and/or 2016 program years. The highest rates of organizations with eligible EPs intending to attest by organization type are FQHCs (100%; n=10); non-CAHs (63%; n= 5); and CMHCs (50%; n=5).

6

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Awareness of Medicaid and Medicare EHR Incentive Programs. For the 42 respondents that stated that they had no intention of implementing an EHR within the next two years, they were subsequently asked about their awareness of Medicaid and Medicare EHR Incentive Programs. Sixty-eight percent (68%) (n=26) of the 38 respondents indicated that they were not aware of these programs while 32% (n=12) stated that they were aware. General dentists had the greatest lack of awareness with 86% (n=24) being unaware of these incentive programs. Additionally, 63% of the dental practices that were unaware of the Medicaid EHR Incentive Program were practices that accepted Medicaid patients.

Certified Electronic Health Record Technology (CEHRT) Status. Sixty-eight percent (68%) (n=141) of reporting organizations currently use, or plan to implement, CEHRT1 within two years. Of those not using, or not planning to use, CEHRT within two years (32%; n=67), general dentists (51%; n=44); pediatric dentists (60%; n=3); county nursing homes (57%; n=4), and home health and hospice agencies (41%; n=7) were the furthest behind in CEHRT implementation. In contrast, 100% of the 10 FQHCs either use, or intend to use, CHERT within the next two years.

Current CEHRT Satisfaction. Over half (51%; n=67) of providers are either “very satisfied” or “somewhat satisfied” with their CEHRT. The highest dissatisfaction rate of all provider types is seen in the CMHCs whereby 50% (n=5) were either “somewhat dissatisfied” or “very dissatisfied.” Home health and hospice agencies (25%; n=3) and FQHCs (20%; n=2) also had high rates of being “somewhat dissatisfied” or “very dissatisfied.” The one freestanding urgent care center and the one rehabilitation hospital had 100% rates of being “very satisfied.” 80% (n=8) of the FQHCs; 71% (n=5) of CAHs; and 63% (n=5) of non-CAHs were “very satisfied” or “somewhat satisfied.”

Plans to Upgrade EHRs to CEHRT. The survey asked about plans to upgrade to CEHRT within the near future (two years). Twenty-seven percent (27%) (n=40) of providers stated that they were planning an upgrade within two years; 36% (n=54) had no plans; and 37% (n=52) were unsure. Notably, 100% (n=8) of responding non-CAHs plan to upgrade EHR systems within the next two years while 70% (n=7) of FQHCs; 57% (n=4) of CAHs; and 50% (n=5) of CMHCs also have plans to upgrade EHR systems in the near future.

Assistance from the State Medicaid Office in CEHRT Adoption. Of the 38 respondents not planning to implement CEHRT within the next two years, 3% (n=1) believe that the State Medicaid Office can assist them in adopting and implementing CEHRT; 45% (n=17) do not believe the State can assist them; and 53% (n=20) are unsure about State assistance.

1 Including 2014 or 2015 CEHRT editions. 7

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Meeting Meaningful Use Objectives. Many Meaningful Use (MU) objectives were cited as being “used routinely” more than 70% of the time including “recording patient history and demographic information” (90%; n=155); “recording clinical notes” (89%; n=152); “recording patient’s medications and allergies” (88%; n=152); “recording patient problem list” (83%; n=143); “recording patient smoking status” (72%; n=124); and “recording and charting vital signs” (70%; n=121). Functions least cited as being “used routinely” included “electronic reporting to immunization registries” (9%; n=15); “providing patients the ability to view online or download or transmit information” (20%; n=34); “exchanging secure messages with patients” (29%; n=49); and “identifying education resources for patients’ specific conditions” (33%; n=55).

Current Health Information Exchange (HIE). Thirty-two percent (32%) (n=53) of providers indicated sharing data with “ambulatory providers outside their office”; 29% (n=48) “within their office/group”; 24% (n=40) for “hospitals with which they are affiliated”; and 24% (n=39) with “pharmacies.” Providers were also asked about the types of patient data exchanged electronically by provider type via current EHR systems. Providers reported using their EHR system(s) to share “laboratory results” (58%; n=33); “imaging reports” (40%; n=25); “patient problem lists” (54%; n=31); “medication lists” (49%; n=34); and “medication allergy lists” (45%; n=30) with hospitals with which they are affiliated. Fewer providers share the following types of patient information with hospitals with which they are not affiliated: “laboratory results” (28%; n=16); “imaging reports” (16%; n=10); “patient problem lists” (30%; n=17); “medication lists” (26%; n=18), and “medication allergy lists” (24%; n=16). However, providers share a similar amount of patient information with ambulatory providers inside and outside of their practice groups including “laboratory results” (61%; n=35 and 53%; n=30, respectively); “imaging reports” (51%; n=32 and 57%; n=36, respectively); “patient problem lists” (65%; n=37 and 58%; n=33, respectively); “medication lists” (62%; n=43 and 55%; n=38, respectively); and “medication allergy lists” (45%; n=30 and 56%; n=37, respectively).

Use of a Health Information Service Provider for Direct Messaging. The survey asked whether providers are employing a Health Information Service Provider (HISP) to meet their direct messaging requirements. Overall, 21% (n=34) reported using a HISP while 79% (n=125) did not. Freestanding urgent care centers (100%; n=2); non-CAHs (100%; n=7); CAHs (86%; n=7); and FQHCs (30%; n=3) had the highest rates of HISP usage.

Patient Portal Functions. Providers offer an array of patient portal functions. Just over a quarter (27%; n=40) of the portals allow patients the ability to “view test results”; 15% (n=22) allow patients to “self-enter health information”; 15% (n=22) allow patients to “request referrals”; 24% (n=34) allow patients to “refill requests for prescriptions”; 30% (n=43) allow patients to “request appointments”; 28% (n=40) allow patients to “ask the providers questions”; and 4% (n=6) allow patients to “upload data from health monitoring devices.”

8

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Broadband Access. Over a third (36%; n=67) of respondents stated that they “strongly agree” or “agree” that they perceived broadband access as posing a challenge to HIT and HIE. Forty percent (40%; n=74) indicated being “neutral” while 23% (n=44) “disagree” or “strongly disagree.” The highest proportion of those citing broadband access issues were the CMHCs with 60% (n=6) reporting “strongly agree” or “agree” and the county nursing homes with 50% (n=3) reporting “strongly agree” or “agree.” The eight non-CAHs that responded had the highest proportion of answers as “disagree” or “strongly disagree” totaling 53% (n=5) of the respondents. Half (50%) of the responses for both pediatric dentists (n=3) and the FQHCs (n=5) also reported “disagree.”

Security. Increasingly, healthcare organizations are facing data risks and vulnerabilities to their electronic health information. Seventy- three percent (73%) (n=90) of practices reported that they had assessed potential risks and vulnerabilities associated with their electronic health information in the last 12 months; 12% (n=15) reported that they were unsure; and 15% (n=18) reported that they had not performed a vulnerability assessment in the last 12 months.

Payment Arrangements. Payment reform efforts, such as pay for performance (P4P) programs or accountable care organizations (ACOs), are taking place across the State within Medicare, Medicaid, and commercial payers. The information systems that providers use will need to be able to adapt to these new payment arrangements. Overall, a majority of providers (63%; n=124) reported that they are not participating in a P4P arrangement. However, 63% (n=5) of the responding non-CAHs and 56% (n=5) of the FQHCs indicated participation in a P4P arrangement. Of the 15 responding nursing homes and SNFs, 13% (n=2) plan to engage in a P4P arrangement within 6 to 12 months. More than half of respondents (58%; n=12) expressed that they were “very satisfied” or “somewhat satisfied” with the ability of their CEHRT to facilitate P4P arrangements. Fifteen percent (15%) (n=4) remained “neutral” on the issue while 5% (n=1) said that they were “somewhat dissatisfied.” While overall, 62% (n=122) cited no plans to participate in an ACO or similar arrangement, the CAHs (71%; n=5); FQHCs (70%; n=7); and non-CAHs (63%; n=5) were more likely than any other provider type to say that they were currently, or would be, participating in these arrangements within the next year. Of those who were considered satisfied with the ability of their respective CHERT to enable implementation and management of ACO arrangements, 53% (n=11) said that they were either “somewhat satisfied” or “very satisfied”; 21% (n=4) were “neutral”; and 5% (n=1) stated that they were “very dissatisfied.”

9

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

2.0 Methodology 2.1 Provider Database Development The development of the provider database (contacts to whom the survey was sent) included only New Hampshire providers or the New Hampshire facilities of providers owned by an out-of-state organization (e.g., one FQHC in New Hampshire had a Vermont parent organization). The State Medicaid Office previously conducted a provider survey in 2012 (although this did not include all of the same provider types). Since 2012, the environmental landscape in New Hampshire has changed. Practices have been acquired or closed and new practices have opened. While this survey was targeted to practice managers, administrators, Chief Information Officers, or Chief Executive Officers (dependent upon the size and type of an organization), there was no existing, statewide database containing their contact information. To compile this information, the following steps were taken:
Step 1: The State Medicaid Office provided the provider contact database from the 2012 survey as well as a list of dentists and dental practice names (without email addresses). An initial update (based on the research team’s local knowledge) was completed which resulted in additions, deletions, and changes.

Step 2: The research team contacted the following statewide organizations for assistance in obtaining (or verifying) provider contact information: New Hampshire Hospital Association; New Hampshire Home Care Association; New Hampshire Long Term Care Association; New Hampshire Association of Counties; New Hampshire Community Behavioral Health Association; and New Hampshire Medical Group Management Association.

Step 3: The Northeast Delta Dental online provider directory was queried to obtain email addresses for dentists actively enrolled in New Hampshire Medicaid and add contact information for non-Medicaid-enrolled dentists. Only general, and pediatric, dentist specialty types were used.

Step 4: The research team obtained provider contact data from the NH DHHS’s licensed facility list; New Hampshire Health Information Organization’s (NHHIO) contact management database; and hospitals’ lists of affiliated practices to add additional providers to the database.

Step 5: A final review was conducted to remove duplicate entries and ensure the integrity of the data. Organizations and practices that were missing information were contacted to obtain contact name and email address information.

10

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

2.2 Survey Instrument Development The State Medicaid Office had two primary business purposes for conducting the 2016 survey including:
Reporting progress to CMS regarding the health information technology landscape in New Hampshire and adoption of CEHRT; and
Obtaining data to use as an internal planning resource for NH DHHS, the 1115 DSRIP Waiver, and SIM. While there was overlap of some of the elements related to these two purposes, there were also questions specifically related to each purpose. Questions from several surveys that had previously been conducted were considered for inclusion in this survey:
2012 NH DHHS HIT HIE Provider Survey;
2014 Center for Disease Control’s National Electronic Health Records Survey long form [originally designed to target individual providers; modified here to target practice level (or higher) organizations such as clinics and hospitals];
2015 Iowa survey instruments and process documents;
2015 Pennsylvania survey instrument; and
CMS State Medicaid HIT Plan Companion Guide 2.0 with comments by State Medicaid Office staff.

A decision tree model was developed with multiple iterations reviewed, and approved, by State Medicaid Office staff. The final survey instrument is found in Appendix B. 2.3 Fielding the Survey Prior to implementing the survey, several providers assisted in testing the web-based instrument. These testers received the survey on February 15, 2016. Several modifications were made based upon tester feedback, and the survey was launched on February 22, 2016. To promote the survey and increase the response rate, multiple email reminders were sent to providers that had started the survey but had not completed it as well as those who had not started it. These reminders were sent on March 1, March 10, March 23, April 5, and April 11. In addition, the research team made weekly outbound telephone calls beginning on March 20 and ending on April 27. The survey was closed on April 29, 2016. 2.4 Analysis The final survey files were made available to the research team on April 29, 2016. The analysis was completed on May 15, and the draft report was emailed to the State Medicaid Office on May 16, 2016. The final report was delivered to the State Medicaid Office on May 27, 2016.

11

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

3.0 Demographics/Background

Of the 720 total surveys administered, 266 (37%) of organizations responded. Table 1 shows the survey response rates by provider type. The Community Mental Health Centers and New Hampshire Hospital had the highest response rates of 100% each. In descending order, the next highest response rates were the Federally Qualified Health Centers with a 91% response rate (n=10); county nursing homes with a 70% response rate (n=7); rehabilitation hospitals with a 67% response rate (n=2); home health and hospice agencies with a 54% response rate (n=21); and critical access hospitals also with a 54% response rate (n=7). While neither of the two, non-hospital owned Rural Health Clinics responded, additional RHCs were included in the responses of multiple hospitals. There is one, Vermont-based FQHC with a New Hampshire site that was included in the survey.

Table 1. Percent of Respondents by Provider Type (Q3)

Total # of Providers that Provider Type Count Responded Response Rate Received the Survey

Community Mental Health Center 10 10 100% Dentist, General 399 127 32% Dentist, Pediatric 34 9 26% Federally Qualified Health Center 11 10 91% Freestanding Urgent Care Center 9 3 33% Home Health and Hospice Agency 39 21 54% Hospital, Critical Access 13 7 54% Hospital, New Hampshire Hospital 1 1 100% Hospital, Non-Critical Access 13 8 62% Hospital, Rehabilitation 3 2 67% Nursing Home & Skilled Nursing Facility 63 23 37% Nursing Home, County 10 7 70% Nursing Home, Glencliff Home 1 0 0% Practice, Other 112 38 34% Rural Health Clinic, Non-Owned 2 0 0% Total 720 266 37%

12

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 2 shows a further breakdown of the dental providers that responded to the survey. Dentists were stratified into either “general” or “pediatric” categories as well as whether they were enrolled in New Hampshire Medicaid. Fewer than 7% (n=9) of all dentists that responded were pediatric dentists. Nearly two-thirds (66%; n=91) of responding dentists accepted Medicaid payments.

Table 2. Distribution of Dentists with Regard to Medicaid

Medicaid Dentist Type Total Percent Dentist, General 128 Not participating in Medicaid 46 36% Participating in Medicaid 82 64% Dentist, Pediatric 9 Participating in Medicaid 9 100% Total 137

[Remainder of Page Left Intentionally Blank]

13

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 1 depicts the self-reported titles of those who completed the survey. In descending order, respondents identified themselves as “Practice Manager or Office Manager” (30%; n=80); “Chief Executive Officer or Executive Director” (18%; n=48); “Administrator” (17%; n=46); “Other” (13%; n=33); “Chief Information Officer or Director of Information Technology” (11%; n=29); and “Owner” (9%; n=24).

Figure 1. Distribution of Survey Respondent Titles (Q2)

Titles of Respondents (n=266)

90

80

70

60

50

Percentage 40 30%

30 18% 17% 20 13% 11% 10 9% 2% <1% 0 Prac2ce Manager or Chief Execu2ve Administrator Other (n=33) Chief Informa2on Owner (n=24) Chief Opera2ng Chief Financial Office Manager Officer or Execu2ve (n=46) Officer or Director of Officer (n=5) Officer (n=1) (n=80) Director (n=48) Informa2on Technology (n=29)

14

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 2, of the 18 hospitals that responded to the survey, 44% (n=8) were non-CAHs while 39% (n=7) were CAHs. Two rehabilitation hospitals also responded as did New Hampshire Hospital, a state-owned facility.

Figure 2. Types of Hospital Respondents (Q4)

Type of Hospital

11% Hospital, Cri7cal Access (n=7)

39% Hospital, New Hampshire Hospital (n=1)

Hospital, Non-Cri7cal Access (n=8) 44% 6% Hospital, Rehabilita7on (n=2)

15

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Each hospital was asked if it had ownership of RHCs. As shown in Figure 3, four CAHs and one non-CAH reported ownership of RHCs and responded on behalf of those RHCs.

Figure 3. Rural Health Clinic Ownership Status by Hospital Type (Q5)

Rural Health Clinic Ownership Status of Responding Hospitals 100% 90%

80% 43% 70% 60% 86% 50%

Percentage 40%

30% 57% 20% 10% 14% 0% Hospital, Cri-cal Access Hospital, Non-Cri-cal Access No - Rural Health Clinic 3 6 Yes - Rural Health Clinic 4 1

16

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 4 depicts the type of skilled nursing facility respondents (i.e., independent, hospital-owned, or county). A majority (76%, n=25) of the SNFs represented in the survey results were independent; 21% (n=7) were county nursing homes; and one (3%; n=1) was a hospital-owned facility. Glencliff Home, a state-owned facility, did not provide a complete survey response and is not included in the survey results.

Figure 4. Skilled Nursing Facility by Type (Q6)

Type of Skilled Nursing Facility

21%

County (n=7) 3% Hospital-owned (n=1) Independent (n=25) 76%

17

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

4.0 Results: Electronic Health Records (EHR) and EHR Incentive Programs 4.1 EHR Systems Overview Figure 5 depicts the reported number of EHRs by provider type both in absolute value and as a percentage of the total within a provider type. The majority of respondents reported using one EHR system (70%; n=186) while 10% (n=25) of respondents use two EHR systems. Of the 266 respondents, 21% (n=55) do not have an EHR system in place. Of those without any EHR system (n=55), dentists comprised the largest percentage (78%; n=43) followed by other practices (primary and specialty care practices not owned by a hospital) (15%; n=8). Figure 5. Number and Percentage of EHR Systems by Provider Type (Q7)

Number of EHR Systems Used by Provider Type 100% 2% 3% 9% 14% 14% 90% 20%

30%

80%

70% 67% 67% 71%

60% 76%

Percentage 70% 91%

50% 100% 100% 100% 100% 76%

86% 40% 80%

70%

30%

20%

31% 33% 29% 10% 21% 21%

10% 9%

0% Community Federally Freestanding Home Health and Hospital, New Hospital, Non- Hospital, Nursing Home & Den7st, General Den7st, Pediatric Hospital, Cri7cal Nursing Home, Prac7ce, Other Mental Health Qualified Health Urgent Care Hospice Agency Hampshire Cri7cal Access Rehabilita7on Skilled Nursing Total (n=266) (n=127) (n=9) Access (n=7) County (n=7) (n=38) Center (n=10) Center (n=10) Center (n=3) (n=21) Hospital (n=1) (n=8) (n=2) Facility (n=23) Provider Type Two 2 2 3 3 5 8 1 1 25 One 8 85 6 7 3 16 2 1 2 21 6 29 186 None 40 3 2 2 8 55

18

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 5, 55 respondents indicated they do not currently use an EHR system. These 55 respondents were then asked about their plans to implement an EHR within the next two years, and 53 of the 55 responded. Of these 53 respondents, 79% (n=42) have no plans to implement an EHR system within the next two years, while 21% (n=11) do plan to implement an EHR system within the next two years (Figure 6). Of those with no plans to implement an EHR system within the next two years, the majority were dentists (83%; n=35), and 66 percent of these dentists are enrolled as New Hampshire Medicaid providers.

Figure 6. Number and Percentage of Providers Without an EHR Who Intend to Implement One Within Two Years (Q8)

Plans to Implement EHR Within Two Years 100% 18% 90% 25% 21% 80% 50% 70% 60% 50% 100% 100% Percentage 82% 40% 75% 79% 30% 50% 20% 10% 0% Nursing Home Home Health Den$st, Den$st, & Skilled Prac$ce, Other and Hospice Total (n=53) General (n=39) Pediatric (n=3) Nursing Facility (n=8) Agency (n=1) (n=2) Provider Type Plans to Implement EHR 7 1 1 2 11 No plans to Implement EHR 32 3 1 6 42

19

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 6, there were 11 respondents who stated that they had plans to implement an EHR system within the next two years. In a subsequent question, they were asked to indicate the reasons driving them to implement an EHR; multiple reasons could be selected. As shown in Figure 7, 44% (n=7) of organizations cited “electronic information exchange capability” as the most popular reason for implementing an EHR system within the next two years. “Availability of certified EHR technology” (13%; n=2), “Federal financial penalties” (6%; n=2), and “trusted colleagues using EHRs” (13%; n=2) were cited as additional reasons for adopting an EHR system within the next two years.

Figure 7. Reasons Driving Providers to Implement EHR Systems Within Two Years (Q9)

Reasons Driving Providers to Implement an EHR System Within Two Years Total Respondents n=11, Mul.ple Responses Allowed 8

7

6

5

4 Count 44% 3

2

1 13% 13% 13% 6% 6% 6% 0 Electronic Availability of Federal Trusted Board informa.on Incen.ve cer.fied EHR financial colleagues cer.fica.on Other exchange payments technology penal.es using EHRs requirement capability Reasons to Implement EHR 7 2 2 2 1 1 1

20

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 8 depicts the brands of EHR that respondents expect to be adopted and implemented within the next two years. Of the nine respondents, 67% (n=6) stated “other” versus a particular brand.

Figure 8. Brand of EHR Organizations Plan to Implement within Next Two Years (Q24)

Brand of EHR That Organiza$ons Plan to Implement Within the Next Two Years 100% 90% 80% 70% 67% 67% 60% 50% 100% 100% 100%

Percentage 40% 30% 17% 11% 20% 11% 10% 17% 11% 0% Home Health Nursing Home & Den$st, General Prac$ce, Other and Hospice Skilled Nursing Total (n=9) (n=6) (n=1) Agency (n=1) Facility (n=1) Provider Type Other 4 1 1 6 Netsmart 1 1 GE/Centricity 1 1 eClinical Works 1 1

21

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 3 shows the multiple reasons why organizations will not implement an EHR within the next two years. In descending order, respondents indicated “no interest” (43%; n=18); “lack of time” (29%; n=12); “privacy and security concerns” (29%; n=12); “lack of financial resources” (26%; n=11); “lack of internal staff” (21%; n=9); and “lack of access to consulting staff” (17%; n=7) as the primary reasons. For those respondents who specified “other” (26%; n=11) as a reason not to implement an EHR system within the next two years, specific reasons cited include “feeling that it would be unnecessary”; “it would change the doctors’ methods of practicing”; and “hinder productivity by increasing the number of technical complications.”

Table 3. Reasons For Not Implementing an EHR Within the Next Two Years (Q10)

Lack of Lack of No system Lack of Lack of Lack of broadband Privacy and Imminent Lack of access to meets the No Provider Type financial federal internal internet access security provider Other time consulting needs of our interest resources grants staff and/or concerns retirement staff specialty bandwidth Dentist, General (n=32) 6 (19%) 3 (9%) 10 (31%) 8 (25%) 7 (22%) 3 (9%) 10 (31%) 4 (13%) 6 (19%) 15 (47%) 8 (25%) Dentist, Pediatric (n=3) 1 (33%) 1 (33%) 1 (33%) 1 (33%) 1 (33%) Nursing Home & Skilled 1 (100%) Nursing Facility (n=1) Practice, Other (n=6) 4 (67%) 1 (17%) 1 (17%) 1 (17%) 2 (33%) 1 (17%) 1 (17%) 1 (17%) 2 (33%) Total (n=42) 11 (26%) 5 (12%) 12 (29%) 9 (21%) 7 (17%) 3 (7%) 12 (29%) 5 (12%) 7 (17%) 18 (43%) 11 (26%)

4.2 Medicare and Medicaid EHR Incentive Programs One intent of this survey was to identify provider awareness, and participation, in the Medicare and/or Medicaid EHR Incentive Programs. The State Medicaid Office would like to understand which provider organizations and EPs had attested, or planned to attest, for either the Medicare, or Medicaid, EHR Incentive Programs. This information will be reported to CMS in the State Medicaid HIT Plan and used for internal planning purposes.

22

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 9, 74% (n=137) of organizations did not attest for a Medicare EHR Incentive Program prior to the 2015 program year while 26% (n=47) indicated that their organizations had attested for the Medicare EHR Incentive Program. All (100%; n=7) of CAHs; 100% (n=8) of non- CAHs; 75% (n=21) of independent practices; 40% (n=4) of FQHCs; and 30% (n=3) of CMHCs reported attesting for the Medicare EHR Incentive Program prior to 2015. Lower rates were shown for county nursing homes (14%; n=1); home health and hospice agency (6%; n=1); and general dentists (3%; n=2).

Figure 9. Number and Percentage of Organizations That Attested for the Medicare EHR Incentive Program Prior to 2015 (Q14)

Organiza7ons That A[ested for the Medicare EHR Incen7ve Program Prior to 2015 100%

90% 25%

80%

70% 60%

70% 74% 60% 86% 94% 97% 50% 100% 100% 100% 100% 100% 100% 100% Percentage

40% 75%

30%

20% 40%

30% 26% 10% 14% 6% 3% 0% Community Federally Freestanding Home Health Hospital, New Hospital, Non- Hospital, Nursing Home & Den7st, General Den7st, Hospital, Cri7cal Nursing Home, Prac7ce, Other Mental Health Qualified Health Urgent Care and Hospice Hampshire Cri7cal Access Rehabilita7on Skilled Nursing Total (n=184) (n=72) Pediatric (n=5) Access (n=7) County (n=7) (n=28) Center (n=10) Center (n=10) Center (n=3) Agency (n=17) Hospital (n=1) (n=8) (n=2) Facility (n=14) Provider Type No 7 70 5 6 3 16 1 2 14 6 7 137 Yes 3 2 4 1 7 8 1 21 47

23

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 4 describes reasons that organizations did not attest for Medicare EHR Incentive Program. Thirteen percent (n=7) did not know how to attest; 13% (n=7) did not meet eligibility requirements; 8% (n=4) cited lack of staffing; 6% (n=3) cited lack of ONC-certified technology; and the remaining 65% (n=34) cited “other.”

Table 4. Number and Percentage of Primary Reasons Organizations Did Not Attest to the Medicare EHR Incentive Program Prior to 2015 (Q15)

EHR is not ONC- Do not/did not Did not meet Missed a Lack of Provider Type certified EHR understand eligibility Other deadline staffing technology how to attest requirements Community Mental Health Center (n=7) 1 (14%) 6 (86%) Dentist, General (n=27) 1 (4%) 1 (4%) 6 (22%) 3 (11%) 3 (11%) 16 (59%) Dentist, Pediatric (n=3) 1 (33%) 2 (67%) Federally Qualified Health Center (n=6) 1 (17%) 1 (17%) 4 (67%) Hospital, New Hampshire Hospital (n=1) 1 (100%) Hospital, Rehabilitation (n=1) 1 (100%) Practice, Other (n=7) 1 (14%) 2 (29%) 5 (71%) Total (n=52) 3 (6%) 1 (2%) 7 (13%) 4 (8%) 7 (13%) 34 (65%)

[Remainder of Page Left Intentionally Blank]

24

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Table 5, a majority (58%; n=56) of 97 organizations did not have EPs attest for a Medicare EHR Incentive Program prior to the 2015 program year while 42% (n=41) of organizations did have EPs attest prior to the 2015 program year. Five of the CAHs responded on behalf of their EPs whereas these same CAHs, themselves, attest for payments. The results can thereby be interpreted as the CAHs referring to their hospital-owned practices.

Table 5. Number and Percentage of EPs That Attested for the Medicare EHR Incentive Program Prior to 2015 Program Year (Q16) Provider Type Attested Did not attest Community Mental Health Center (n=10) 3 (30%) 7 (70%) Dentist, General (n=31) 31 (100%) Dentist, Pediatric (n=3) 3 (100%) Federally Qualified Health Center (n=10) 4 (40%) 6 (60%) Hospital, Critical Access (n=7) 5 (71%) 2 (29%) Hospital, Non-Critical Access (n=8) 8 (100%) Hospital, Rehabilitation (n=1) 1 (100%) Practice, Other (n=27) 21 (78%) 6 (22%)

Total (n=97) 41 (42%) 56 (58%)

[Remainder of Page Left Intentionally Blank]

25

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 6 shows the reasons that EPs did not attest for Medicare EHR Incentive Program including “not understanding how to attest;” “lack of staffing;” and “not meeting eligibility requirements.” Other reasons that EPs did not attest included “not having enough of a Medicare population” and “attested through Medicaid instead.” Many dentists indicated “other” stating that the Medicare EHR Incentive Program was not applicable to providers in their practices. A CAH stated that the “cost of PQRS reporting is higher than the penalty.”

Table 6. Primary Reasons EPs Did Not Attest to Medicare EHR Incentive Program (Q16i)

EHR is not ONC- Do not/did not Did not meet Lack of Provider Type certified understand how eligibility Other staffing technology to attest requirements Community Mental Health Center (n=7) 1 (14%) 6 (86%) Dentist, General (n=28) 2 (7%) 6 (21%) 3 (11%) 3 (11%) 15 (54%) Dentist, Pediatric (n=3) 3 (100%) Federally Qualified Health Center (n=6) 1 (17%) 1 (17%) 4 (67%) Hospital, Critical Access (n=2) 1 (50%) 1 (50%) Hospital, Rehabilitation (n=1) 1 (100%) Practice, Other (n=5) 1 (20%) 1 (20%) 2 (40%) 1 (20%) Total (n=52) 4 (8%) 6 (12%) 6 (12%) 6 (12%) 31 (60%)

[Remainder of Page Left Intentionally Blank]

26

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 10, more than half (51%; n=100) of responding organizations indicated that they do not intend to attest for the Medicare EHR Incentive Program for the 2015 and/or 2016 program years. However, 18% (n=35) of organizations plan to attest for the Medicare EHR Incentive Program for 2015 and/or 2016 program years while 31% (n=62) indicated that they are unsure about plans to attest.

Figure 10. Number and Percentage of Organizations That Plan to Attest for the Medicare EHR Incentive Program for 2015 or 2016 (Q17)

Organiza7ons Planning to A[est for the Medicare EHR Incen7ve Program for the 2015/2016 Program Years 100% 10% 14% 90% 28% 28% 31% 35% 33% 80% 43%

70% 60%

75% 60% 31%

50% 80% 100% 100% 100% 100%

Percentage 86% 51% 40% 67% 43% 62% 67% 30%

20% 40% 41%

25% 10% 18% 14% 10% 6% 0% 3% Federally Nursing Home Community Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Nursing Den7st, Qualified & Skilled Prac7ce, Mental Health General Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Home, County Total (n=197) Pediatric (n=5) Health Center Nursing Other (n=29) Center (n=10) (n=77) Center (n=3) Agency (n=18) (n=7) Hospital (n=1) (n=8) (n=2) (n=7) (n=10) Facility (n=20) Provider Type Unsure 1 27 1 5 1 1 15 3 8 62 No 8 48 5 6 2 12 2 5 3 9 100 Yes 1 2 4 1 6 8 1 12 35

27

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 11, 33% (n=32) of organizations have EPs that plan to attest for the Medicare EHR Incentive Program for the 2015/2016 program years. Twenty-seven (27%; n=26) of responding organizations indicated that they are unsure whether EPs in their organizations will attest for the Medicare EHR Incentive Program while most organizations (40%; n=38) do not plan to have EPs attest for the Medicare EHR Incentive Program in the 2015 and/or 2016 program years.

Figure 11. Number and Percentage of EPs That Intend to Attest for a Medicare EHR Incentive Program for 2015 or 2016 (Q18)

Organiza7ons with Eligible Professionals Planning to AZest for a Medicare EHR Incen7ve Program for the 2015 and/or 2016 Program Years 100% 10% 90% 30% 29% 30% 80% 38% 27%

70% 40%

60% 22% 50% 100% 100% 100% 100%

Percentage 40% 71% 70% 59% 30% 40% 50% 48% 20%

10%

0% 3% Community Federally Den7st, Den7st, Hospital, Hospital, New Hospital, Non- Hospital, Mental Qualified Prac7ce, General Pediatric Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Total (n=96) Health Center Health Center Other (n=27) (n=29) (n=3) (n=7) Hospital (n=1) (n=8) (n=1) (n=10) (n=10) Provider Type Unsure 3 11 1 2 1 8 26 No 7 17 3 4 1 6 38 Yes 1 5 5 8 13

28

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 12 shows that 77% (n=134) of responding organizations did not attest for the Medicaid EHR Incentive Program prior to 2015. Notably, 93% (n=63) of dentists did not attest prior to 2015; of these, 68% (n=42) are Medicaid-enrolled dentists (data not shown).

Figure 12. Number and Percentage of Organizations That Attested to the Medicaid EHR Incentive Program Prior to 2015 (Q19)

Organiza7ons that AZested for the Medicaid EHR Incen7ve Program Prior to the 2015 Program Year 100%

90% 20% 25% 29% 80% 40%

70% 69% 77% 60% 85% 86% 93% 50% 100% 100% 100% 100% Percentage 40% 80% 75% 71% 30% 60%

20% 31% 23% 10% 15% 14% 7% 0% Federally Nursing Home Community Freestanding Home Health Hospital, Hospital, Non- Hospital, Den7st, Den7st, Qualified & Skilled Nursing Home, Prac7ce, Other Mental Health Urgent Care and Hospice Cri7cal Access Cri7cal Access Rehabilita7on Total (n=175) General (n=68) Pediatric (n=4) Health Center Nursing County (n=7) (n=26) Center (n=10) Center (n=3) Agency (n=17) (n=7) (n=8) (n=2) (n=10) Facililty (n=13) Provider Type No 4 63 4 2 3 17 2 2 2 11 6 18 134 Yes 6 5 8 5 6 2 1 8 41

29

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 13, respondents reported various reasons that their organizations did not attest for the Medicaid EHR Incentive Program. A quarter (25%; n=34) of responding organizations cited not knowing how to attest; 20% (n=20) stated that they did not meet eligibility requirements; and 33% (n=44) cited “other” reasons including the “arduous process”; “not being aware of it”; and “not a Medicaid provider.” Figure 13 Number and Percentage of Reasons Organizations With EPs Did Not Attest to the Medicaid EHR Incentive Program Prior to 2015 (Q19i)

. Reasons Organiza6ons Did Not A\est for the Medicaid EHR Incen6ve Program Prior to the 2015 Program Year 100%

90% 17% 25% 29% 27% 32% 33% 80%

50% 50% 50% 50%

70% 56%

25% 60% 33% 13% 29% 20% 50% 100% 100%

Percentage 8%

40% 25% 6% 64%

30% 24% 17% 28% 50% 50% 50% 50% 33% 20% 25%

25% 10% 17% 18% 6% 1% 3% 6% 5% 0% Federally Nursing Home Community Freestanding Home Health Hospital, Hospital, Non- Hospital, Den6st, Den6st, Qualified & Skilled Nursing Home, Prac6ce, Other Mental Health Urgent Care and Hospice Cri6cal Access Cri6cal Access Rehabilita6on Total (115) General (n=51) Pediatric (n=2) Health Center Nursing Facility County (n=5) (n=17) Center (n=4) Center (n=2) Agency (n=16) (n=2) (n=2) (n=2) (n=2) (n=10) Provider Type Other 1 20 2 5 1 1 3 1 10 44 Did not meet eligibility requirements 1 8 1 1 5 1 2 1 2 5 27 Lack of staffing 1 5 1 1 8 Do not/did not understand how to a\est 21 4 7 1 1 34 Missed a deadline 1 1 EHR not CEHRT 2 3 1 1 7 30

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 14, 65% (n=60) of 93 respondents reported that EPs in their respective organizations did not attest for the Medicaid EHR Incentive Program prior to the 2015 program year. The highest attestation rates are attributed to 90% of FQHCs (n=9); 70% of CMHCs (n=7); and 57% of CAHs (n=4).

Figure 14. Number and Percentage of Organizations With EPs That Attested to the Medicaid EHR Incentive Program Prior to 2015 (Q20)

Organiza7ons With Eligible Professionals That AXested for the Medicaid EHR Incen7ve Program Prior to 2015 100% 10% 90% 30% 80% 43% 50% 70% 65% 69% 60%

50% 97% 100% 100% 90% Percentage 40% 70% 30% 57% 50% 20% 35% 31% 10%

0% 3% Community Federally Hospital, Non- Hospital, Den7st, General Den7st, Pediatric Hospital, Cri7cal Prac7ce, Other Mental Health Qualified Health Cri7cal Access Rehabilita7on Total (n=93) (n=30) (n=1) Access (n=7) (n=26) Center (n=10) Center (n=10) (n=8) (n=1) No 3 29 1 1 3 4 1 18 60 Yes 7 1 9 4 4 8 33

31

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Table 7, there are a multitude of reasons that organizations reported that their EPs did not attest for the Medicaid EHR Incentive Program. Besides “other” (46%; n=24), “did not meet eligibility requirements” (25%; n=13) was the highest reason across all provider types followed by “do not/did not understand how to attest” (15%; n=8) and “lack of staffing” (12%; n=6).

Table 7. Reasons EPs Did Not Attest for the Medicaid EHR Incentive Program (Q20i)

EHR is not Do not/Did not Did not meet Missed a Lack of Provider Type ONC-certified understand how eligibility Other deadline staffing technology to attest requirements Community Mental Health Center (n=3) 1 (33%) 1 (33%) 1 (33%) Dentist, General (n=23) 7 (30%) 3 (13%) 4 (17%) 10 (43%) Dentist, Pediatric (n=1) 1 (100%) Federally Qualified Health Center (n=1) 1 (100%) Hospital, Critical Access (n=3) 1 (33%) 1 (33%) 1 (33%) Hospital, Non-Critical Access (n=4) 1 (25%) 3 (75%) 1 (25%) Hospital, Rehabilitation (n=1) 1 (100%) Practice, Other (n=16) 1 (6%) 1 (6%) 5 (31%) 9 (56%) Total (n=52) 2 (4%) 1 (2%) 8 (15%) 6 (12%) 13 (25%) 24 (46%)

[Remainder of Page Left Intentionally Blank]

32

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Approximately half (49%, n=91) of reporting organizations do not intend to attest for the Medicaid EHR Incentive Program for the 2015 and/or 2016 program years (Figure 15). However, 80% (n=8) of FQHC respondents, 75% (n=6) of non-CAH respondents, and 50% (n=5) of CMHC respondents plan to attest during this time period.

Figure 15. Number and Percentage of Organizations Planning to Attest for the Medicaid EHR Incentive Program for 2015/2016 (Q21)

Organiza7on Plans to A[est for a Medicaid EHR Incen7ve Program for the 2015 and/or 2016 Program Years 100%

14% 90% 20% 21% 25% 30% 33% 33% 33% 80% 41% 43%

70% 65% 43% 60% 20%

50% 33% 100% 100% 100% 64% Percentage 49% 40% 80% 75% 61% 43% 55% 30% 50% 24% 20% 43% 33%

10% 18% 12% 14% 14% 4% 6% 0% Federally Nursing Home Community Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Den7st, Den7st, Qualified & Skilled Nursing Home, Prac7ce, Other Mental Health Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Total (n=187) General (n=73) Pediatric (n=3) Health Center Nursing Facility County (n=7) (n=28) Center (n=10) Center (n=3) Agency (n=18) (n=7) Hospital (n=1) (n=8) (n=2) (n=10) (n=17) Provider Type Unsure 3 30 1 6 1 1 11 3 6 62 No 2 40 1 2 3 11 3 2 2 4 3 18 91 Yes 5 3 1 8 1 3 6 2 1 4 34

33

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

As shown in Figure 16, there are organizations with EPs that intend to attest to the Medicaid EHR Incentive Program in the 2015 and/or 2016 program years. The highest rates of organizations with EPs that intend to attest by organization type are FQHCs (100%; n=10); non-CAHs (63%; n=5); and CMHCs (50%; n=5).

Figure 16. Number and Percentage of Organizations With EPs Planning to Attest for the Medicaid EHR Incentive Program for 2015/2016 (Q22)

Organiza7ons With Eligible Professionals Planning to A[est for the Medicaid EHR Incen7ve Program for the 2015 and/or 2016 Years 100%

90% 19% 30% 27% 38% 80% 43% 43% 50% 70%

60% 20%

50% 100% 100% 100% 62% 43%

Percentage 29% 40%

30% 54% 63% 50% 50% 20% 29% 30% 10% 19%

0% 4% Federally Community Den7st, Hospital, Hospital, New Hospital, Non- Hospital, Den7st, Qualified Prac7ce, Mental Health General Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Total (n=93) Pediatric (n=2) Health Center Other (n=26) Center (n=10) (n=28) (n=7) Hospital (n=1) (n=8) (n=1) (n=10) Provider Type Unsure 3 12 1 3 1 5 25 No 2 15 1 2 3 1 16 40 Yes 5 1 10 2 5 5 28

34

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 6, 42 respondents stated they had no intention of implementing an EHR within the next two years; they were subsequently asked about their awareness of Medicaid and Medicare EHR Incentive Programs. As shown in Figure 17, 68% (n=26) of the 38 respondents indicated that they were not aware of these programs while 32% (n=12) stated that they were aware. General dentists had the highest lack of awareness with 86% (n=24) being unaware of these incentive programs. While not shown in Figure 6, 63% of the dental practices that were unaware of the Medicaid EHR Incentive Program were practices that accepted Medicaid patients.

Figure 17. Provider Awareness of Medicaid and Medicare EHR Incentive Programs for Those With No Intention of Implementing an EHR Within the Next Two Years (Q8 and Q11)

Provider Awareness of Medicaid and Medicare EHR Incen$ve Programs for Those with No Inten$on of Implemen$ng an EHR Within Two Years 100% 90% 17% 80% 33% 70% 68% 60% 86% 50% 100% 40% 83% Percentage 30% 67% 20% 32% 10% 14% 0% Nursing Home Den$st, Den$st, & Skilled Prac$ce, Other Total (n=38) General (n=28) Pediatric (n=3) Nursing Facility (n=6) (n=1) Provider Type No-Not Implemen$ng 24 1 1 26 Yes-Implemen$ng 4 2 1 5 12

35

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 6, 42 respondents stated they had no intention of implementing an EHR within the next two years; they were subsequently asked about their interest in learning more about the Medicaid and/or Medicare EHR Incentive Programs, and there were 38 respondents. Figure 18 shows that 26% (n=10) of the 38 respondents reported that they are interested in learning more about the Medicaid and/or Medicare EHR Incentive Programs while 74% (n=28) cited no interest. The names of interested providers have been provided to the State Medicaid Office.

Figure 18. Practice Interest in EHR Incentive Programs for Those with No Intention of Implementing an EHR Within the Next Two Years (Q12)

Provider Interest in Learning More About the Medicaid and/or Medicare EHR Incen$ve Program 100% 90% 80% 70% 71% 67% 74% 60% 83% 50% 100% 40%

Percentage 30% 20% 29% 33% 26% 10% 17% 0% Nursing Home & Den$st, General Den$st, Pediatric Prac$ce, Other Skilled Nursing Total (n=38) (n=28) (n=3) (n=6) Facility (n=1) Provider Type No 20 2 1 5 28 Yes 8 1 1 10

36

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 6, 42 respondents stated they had no intention of implementing an EHR within the next two years; they were subsequently asked whether or not the State Medicaid Office can assist them in adopting and implementing CEHRT. Of the 38 respondents to this question, 3% (n=1) believe that the State Medicaid Office can assist them in adopting and implementing CEHRT; 45% (n=17) do not believe the State can assist them; and 53% (n=20) are unsure about State assistance (Figure 19). The names of those who believe assistance is possible or are unsure have been provided to the State Medicaid Office.

Figure 19. Provider Perception of State Assistance with EHR Adoption for Those with No Intention of Implementing an EHR Within the Next Two Years (Q13)

Provider Percep$on on Whether State Medicaid Office Can Assist in Adop$ng and Implemen$ng CEHRT in the Near Future 100% 90% 33% 80% 50% 53% 70% 60% 83% 50% 100% 40% Percentage 67% 30% 46% 45% 20% 10% 17% 0% 4% 3% Nursing Home & Den$st, General Den$st, Pediatric Prac$ce, Other Skilled Nursing Total (n=38) (n=28) (n=3) (n=6) Facility (n=1) Provider Type Unsure 14 1 5 20 No 13 2 1 1 17 Yes 1 1

37

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

4.3 CEHRT Technology, Vendor Brands, and EHR Consolidation Plans A survey goal was to learn about the status of ONC-certified EHR technology implementations in New Hampshire. Another was to understand which vendor EHR systems are in use in New Hampshire and, if providers are planning to upgrade or consolidate systems, what those plans might be.

Table 8 is a detailed breakdown of all of the EHR systems reported as being used by each of the provider types. Table 8. Current Brand of EHR by Provider Type (Q25 and Q26)

Federally Home Hospital, Nursing Community Dentist, Dentist, Qualified Freestanding Health and Hospital, New Hospital, Non- Hospital, Nursing Home & Practice, Total Critical Home, EHR Vendor Mental Health General Pediatric Health Urgent Care Hospice Hampshire Critical Access Rehabilitation Skilled Nursing Other (%) Access County Center (n=10) (n=60) (n=4) Center Center (n=3) Agency Hospital (n=1) (n=8) (n=2) Facility (n=20) (n=28) (n=177) (n=6) (n=7) (n=10) (n=18) Allscripts 1 3 1 1 3 9 (5%) Amazing Charts 1 1 (1%) athenahealth 2 2 (1%) Carefacts 2 2 (1%) Carestream 2 2 (1%) Cerner 2 1 3 (2%) Continelink 2 2 (1%) Dentrix 13 13 (7%) e-MDs 1 1 2 (1%) Eaglesoft 14 2 16 (9%) eClinicalWorks 1 3 4 (2%) Epic Systems 1 1 1 1 4 (2%) GE/Centricity 1 8 2 11 (6%) Greenway Medical 1 1 2 (1%) Technologies Healthcare Management 1 1 (1%) Systems HealthWyse 2 2 (1%) McKesson 2 2 2 2 8 (5%) Meditech 1 1 2 (1%) Netsmart 1 1 2 (1%) Netsmart/LWSI 4 4 (2%) Netsmart/Tier 1 1 (1%) NextGen 1 1 2 (1%) 57 4 17 2 1 1 6 1 1 7 4 13 Other (32%) Patterson 4 4 (2%) PointClickCare 13 3 16 (9%) Practice works 2 2 (1%) Siemens 1 1 (1%) Softdent 2 2 (1%) WinOMS 3 3 (2%) 38

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 20 shows 68% (n=141) of reporting organizations currently use, or plan to implement, CEHRT2 within two years. Of those not using, or not planning to use, CEHRT within two years (32%; n=67), general dentists (51%; n=44); pediatric dentists (60%; n=3); county nursing homes (57%; n=4), and home health and hospice agencies (41%; n=7) were the furthest behind in CEHRT implementation. In contrast, 100% of the 10 FQHCs either use, or intend to use, CHERT within the next two years.

Figure 20. Number and Percentage of Organizations That Currently Use, or Plan to Use, CEHRT Within the Next Two Years (Q23)

Currently Use, or Plan to Use, CEHRT Within the Next Two Years

100% 10% 90% 29% 32% 80% 41% 51% 70% 60% 57%

60%

50% 100% 100% 100% 100% 100% 100% 100% 90% Percentage 40% 71% 68% 30% 59% 49% 20% 40% 43%

10%

0% Nursing Community Federally Den7st, Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Hospital, Home & Nursing Mental Qualified Prac7ce, General Pediatric Urgent Care and Hospice Cri7cal Access Hampshire Non-Cri7cal Rehabilita7on Skilled Home, Total (n=208) Health Center Health Center Other (n=31) (n=86) (n=5) Center (n=3) Agency (n=17) (n=7) Hospital (n=1) Access (n=8) (n=2) Nursing County (n=7) (n=10) (n=10) Facility (n=21) Provider Type No 44 3 7 6 4 3 67 Yes 10 42 2 10 3 10 7 1 8 2 15 3 28 141

2 Including 2014 or 2015 CEHRT editions. 39

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

There are many reasons cited in Table 9 for why providers are not implementing CEHRT within the next two years. Besides citing “other” (39%; n=25), the most common reasons were “no interest” (31%; n=20); “no system meets the needs of our specialty” (16%; n=10); “lack of financial resources” (14%; n=9); and “lack of access to consulting staff” (8%; n=5).

Table 9. Reasons by Provider Type for Not Implementing CEHRT Within the Next Two Years (Q23i)

Lack of No system Lack of Lack of Lack of Lack of access broadband Privacy and Imminent Lack of meets the No Provider Type financial federal internal to consulting internet access security provider Other time needs of our interest resources grants staff staff and/or concerns retirement specialty bandwidth Dentist, General (n=43) 4 (9%) 1 (2%) 4 (9%) 3 (7%) 3 (7%) 1 (2%) 2 (3%) 7 (16%) 3 (7%) 17 (40%) 14 (33%) Dentist, Pediatric (n=2) 2 (100%) Home Health and Hospice 3 (43%) 1 (14%) 1 (14%) 1 (14%) 4 (57%) Agency (n=7) Nursing Home & Skilled 1 (20%) 4 (80%) Nursing Facility (n=5) Nursing Home, County (n=4) 1 (25%) 1 (25%) 1 (25%) 2 (50%) 1 (25%) 2 (50%) 2 (50%) Practice, Other (n=3) 1 (33%) 1 (33%) 1 (33%) 1 (33%) 1 (33%) Total (n=64) 9 (14%) 4 (6%) 5 (8%) 6 (7%) 5 (8%) 1 (2%) 2 (3%) 10 (16%) 4 (6%) 20 (31%) 25 (39%)

[Remainder of Page Left Intentionally Blank]

40

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Twenty-seven providers reported having more than one EHR system in Figure 5. When asked about plans for EHR consolidation, Figure 21 shows the planned actions: “within the next 12 months” (9%; n=2); “within 18 months” (17%; n=4); “within 24 months” (22%; n=5) and “no plans to consolidate at this time” (52%; n=12).

Figure 21. Plans to Consolidate Multiple EHR Systems (Q27)

Plans to Consolidate Mul6ple EHR Systems to One Within the Near Future 100% 90% 20% 80% 38% 50% 52% 70% 20% 67% 60% 50% 100% 100% 20% 25% 100% 40% 22% 30% Provider (count) 50% 20% 40% 33% 38% 17% 10% 9% 0% Community Federally Home Hospital, Hospital, Nursing Mental Den6st, Qualified Health and Cri6cal Non-Cri6cal Home, Health General Health Hospice Total (n=23) Access Access County Center (n=1) Center Agency (n=5) (n=8) (n=1) (n=2) (n=3) (n=3) Provider Type No plans to consolidate systems at this 6me 1 1 2 3 1 3 1 12 Yes, within the next 24 months 1 1 1 2 5 Yes, within the next 18 months 1 3 4 Yes, within the next 12 months 2 2

41

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Providers were also asked to which brand of CEHRT they planned to consolidate. Figure 22 shows the breakdown by type of provider. The greatest variation was reflected in the hospital provider types. CAHs were equally spread across “athenahealth,” “McKesson,” “Cerner,” and “other” (25%; n=1). Non-CAHs predominantly chose “Epic Systems” (60%; n=3) with the remaining evenly split between “Cerner” (20%; n=1) and “other” (20%; n=1). One CMHC cited “Netsmart/Tier” (100%; n=1) and one FQHC cited “other” (100%; n=1).

Figure 22. EHR Brands to Which Providers Plan to Consolidate (Q28)

EHR Brands to Which Providers are Consolida

42

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

The survey asked about plans to upgrade to CEHRT within the near future (two years). As shown in Figure 24, 27% (n=40) of providers stated that they were planning an upgrade within two years; 36% (n=54) had no plans; and 37% (n=52) were unsure. Notably, 100% (n=8) of responding non-CAHs plan to upgrade EHR systems within the next two years while 70% (n=7) of FQHCs; 57% (n=4) of CAHs; and 50% (n=5) of CMHCs also have plans to upgrade EHR systems in the near future.

Figure 24. Provider Plans to Upgrade CEHRT System within the Next Two Years (Q39)

Status of Provider Plans to Upgrade CEHRT System Within Two Years 100% 10% 90% 19% 30% 29% 33% 37% 80% 20% 49% 50%

70% 62% 67% 14% 60% 20%

50% 100% 100% 100% 100% 67%

Percentage 36% 40% 70% 36% 67% 30% 43% 57% 23% 50% 20% 33% 27% 10% 15% 14% 14% 8% 0% Community Federally Nursing Home Den7st, Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Hospital, Nursing Mental Qualified & Skilled Prac7ce, General Pediatric Urgent Care and Hospice Cri7cal Access Hampshire Non-Cri7cal Rehabilita7on Home, County Total (n=146) Health Center Health Center Nursing Other (n=21) (n=51) (n=3) Center (n=1) Agency (n=14) (n=7) Hospital (n=1) Access (n=8) (n=1) (n=6) (n=10) (n=10) Facility (n=13) Provider Type Unsure 3 25 2 1 7 2 8 2 4 54 No 2 22 2 1 5 1 1 1 3 14 52 Yes 5 4 1 7 2 4 8 2 4 3 40 43

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

In Figure 25, the majority of providers (58%; n=23) upgrading to CEHRT plan to do so with their current vendor; 30% (n=12) plan to upgrade with a different vendor; and 13% (n=5) were unsure. While general dentists (75%; n=3); pediatric dentists (100%; n=1); FQHCs (71%; n=5); and CAHs (75%; n=3) were most inclined to upgrade with their current vendor, 100% (n=2) of home health and hospice agencies; 50% (n=4) of non-CAHs; and 50% (n=2) of county nursing homes were most inclined to upgrade with another vendor.

Figure 25. Provider Plans to Upgrade to CEHRT (Q40)

Providers Upgrading CEHRT with Current or New Vendor 100%

90% 33% 80% 40% 50% 50% 70% 58% 75% 71% 75% 60%

Percentage 50% 20% 100% 100% 100% 33%

40%

30% 30% 50% 50% 20% 40% 33% 25% 29% 25% 10% 13% 0% Nursing Community Federally Home Den6st, Den6st, Hospital, Hospital, Home & Nursing Mental Qualified Health and Prac6ce, General Pediatric Cri6cal Non-Cri6cal Skilled Home, Total (n=40) Health Health Hospice Other (n=3) (n=4) (n=1) Access (n=4) Access (n=8) Nursing County (n=4) Center (n=5) Center (n=7) Agency (n=2) Facility (n=2) Provider Type Upgrading with current vendor 2 3 1 5 3 4 2 2 1 23 Upgrading with another vendor 1 1 2 1 4 2 1 12 Unsure 2 2 1 5

44

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 26 depicts the CEHRT brand to which providers plan to upgrade. Of the non-CAHs, 50% (n=2), plan to upgrade to “Epic Systems” while 25% (n=1) of these hospitals stated that they would upgrade to “Cerner.” Several respondents (33%; n=4) cited “unknown.” Two of the providers that indicated “other” shared that they would be upgrading to “PointClickCare” and “Homecare-Homebase,” respectively.

Figure 26. EHR Vendor to Which Providers Plan to Upgrade (Q41)

CEHRT Brand to Which Providers Plan to Upgrade 100% 90% 25% 80% 33% 50% 50% 70% 60% 25% 50% 100% 100% 100% 50% 100% Percentage 40% 8% 30% 50% 50% 17% 20% 25% 10% 17% 0% Community Home Health Hospital, Hospital, Nursing Mental Den6st, Prac6ce, and Hospice Cri6cal Non-Cri6cal Home, Total (n=12) Health Center General (n=1) Other (n=1) Agency (n=2) Access (n=1) Access (n=4) County (n=2) (n=1) Provider Type Unknown 1 1 1 1 4 Other 1 1 1 3 Meditech 1 1 Epic Systems 2 2 Cerner 1 1 2

45

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 27 summarizes overall provider satisfaction and dissatisfaction with current CEHRT. Fifty-one percent (n=67) of providers are either “very satisfied” or “somewhat satisfied” with their CEHRT. The highest dissatisfaction rate of all provider types is seen in the CMHCs whereby 50% (n=5) were either “somewhat dissatisfied” or “very dissatisfied.” Home health and hospice agencies (25%; n=3) and FQHCs (20%; n=2) also had high rates of being “somewhat dissatisfied” or “very dissatisfied.” The one freestanding urgent care center and the one rehabilitation hospital had 100% rates of being “very satisfied.” 80% (n=8) of the FQHCs; 71% (n=5) of CAHs; and 63% (n=5) of non-CAHs reported being “very satisfied” or “somewhat satisfied.”

Figure 27 Provider Satisfaction and Dissatisfaction with CEHRT System (Q42)

. Overall Sa7sfac7on and Dissa7sfac7on With CEHRT System 100% 8% 15% 13% 90% 23% 25% 22% 30% 33% 33% 80% 50% 8% 70% 26% 50% 71% 50% 29%

Percentage 60% 20% 30%

50% 100% 100% 100% 33%

40% 44% 67% 30% 17% 69% 30% 40% 30% 34% 17% 20% 8% 38% 29% 10% 13% 20% 17% 17% 10% 11% 10% 5% 0% 3% 5% Federally Nursing Home Community Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Nursing Den7st, Qualified & Skilled Prac7ce, Mental Health General Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Home, County Total (n=131) Pediatric (n=3) Health Center Nursing Other (n=20) Center (n=10) (n=39) Center (n=1) Agency (n=12) (n=7) Hospital (n=1) (n=8) (n=1) (n=6) (n=10) Facility (n=13) Provider Type Very sa7sfied 3 6 1 5 1 1 1 1 3 2 5 29 Somewhat sa7sfied 10 3 6 5 1 4 1 2 6 38 Neutral 2 17 2 2 2 3 9 1 6 44 Somewhat dissa7sfied 4 5 2 1 2 14 Very dissa7sfied 1 1 2 1 1 6

46

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

4.4 EHR Capabilities and Meeting Specific Meaningful Use Objectives

Tables 10 through 18 were derived from questions taken from the 2014 Center for Disease Control’s National Electronic Health Records Survey long form.

The first question (Table 10, next page) was designed to assess how respondents were meeting selected MU objectives. Many objectives were cited as being “used routinely” more than 70% of the time including “recording patient history and demographic information” (90%; n=155); “recording clinical notes” (89%; n=152); “recording patient’s medications and allergies” (88%; n=152); “recording patient problem list” (83%; n=143); “recording patient smoking status” (72%; n=124); and “recording and charting vital signs” (70%; n=121). Functions least cited as being “used routinely” included “electronic reporting to immunization registries” (9%; n=15); “providing patients the ability to view online or download or transmit information” (20%; n=34); “exchanging secure messages with patients” (29%; n=49); and “identifying education resources for patients’ specific conditions” (33%; n=55).

[Remainder of Page Left Intentionally Blank]

47

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 10. Percent of Organizations with Computerized Capabilities to Meet Selected MU Objectives (Q43)

Home Nursing Community Federally Hospital, Hospital, Health Hospital, Home & Nursing Mental Dentist, Dentist, Qualified Freestanding New Non- Hospital, Practice, Function and Critical Skilled Home, Total Health General Pediatric Health Urgent Care Hampshire Critical Rehabilitation Other Hospice Access Nursing County Center Center Hospital Access Agency Facility No (n=5) 4 (6%) 1 (33%) 5 (3%) Recording No, but currently planned (n=3) 2 (3%) 1 (6%) 3 (2%) patient history Not Applicable (n=3) 3 (5%) 3 (2%) and Unknown (n=2) 2 (3%) 2 (1%) demographic Yes, but not used routinely (n=3) 2 (3%) 1 (4%) 3 (2%) information Yes, but turned off or not used (n=2) 2 (3%) 2 (1%) Yes, used routinely (n=155) 10 (100%) 49 77%) 2 (67%) 10 (100%) 2 (100%) 17 (100%) 7 (100%) 1 (100%) 8 (100%) 2 (100%) 15 (94%) 7 (100%) 25 (96%) 155 (90%) No (n=9) 8 (13%) 1 (33%) 9 (5%) No, but currently planned (n=4) 2 (3%) 1 (100%) 1 (6%) 4 (2%) Recording Not Applicable (n=5) 5 (8%) 5 (3%) patient Unknown (n=2) 2 (3%) 2 (1%) problem list Yes, but not used routinely (n=8) 1 (10%) 4 (6%) 1 (13%) 2 (8%) 8 (5%) Yes, but turned off or not used (n=1) 1 (2%) 1 (1%) Yes, used routinely (n=143) 9 (90%) 42 (66%) 2 (67%) 10 (100%) 1 (100%) 17 (100%) 7 (100%) 7 (88%) 2 (100%) 15 (94%) 7 (100%) 24 (92%) 143 (83%) No (n=14) 11 (17%) 1 (33%) 1 (14%) 1 (4%) 14 (8%) No, but currently planned (n=3) 2 (3%) 1 (6%) 3 (2%) Recording and Not Applicable (n=8) 7 (11%) 1 (4%) 8 (5%) charting vital Unknown (n=3) 2 (3%) 1 (14%) 3 (2%) signs Yes, but not used routinely (n=19) 3 (30%) 15 (23%) 1 (6%) 19 (11%) Yes, but turned off or not used (n=4) 2 (3%) 1 (6%) 1 (6%) 4 (2%) Yes, used routinely (n=121) 7 (70%) 25 (39%) 2 (67%) 10 (100%) 1 (100%) 15 (88%) 6 (88%) 1 (100%) 8 (100%) 2 (100%) 14 (88%) 6 (86%) 24 (92%) 121 (70%) No (n=14) 10 (16%) 1 (33%) 1 (6%) 1 (14%) 1 (4%) 14 (8%) No, but currently planned (n=2) 1 (2%) 1 (6%) 2 (1%) Recording Not Applicable (n=9) 6 (9%) 1 (6%) 1 (14%) 1 (4%) 9 (5%) patient Unknown (n=3) 1 (10%) 1 (2%) 1 (6%) 3 (2%) smoking status Yes, but not used routinely (n=15) 2 (20%) 7 (11%) 1 (33%) 3 (18%) 2 (8%) 15 (9%) Yes, but turned off or not used (n=5) 4 (6%) 1 (6%) 5 (3%) Yes, used routinely (n=124) 7 (70%) 35 (55%) 1 (33%) 10 (100%) 1 (100%) 13 (76%) 7 (100%) 1 (100%) 8 (100%) 2 (100%) 12 (75%) 5 (71%) 22 (85%) 124 (72%) No (n=7) 3 (5%) 1 (33%) 2 (25%) 1 (4%) 7 (4%) No, but currently planned (n=4) 2 (3%) 1 (13%) 1 (6%) 4 (2%) Recording Not Applicable (n=2) 2 (3%) 2 (1%) clinical notes Yes, but not used routinely (n=2) 2 (3%) 2 (1%) Yes, but turned off or not used (n=4) 2 (3%) 1 (13%) 1 (6%) 4 (2%) Yes, used routinely (n=152) 10 (100%) 53 (83%) 2 (67%) 10 (100%) 1 (100%) 17 (100%) 7 (100%) 1 (100%) 4 (50%) 2 (100%) 14 (88%) 6 (100%) 25 (96%) 152 (89%)

48

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Nursing Community Federally Home Hospital, Hospital, Hospital, Home & Nursing Mental Dentist, Dentist, Qualified Freestanding Health and New Non- Hospital, Practice, Function Critical Skilled Home, Total Health General Pediatric Health Urgent Care Hospice Hampshire Critical Rehabilitation Other Access Nursing County Center Center Agency Hospital Access Facility No (n=6) 2 (3%) 1 (33%) 1 (6%) 1 (14%) 1 (4%) 6 (3%) No, but currently planned (n=5) 2 (3%) 3 (19%) 5 (3%) Recording patient's Not Applicable (n=2) 2 (3%) 2 (1%) medications and Unknown (n=1) 1 (2%) 1 (1%) allergies Yes, but not used routinely (n=3) 2 (3%) 1 (4%) 3 (2%) Yes, but turned off or not used (n=4) 3 (5%) 1 (6%) 4 (2%) Yes, used routinely (n=152) 10 (100%) 52 (81%) 2 (67%) 10 (100%) 2 (100%) 17 (100%) 7 (100%) 1 (100%) 8 (100%) 2 (100%) 11 (69%) 6 (86%) 24 (92%) 152 (88%) No (n=18) 1 (10%) 11 (17%) 1 (33%) 1 (6%) 1 (6%) 1 (14%) 2 (8%) 18 (11%) No, but currently planned (n=9) 2 (3%) 10 (100%) 4 (23%) 2 (29%) 9 (5%) Reconciling lists of Not Applicable (n=9) 5 (8%) 1 (33%) 2 (13%) 1 (4%) 9 (5%) patients medications Unknown (n=10) 2 (20%) 4 (6%) 1 (6%) 1 (14%) 2 (8%) 10 (6%) to identify the most accurate Yes, but not used routinely (n=8) 2 (20%) 5 (8%) 1 (4%) 8 (5%) Yes, but turned off or not used (n=3) 1 (10%) 1 (2%) 1 (6%) 3 (2%) Yes, used routinely (n=114) 4 (40%) 35 (55%) 1 (33%) 9 (90%) 1 (100%) 16 (94%) 7 (100%) 1 (100%) 8 (100%) 2 (100%) 7 (44%) 3 (43%) 20 (77%) 114 (67%) No (n=25) 12 (19%) 1 (33%) 4 (24%) 3 (19%) 2 (29%) 3 (12%) 25 (15%) No, but currently planned (n=8) 2 (3%) 1 (6%) 4 (25%) 1 (4%) 8 (5%) Providing reminders Not Applicable (n=19) 14 (22%) 1 (33%) 1 (6%) 1 (50%) 1 (6%) 1 (4%) 19 (11%) for guidline-based Unknown (n=12) 3 (30%) 4 (6%) 1 (100%) 1 (6%) 2 (29%) 1 (4%) 12 (7%) interventions and screening Yes, but not used routinely (n=16) 5 (8%) 1 (10%) 2 (12%) 1 (14%) 1 (13%) 1 (14%) 5 (19%) 16 (9%) Yes, but turned off or not used (n=8) 3 (30%) 2 (3%) 1 (6%) 1 (6%) 1 (4%) 8 (5%) Yes, used routinely (n=84) 4 (40%) 25 (39%) 1 (33%) 9 (90%) 1 (100%) 8 (47%) 6 (86%) 7 (88%) 1 (50%) 6 (38%) 2 (29%) 14 (54%) 84 (49%) No (n=26) 12 (19%) 6 (35%) 3 (19%) 4 (57%) 1 (4%) 26 (15%) No, but currently planned (n=9) 2 (20%) 2 (3%) 1 (33%) 3 (19%) 1 (14%) 9 (5%) Not Applicable (n=15) 3 (5%) 10 (59%) 2 (13%) 15 (9%) Ordering Unknown (n=3) 2 (3%) 1 (6%) 3 (2%) prescriptions Yes, but not used routinely (n=7) 4 (6%) 1 (10%) 1 (6%) 1 (4%) 7 (4%) Yes, but turned off or not used (n=5) 3 (5%) 1 (13%) 1 (6%) 5 (3%) Yes, used routinely (n=107) 8 (80%) 38 (59%) 2 (67%) 9 (90%) 1 (100%) 7 (100%) 1 (100%) 7 (88%) 2 (100%) 6 (38%) 2 (29%) 24 (92%) 107 (62%) No (n=37) 32 (82%) 2 (100%) 1 (50%) 2 (8%) 37 (33%) No, but currently planned (n=1) 1 (100%) 1 (1%) Prescriptions Not Applicable (n=1) 1 (100%) 1 (1%) sent Unknown (n=2) 1 (14%) 1 (4%) 2 (2%) electronically to Yes, but not used routinely (n=7) 1 (3%) 2 (20%) 2 (29%) 1 (14%) 1 (4%) 7 (6%) the pharmacy Yes, but turned off or not used (n=4) 4 (10%) 4 (4%) Yes, used routinely (n=59) 8 (100%) 2 (5%) 8 (80%) 1 (100%) 4 (57%) 6 (86%) 1 (50%) 6 (100%) 2 (100%) 21 (84%) 59 (53%) No (n=23) 20 (51%) 2 (100%) 1 (4%) 23 (21%) Warnings of drug Not Applicable (n=3) 1 (3%) 1 (100%) 1 (4%) 3 (3%) interactions or Unknown (n=3) 1 (13%) 2 (5%) 3 (3%) contraindications Yes, but not used routinely (n=3) 1 (3%) 1 (10%) 1 (4%) 3 (3%) provided Yes, but turned off or not used (n=1) 1 (3%) 1 (1%) Yes, used routinely (n=78) 7 (88%) 14 (36%) 9 (90%) 1 (100%) 7 (100%) 1 (100%) 7 (100%) 2 (100%) 6 (100%) 2 (100%) 22 (88%) 78 (70%) 49

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Nursing Community Federally Home Hospital, Hospital, Freestanding Hospital, Home & Nursing Mental Dentist, Dentist, Qualified Health and New Non- Hospital, Practice, Function Urgent Care Critical Skilled Home, Total Health General Pediatric Health Hospice Hampshire Critical Rehabilitation Other Center Access Nursing County Center Center Agency Hospital Access Facility No (n=25) 21 (54%) 1 (50%) 3 (12%) 25 (23%) Not Applicable (n=5) 3 (8%) 1 (100%) 1 (4%) 5 (5%) Drug formulary Unknown (n=8) 1 (13%) 6 (15%) 1 (14%) 8 (7%) checks Yes, but not used routinely (n=7) 2 (25%) 1 (3%) 2 (20%) 1 (50%) 1 (4%) 7 (6%) performed Yes, but turned off or not used (n=1) 1 (3%) 1 (1%) Yes, used routinely (n=65) 5 (63%) 7 (18%) 1 (50%) 8 (80%) 1 (100%) 6 (86%) 1 (100%) 7 (100%) 2 (100%) 6 (100%) 1 (50%) 20 (80%) 65 (59%) No (n=45) 1 (10%) 25 (39%) 2 (67%) 2 (12%) 1 (50%) 7 (47%) 3 (43%) 4 (15%) 45 (41%) No, but currently planned (n=5) 3 (30%) 1 (100%) 3 (20%) 1 (14%) 1 (4%) 5 (5%) Not Applicable (n=45) 1 (10%) 32 (50%) 1 (33%) 10 (59%) 1 (4%) 45 (41%) Ordering lab tests Unknown (n=7) 1 (2%) 1 (6%) 1 (7%) 1 (14%) 3 (12%) 7 (6%) Yes, but not used routinely (n=8) 1 (10% 2 (3%) 1 (10%) 1 (6%) 1 (7%) 1 (14%) 1 (4%) 8 (7%) Yes, but turned off or not used (n=10) 4 (40%) 3 (5%) 1 (10%) 1 (7%) 1 (4%) 10 (9%) Yes, used routinely (n=48) 1 (2%) 8 (80%) 2 (100%) 3 (18%) 7 (100%) 8 (100%) 1 (50%) 2 (13%) 1 (14%) 15 (58%) 48 (43%) No (n=9) 2 (67%) 1 (11%) 1 (25%) 2 (67%) 3 (19%) 9 (8%) No, but currently planned (n=2) 1 (25%) 1 (100%) 2 (2%) Sending orders Yes, but not used routinely (n=9) 1 (100%) 3 (33%) 1 (25%) 1 (14%) 1 (50%) 2 (13%) 9 (8%) electronically Yes, but turned off or not used (n=1) 1 (6%) 1 (1%) Yes, used routinely (n=35) 1 (33%) 5 (56%) 2 (100%) 1 (25%) 6 (86%) 8 (100%) 1 (33%) 1 (50%) 10 (63%) 35 (32%) No (n=48) 2 (20%) 26 (41%) 1 (33%) 5 (29%) 1 (50%) 6 (40%) 4 (57%) 3 (12%) 48 (43%) No, but currently planned (n=8) 3 (30%) 1 (100%) 2 (13%) 1 (14%) 1 (4%) 8 (7%) Not Applicable (n=37) 30 (48%) 2 (67%) 3 (18%) 1 (14%) 1 (4%) 37 (33%) Viewing lab Unknown (n=5) 2 (3%) 1 (6%) 1 (7%) 1 (4%) 5 (5%) results Yes, but not used routinely (n=8) 1 (10%) 1 (2%) 1 (10%) 1 (6%) 1 (7%) 3 (12%) 8 (7%) Yes, but turned off or not used (n=8) 4 (40%) 1 (2%) 2 (13%) 1 (4%) 8 (7%) Yes, used routinely (n=57) 3 (5%) 9 (90%) 2 (100%) 7 (41%) 7 (100%) 8 (100%) 1 (50%) 3 (20%) 1 (14%) 16 (62%) 57 (51%) The EHR/EMR No (n=13) 3 (75%) 1 (50%) 2 (25%) 1 (14%) 2 (50%) 1 (100%) 3 (16%) 13 (12%) automatically Not Applicable (n=1) 1 (25%) 1 (1%) graphs a specific Unknown (n=17) 1 (100%) 1 (10%) 3 (38%) 2 (50%) 10 (53%) 17 (15%) patient's lab Yes, but not used routinely (n=10) 3 (30%) 2 (25%) 1 (13%) 4 (21%) 10 (9%) results over time Yes, used routinely (n=24) 6 (60%) 1 (50%) 1 (13%) 6 (86%) 7 (88%) 1 (100%) 2 (11%) 24 (22%) No (n=51) 4 (40%) 18 (30%) 1 (10%) 3 (18%) 1 (100%) 1 (50%) 10 (67%) 6 (86%) 7 (29%) 51 (31%) No, but currently planned (n=3) 1 (6%) 1 (7%) 1 (14%) 3 (2%) Not Applicable (n=55) 5 (50%) 32 (52%) 2 (67%) 1 (50%) 13 (76%) 2 (8%) 55 (33%) Ordering Unknown (n=5) 1 (2%) 1 (10%) 3 (13%) 5 (3%) radiology tests Yes, but not used routinely (n=2) 2 (100%) 2 (6%) Yes, but turned off or not used (n=5) 1 (10%) 1 (10%) 2 (13%) 1 (4%) 5 (3%) Yes, used routinely (n=46) 10 (16%) 1 (33%) 7 (70%) 1 (50%) 7 (100%) 8 (100%) 1 (50%) 2 (13%) 9 (38%) 46 (28%)

50

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Community Federally Hospital, Nursing Home Freestanding Home Health Hospital, Hospital, Nursing Mental Dentist, Dentist, Qualified New Hospital, & Skilled Practice, Function Urgent Care and Hospice Critical Non-Critical Home, Total Health General Pediatric Health Hampshire Rehabilitation Nursing Other Center Agency Access Access County Center Center Hospital Facility No (n=34) 4 (40%) 5 (8%) 1 (10%) 4 (24%) 1 (100%) 2 (100%) 8 (53%) 5 (71%) 4 (17%) 34 (20%) No, but currently planned (n=4) 1 (2%) 1 (6%) 1 (7%) 1 (14%) 4 (2%) Viewing imaging Not Applicable (n=35) 5 (50%) 14 (23%) 1 (33%) 1 (50%) 10 (59%) 1 (13%) 1 (14%) 2 (8%) 35 (21%) Unknown (n=9) 1 (2%) 2 (20%) 1 (14%) 5 (21%) 9 (5%) results Yes, but not used routinely (n=8) 2 (3%) 1 (10%) 1 (7%) 4 (17%) 8 (5%) Yes, but turned off or not used (n=6) 1 (10%) 2 (3%) 2 (13%) 1 (4%) 6 (4%) Yes, used routinely (n=71) 36 (59%) 2 (67%) 6 (60%) 1 (50%) 2 (12%) 6 (86%) 7 (88%) 3 (20%) 8 (33%) 71 (43%) No (n=42) 1 (10%) 18 (30%) 1 (33%) 5 (29%) 1 (50%) 9 (60%) 4 (57%) 3 (13%) 42 (25%) Identifying No, but currently planned (n=4) 1 (10%) 1 (2%) 1 (6%) 1 (14%) 4 (2%) educational Not Applicable (n=27) 20 (33%) 1 (33%) 4 (24%) 1 (7%) 1 (4%) 27 (16%) resources for Unknown (n=11) 2 (20%) 3 (5%) 1 (14%) 1 (100%) 1 (7%) 1 (14%) 2 (8%) 11 (7%) patients' specific Yes, but not used routinely (n=20) 2 (20%) 8 (13%) 3 (30%) 2 (12%) 2 (13%) 1 (14%) 2 (8%) 20 (12%) conditions Yes, but turned off or not used (n=8) 4 (40%) 1 (2%) 1 (6%) 2 (8%) 8 (5%) Yes, used routinely (n=55) 10 (16%) 1 (33%) 7 (70%) 2 (100%) 4 (24%) 6 (86%) 8 (100%) 1 (50%) 2 (13%) 14 (58%) 55 (33%) No (n=37) 25 (40%) 1 (33%) 1 (50%) 1 (50%) 3 (20%) 2 (29%) 4 (17%) 37 (22%) Reporting clinical No, but currently planned (n=5) 2 (20%) 1 (2%) 1 (6%) 1 (4%) 5 (3%) quality measures to Not Applicable (n=33) 28 (45%) 1 (50%) 3 (18%) 1 (4%) 33 (20%) federal or state Unknown (n=11) 1 (10%) 3 (5%) 1 (33%) 1 (14%) 1 (100%) 1 (7%) 1 (14%) 2 (8%) 11 (7%) agencies (such as Yes, but not used routinely (n=10) 2 (20%) 2 (3%) 2 (20%) 1 (6%) 1 (14%) 2 (8%) 10 (6%) CMS or Medicaid) Yes, but turned off or not used (n=7) 4 (40%) 1 (2%) 1 (14%) 1 (4%) 7 (4%) Yes, used routinely (n=64) 1 (10%) 1 (2%) 1 (33%) 8 (80%) 12 (71%) 5 (71%) 8 (100%) 1 (50%) 11 (73%) 3 (43%) 13 (54%) 64 (38%) No (n=27) 2 (3%) 1 (50%) 4 (24%) 1 (14%) 2 (25%) 1 (50%) 9 (60%) 5 (71%) 2 (8%) 27 (16%) Identifying patients No, but currently planned (n=4) 1 (10%) 1 (2%) 1 (6%) 1 (4%) 4 (2%) due for preventative Not Applicable (n=20) 4 (6%) 1 (50%) 9 (53%) 1 (13%) 1 (50%) 3 (20%) 1 (4%) 20 (12%) or follow-up care in Unknown (n=10) 3 (30%) 1 (2%) 1 (6%) 1 (14%) 1 (100%) 1 (7%) 1 (14%) 1 (4%) 10 (6%) order to send Yes, but not used routinely (n=17) 1 (10%) 7 (11.2%) 2 (20%) 3 (43%) 1 (13%) 3 (13%) 17 (10%) patients reminders Yes, but turned off or not used (n=10) 5 (50%) 1 (2%) 1 (33%) 1 (7%) 2 (8%) 10 (6%) Yes, used routinely (n=79) 45 (72%) 2 (67%) 8 (80%) 2 (12%) 2 (29%) 4 (50%) 1 (7%) 1 (14%) 14 (58%) 79 (47%) No (n=22) 15 (24%) 1 (33%) 1 (6%) 2 (13%) 2 (29%) 1 (4%) 22 (13%) Generating lists of No, but currently planned (n=4) 1 (10%) 2 (3%) 1 (14%) 4 (2%) Not Applicable (n=28) 25 (40%) 1 (50%) 1 (6%) 1 (4%) 28 (17%) patients with Unknown (n=13) 2 (20%) 3 (5%) 3 (18%) 1 (14%) 1 (100%) 1 (7%) 2 (8%) 13 (8%) particular health Yes, but not used routinely (n=41) 3 (30%) 10 (16%) 2 (20%) 1 (50%) 5 (29%) 2 (29%) 2 (25%) 5 (33%) 2 (29%) 9 (38%) 41 (25%) conditions Yes, but turned off or not used (n=3) 1 (10%) 2 (3%) 3 (2%) Yes, used routinely (n=56) 3 (30%) 4 (6%) 2 (67%) 8 (80%) 7 (41%) 4 (57%) 6 (75%) 2 (100%) 7 (47%) 2 (29%) 11 (46%) 56 (34%) No (n=54) 2 (20%) 21 (34%) 1 (33%) 1 (10%) 1 (50%) 8 (47%) 1 (14%) 1 (13%) 2 (100%) 9 (60%) 1 (14%) 6 (25%) 54 (32%) No, but currently planned (n=6) 2 (20%) 2 (29%) 2 (8%) 6 (4%) Electronic reporting Not Applicable (n=57) 4 (40%) 36 (58%) 2 (67%) 1 (10%) 6 (35%) 1 (13%) 1 (7%) 6 (25%) 57 (34%) to immunization Unknown (n=12) 2 (20%) 2 (3%) 1 (6%) 1 (14%) 1 (7%) 3 (43%) 2 (8%) 12 (7%) registries Yes, but not used routinely (n=6) 1 (2%) 1 (10%) 2 (29%) 2 (8%) 6 (4%) Yes, but turned off or not used (n=17) 2 (20%) 1 (2%) 4 (40%) 1 (14%) 4 (50%) 1 (7%) 4 (17%) 17 (10%) Yes, used routinely (n=15) 1 (10%) 1 (50%) 2 (12%) 1 (100%) 2 (25%) 3 (20%) 3 (43%) 2 (8%) 15 (9%)

51

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Community Federally Hospital, Nursing Home Freestanding Home Health Hospital, Hospital, Nursing Mental Dentist, Dentist, Qualified New Hospital, & Skilled Practice, Function Urgent Care and Hospice Critical Non-Critical Home, Total Health General Pediatric Health Hampshire Rehabilitation Nursing Other Center Agency Access Access County Center Center Hospital Facility No (n=32) 13 (21%) 1 (33%) 7 (41%) 1 (50%) 5 (33%) 4 (57%) 1 (4%) 32 (19%) Providing patients No, but currently planned (n=4) 2 (20%) 1 (2%) 1 (7%) 4 (2%) with clinical Not Applicable (n=28) 19 (30%) 4 (24%) 1 (50%) 2 (13%) 1 (14%) 1 (4%) 28 (17%) Unknown (n=8) 1 (10%) 3 (5%) 1 (14%) 1 (7%) 1 (14%) 1 (4%) 8 (5%) summaries for each Yes, but not used routinely (n=26) 1 (10%) 9 (14%) 3 (30%) 3 (18%) 2 (29%) 1 (13%) 2 (13%) 1 (14%) 4 (17%) 26 (16%) visit Yes, but turned off or not used (n=11) 5 (50%) 4 (6%) 1 (6%) 1 (4%) 11 (7%) Yes, used routinely (n=58) 1 (10%) 12 (19%) 2 (67%) 7 (70%) 2 (100%) 2 (12%) 4 (57%) 1 (100%) 7 (88%) 4 (27%) 16 (64%) 58 (35%) No (n=57) 3 (30%) 20 (33%) 1 (33%) 1 (50%) 10 (59%) 1 (100%) 2 (100%) 10 (67%) 5 (71%) 4 (17%) 57 (34%) No, but currently planned (n=9) 4 (40%) 2 (3%) 1 (7%) 2 (8%) 9 (5%) Exchanging secure Not Applicable (n=20) 10 (16%) 3 (18%) 1 (13%) 4 (27%) 1 (14%) 1 (4%) 20 (12%) messages with Unknown (n=6) 2 (3%) 1 (6%) 1 (14%) 1 (14%) 1 (4%) 6 (4%) patients Yes, but not used routinely (n=14) 4 (6%) 1 (10%) 1 (6%) 3 (43%) 3 (38%) 2 (8%) 14 (8%) Yes, but turned off or not used (n=12) 3 (30%) 1 (2%) 3 (30%) 2 (12%) 2 (29%) 1 (4%) 12 (7%) Yes, used routinely (n=49) 22 (35%) 2 (67%) 6 (60%) 1 (50%) 1 (14%) 4 (50%) 13 (54%) 49 (29%) No (n=66) 3 (30%) 32 (51%) 2 (67%) 9 (53%) 1 (100%) 2 (100%) 7 (47%) 6 (86%) 4 (17%) 66 (40%) Providing patients the No, but currently planned (n=9) 4 (40%) 2 (3%) 1 (33%) 1 (50%) 1 (7%) 9 (5%) ability to view online, Not Applicable (n=27) 17 (27%) 4 (24%) 4 (27%) 1 (14%) 1 (4%) 27 (16%) download or transmit Unknown (n=10) 1 (10%) 2 (3%) 1 (6%) 1 (14%) 3 (20%) 2 (8%) 10 (6%) information from their Yes, but not used routinely (n=14) 1 (10%) 4 (6%) 1 (6%) 4 (57%) 2 (25%) 2 (8%) 14 (8%) medical record Yes, but turned off or not used (n=7) 1 (10%) 1 (2%) 2 (20%) 2 (12%) 1 (4%) 7 (4%) Yes, used routinely (n=34) 3 (5%) 8 (80%) 1 (50%) 2 (29%) 6 (75%) 14 (58%) 34 (20%)

[Remainder of Page Left Intentionally Blank]

52

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 11 shows the patient portal functions available by provider type. Providers offer an array of patient portal functions. There are more portal functions available for CMHCs, FQHCs, non-CAHs, and CAHs than other provider types. Just over a quarter (27%; n=40) of the portals allow patients the ability to “view test results”; 15% (n=22) allow patients to “self-enter health information”; 15% (n=22) allow patients to “request referrals”; 24% (n=34) allow patients to “refill requests for prescriptions”; 30% (n=43) allow patients to “request appointments”; 28% (n=40) allow patients to “ask the providers questions”; and 4% (n=6) allow patients to “upload data from health monitoring devices.”

Table 11. Number and Percentage of Patient Portal Functions by Provider Type (Q36)

Nursing Community Home Federally Freestanding Hospital, Hospital, New Home & Mental Dentist, Dentist, Health and Hospital, Non- Hospital, Nursing Practice, Portal Function Qualified Urgent Care Critical Hampshire Skilled Total Health General Pediatric Hospice Critical Access Rehabilitation Home, County Other Health Center Center Access Hospital Nursing Center Agency Facility No 2 (20%) 39 (83%) 2 (100%) 1 (50%) 12 (86%) 1 (100%) 2 (25%) 2 (100%) 10 (77%) 6 (86%) 6 (26%) 83 (57%) View test results Unsure 6 (60%) 8 (17%) 1 (7%) 3 (23%) 1 (14%) 4 (17%) 23 (16%) Yes 2 (20%) 10 (100%) 1 (50%) 1 (7%) 7 (100%) 6 (75%) 13 (57%) 40 (27%) Self-enter health No 3 (30%) 39 (83%) 2 (100%) 2 (100%) 12 (86%) 2 (33%) 1 (100%) 4 (57%) 2 (100%) 10 (77%) 5 (71%) 12 (52%) 94 (66%) information (e.g., Unsure 5 (50%) 8 (17%) 1 (11%) 2 (14%) 3 (50%) 3 (23%) 1 (14%) 4 (17%) 27 (19%) weight, symptoms) Yes 2 (20%) 8 (89%) 1 (17%) 3 (43%) 1 (14%) 7 (30%) 22 (15%) No 4 (40%) 37 (79%) 2 (100%) 1 (13%) 2 (100%) 12 (86%) 3 (50%) 1 (100%) 4 (50%) 2 (100%) 10 (77%) 6 (86%) 10 (43%) 94 (66%) Request referrals Unsure 6 (60%) 8 (17%) 2 (14%) 3 (50%) 1 (13%) 3 (23%) 1 (14%) 3 (13%) 27 (19%) Yes 2(4%) 7 (88%) 3 (38%) 10 (43%) 22 (15%) No 4 (40%) 36 (77%) 2 (100%) 2 (100%) 12 (86%) 1 (17%) 1 (100%) 4 (50%) 2 (100%) 10 (77%) 6 (86%) 7 (32%) 87 (60%) Request refills for Unsure 5 (50%) 8 (17%) 2 (14%) 2 (33%) 3 (23%) 1 (14%) 2 (9%) 23 (16%) prescriptions Yes 1 (10%) 3 (6%) 10 (100%) 3 (50%) 4 (50%) 13 (59%) 34 (24%) No 4 (40%) 27 (56%) 2 (100%) 2 (100%) 12 (92%) 1 (100%) 3 (38%) 2 (100%) 10 (77%) 6 (86%) 8 (35%) 77 (53%) Request Unsure 5 (50%) 10 (21%) 1 (8%) 2 (33%) 3 (23%) 1 (14%) 3 (13%) 25 (17%) appointments Yes 1 (10%) 11 (23%) 10 (100%) 4 (67%) 5 (63%) 12 (52%) 43 (30%) No 3 (30%) 29 (62%) 2 (100%) 2 (100%) 12 (86%) 1 (100%) 3 (38%) 2 (100%) 10 (77%) 6 (86%) 7 (30%) 77 (54%) Ask the provider Unsure 7 (70%) 10 (21%) 2 (14%) 1 (17%) 1 (13%) 3 (23%) 1 (14%) 1 (4%) 26 (18%) questions Yes 8 (17%) 8 (100%) 5 (83%) 4 (50%) 15 (65%) 40 (28%) Upload data from No 4 (40%) 38 (81%) 2 (100%) 6 (67%) 2 (100%) 11 (79%) 4 (67%) 1 (100%) 6 (75%) 2 (100%) 10 (77%) 6 (86%) 15 (65%) 107 (74%) self-monitoring Unsure 6 (60%) 9 (19%) 1 (11%) 2 (14%) 2 (33%) 2 (25%) 3 (23%) 1 (14%) 5 (22%) 31 (22%) devices (e.g., blood Yes 2 (22%) 1 (7%) 3 (13%) 6 (4%) glucose readings) No 1 (33%) 15 (71%) 2 (100%) 4 (75%) 1 (100%) 1 (100%) 2 (100%) 4 (67%) 4 (80%) 34 (71%) Other Unsure 2 (67%) 5 (24%) 1 (25%) 2 (33%) 1 (20%) 2 (100%) 13 (27%) Yes 1 (5%) 1 (2%)

53

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 12 identifies the perceived impacts of the EHR on the efficacy of various clinical practices. When asked if “overall, the practice has optimized the use of its EHR system,” 49% (n=69) stated that they “somewhat agree” or “strongly agree”; when asked if “the EHR provides clinical benefits for the practice,” 52% (n=73) stated that they “somewhat agree” or “strongly agree”; when asked if “the EHR allows the delivery of better patient care,” 48% (n=68) stated they “somewhat agree” or “strongly agree”; and, when asked if “overall, the benefits of having an EHR outweigh its cost,” 44% (n=61) stated they stated they “somewhat agree” or “strongly agree.”

Table 12. Perceived Impact of EHR on Efficacy of Various Clinical Practices (Q37)

Community Federally Freestanding Home Health Hospital, Hospital, New Hospital, Nursing Home & Nursing Mental Dentist, Dentist, Hospital, Practice, Function Qualified Urgent Care and Hospice Critical Hampshire Non-Critical Skilled Nursing Home, Total Health General Pediatric Rehabilitation Other Health Center Center Agency Access Hospital Access Facility County Center Strongly Disagree 3 (7%) 1 (33%) 4 (33$) 1 (8%) 2 (9%) 11 (8%) Somewhat Disagree 4 (40%) 3 (7%) 2 (20%) 1 (8%) 2 (15%) 3 (13%) 15 (11%) Overall, the practice Neutral 1 (10%) 6 (13%) 1 (33%) 2 (29%) 1 (13%) 1 (100%) 1 (8%) 2 (29%) 3 (13%) 18 (13%) has optimized the Somewhat Agree 2 (20%) 9 (20%) 1 (33%) 2(20%) 2 (17%) 3 (43%) 1 (100%) 4 (50%) 2 (15%) 3 (43%) 8 (35%) 37 (26%) use of its EHR system Strongly Agree 2 (20%) 7 (16%) 6 (60%) 1 (100%) 4 (33%) 2 (29%) 3 (38%) 1 (8%) 6 (26%) 32 (23%) Do Not Know 1 (10%) 5 (11%) 2 (15%) 1 (14%) 9 (6%) Not Applicable 12 (27%) 1 (8%) 4 (31%) 1 (14%) 1 (4%) 19 (13%) Strongly Disagree 1 (2%) 1 (8%) 1 (14%) 2 (9%) 5 (4%) Somewhat Disagree 1 (10%) 1 (2%) 1 (8%) 1 (8%) 3 (13%) 7 (5%) Neutral 1 (10%) 1 (2%) 1 (50%) 1 (10%) 1 (8%) 1 (14%) 3 (13%) 9 (6%) The practice receives Somewhat Agree 2 (5%) 2 (20%) 2 (29%) 1 (100%) 1 (13%) 1 (8%) 5 (22%) 14 (10%) lab results faster Strongly Agree 1 (2%) 7 (70%) 1 (100%) 1 (8%) 4 (57%) 6 (75%) 1 (8%) 5 (22%) 26 (19%) Do Not Know 2 (20%) 4 (9%) 1 (100%) 3 (23%) 1 (14%) 11 (8%) Not Applicable 6 (60%) 34 (77%) 1 (50%) 9 (75%) 1 (13%) 6 (46%) 5 (71%) 5 (22%) 67 (48%) Strongly Disagree 1 (2%) 1 (33%) 3 (13%) 5 (4%) Somewhat Disagree 1 (10%) 2 (4%) 3 (13%) 6 (4%) The EHR produces Neutral 1 (10%) 5 (11%) 1 (33%) 1 (8%) 2 (29%) 1 (100%) 1 (8%) 1 (14%) 4 (17%) 17 (12%) clinical benefits for Somewhat Agree 3 (30%) 7 (16%) 1 (33%) 3 (30%) 1 (8%) 2 (29%) 1 (100%) 1 (13%) 1 (8%) 1 (14%) 6 (26%) 27 (19%) the practice Strongly Agree 4 (40%) 8 (18%) 7 (70%) 1 (100%) 7 (58%) 3 (43%) 7 (88%) 2 (15%) 2 (29%) 5 (22%) 46 (33%) Do Not Know 1 (10%) 4 (9%) 1 (8%) 5 (38%) 1 (14%) 12 (9%) Not Applicable 18 (40%) 2 (17%) 4 (31%) 2 (29%) 2 (9%) 28 (20%) Strongly Disagree 5 (50%) 3 (7%) 1 (33%) 1 (14%) 5 (22%) 15 (11%) Somewhat Disagree 1 (10%) 2 (4%) 1 (10%) 2 (17%) 1 (8%) 7 (30%) 14 (10%) Overall, the EHR Neutral 6 (13%) 1 (33%) 3 (30%) 5 (71%) 2 (25%) 1 (100%) 1 (14%) 1 (4%) 20 (14%) saves the practice Somewhat Agree 2 (20%) 6 (13%) 1 (33%) 1 (10%) 2 (17%) 1 (14%) 1 (100%) 3 (38%) 2 (15%) 1 (14%) 5 (22%) 25 (18%) time Strongly Agree 2 (20%) 9 (20%) 5 (50%) 1 (100%) 7 (58%) 3 (38%) 3 (23%) 2 (29%) 4 (17%) 36 (26%) Do Not Know 5 (11%) 3 (23%) 1 (14%) 9 (6%) Not Applicable 14 (31%) 1 (8%) 4 (31%) 2 (29%) 1 (4%) 22 (16%) Strongly Disagree 1 (2%) 1 (33%) 1 (8%) 1 (4%) 4 (3%) Somewhat Disagree 5 (11%) 1 (10%) 1 (14%) 2 (15%) 2 (29%) 2 (9%) 13 (9%) The time spent Neutral 1 (10%) 6 (13%) 1 (33%) 2 (20%) 2 (17%) 1 (14%) 1 (13%) 2 (29%) 3 (13%) 19 (13%) documenting patient Somewhat Agree 1 (10%) 6 (13%) 4 (40%) 3 (25%) 2 (29%) 1 (100%) 6 (75%) 1 (100%) 5 (38%) 2 (29%) 2 (9%) 33 (23%) care has increased Strongly Agree 8 (80%) 7 (16%) 1 (33%) 3 (30%) 6 (50%) 3 (43%) 1 (13%) 2 (15%) 14 (61%) 45 (32%) Do Not Know 5 (11%) 1 (100%) 6 (4%) Not Applicable 15 (33%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 21 (15%) 54

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Community Federally Freestanding Home Health Hospital, Hospital, New Hospital, Nursing Home & Nursing Mental Dentist, Dentist, Hospital, Practice, Function Qualified Urgent Care and Hospice Critical Hampshire Non-Critical Skilled Nursing Home, Total Health General Pediatric Rehabilitation Other Health Center Center Agency Access Hospital Access Facility County Center Strongly Disagree 2 (20%) 2 (4%) 2 (9%) 6 (4%) Somewhat Disagree 4 (40%) 2 (4%) 2 (17%) 5 (22%) 13 (9%) Overall, the practice Neutral 8 (18%) 2 (67%) 2 (29%) 1 (100%) 1 (13%) 1 (8%) 2 (29%) 7 (30%) 24 (17%) functions more Somewhat Agree 1 (10%) 7 (16%) 3 (30%) 4 (33%) 5 (71%) 4 (50%) 1 (100%) 5 (38%) 1 (14%) 4 (17%) 35 (25%) efficiently with the Strongly Agree 3 (30%) 8 (18%) 1 (33%) 7 (70%) 1 (100%) 5 (42%) 3 (38%) 2 (15%) 3 (43%) 4 (17%) 37 (26%) EHR system Do Not Know 4 (9%) 2 (15%) 6 (4%) Not Applicable 14 (31%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 20 (14%) Strongly Disagree 1 (33%) 1 (8%) 2 (1%) Somewhat Disagree 1 (10%) 1 (8%) 1 (14%) 4 (17%) 7 (5%) The EHR changes the Neutral 1 (10%) 9 (21%) 1 (33%) 2 (20%) 1 (8%) 2 (29%) 1 (13%) 4 (31%) 3 (43%) 3 (13%) 27 (19%) way the clinical team Somewhat Agree 2 (20%) 9 (21%) 4 (40%) 2 (17%) 2 (29%) 1 (100%) 2 (25%) 1 (100%) 3 (23%) 1 (14%) 7 (30%) 34 (24%) interacts with Strongly Agree 4 (40%) 7 (16%) 1 (33%) 4 (40%) 6 (50%) 3 (43%) 5 (63%) 1 (8%) 1 (14%) 7 (30%) 39 (28%) patients Do Not Know 2 (20%) 4 (9%) 1 (100%) 2 (15%) 1 (4%) 10 (7%) Not Applicable 14 (33%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 20 (14%) Strongly Disagree 1 (2%) 1 (4%) 2 (1%) Somewhat Disagree 3 (30%) 4 (9%) 1 (33%) 1 (8%) 6 (26%) 15 (11%) The EHR enhances Neutral 3 (30%) 4 (9%) 1 (33%) 2 (17%) 1 (14%) 2 (25%) 1 (100%) 2 (15%) 5 (71%) 6 (26%) 27 (19%) patient data Somewhat Agree 2 (20%) 8 (18%) 2 (20%) 3 (25%) 5 (71%) 1 (100%) 4 (50%) 4 (31%) 5 (22%) 34 (24%) confidentiality. Strongly Agree 1 (10%) 7 (16%) 1 (33%) 7 (70%) 1 (100%) 5 (42%) 1 (14%) 2 (25%) 2 (15%) 1 (14%) 4 (17%) 32 (23%) Do Not Know 1 (10%) 7 (16%) 2 (15%) 10 (7%) Not Applicable 13 (30%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 19 (14%) Strongly Disagree 5 (11%) 1 (33%) 2 (9%) 8 (6%) Somewhat Disagree 2 (20%) 1 (8%) 1 (14%) 7 (30%) 11 (8%) The EHR allows the Neutral 1 (10%) 10 (23%) 1 (33%) 1 (8%) 1 (14%) 1 (100%) 2 (15%) 5 (71%) 5 (22%) 27 (19%) delivery of better Somewhat Agree 2 (20%) 6 (14%) 2 (20%) 2 (17%) 5 (71%) 4 (50%) 5 (38%) 1 (14%) 7 (30%) 34 (24%) patient care Strongly Agree 3 (30%) 7 (16%) 1 (33%) 8 (80%) 7 (58%) 1 (100%) 4 (50%) 2 (15%) 1 (4%) 34 (24%) Do Not Know 2 (20%) 5 (11%) 1 (100%) 1 (8%) 9 (6%) Not Applicable 11 (25%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 17 (12%) Strongly Disagree 4 (40%) 5 (11%) 1 (33%) 4 (17%) 14 (10%) Somewhat Disagree 1 (10%) 2 (5%) 1 (10%) 2 (17%) 1 (8%) 10 (43%) 17 (12%) The EHR produces Neutral 6 (14%) 1 (33%) 1 (10%) 1 (8%) 1 (14%) 2 (25%) 1 (100%) 3 (23%) 4 (57%) 3 (13%) 23 (16%) financial benefits for Somewhat Agree 2 (20%) 8 (18%) 3 (30%) 2 (17%) 6 (86%) 4 (50%) 2 (15%) 1 (14%) 3 (13%) 31 (22%) the practice Strongly Agree 3 (30%) 6 (14%) 1 (33%) 5 (50%) 6 (50%) 1 (100%) 2 (25%) 2 (15%) 2 (9%) 28 (20%) Do Not Know 6 (14%) 1 (100%) 2 (15%) 1 (14%) 10 (7%) Not Applicable 11 (25%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 17 (12%) Strongly Disagree 2 (20%) 4 (9%) 1 (33%) 6 (26%) 13 (9%) Somewhat Disagree 3 (30%) 4 (9%) 4 (17%) 11 (8%) Overall, the benefits Neutral 1 (10%) 6 (14%) 1 (33%) 1 (10%) 4 (33%) 2 (29%) 1 (100%) 4 (31%) 3 (43%) 7 (30%) 30 (21%) of having an EHR Somewhat Agree 1 (10%) 6 (14%) 2 (20%) 1 (8%) 1 (14%) 2 (25%) 3 (23%) 3 (43%) 3 (13%) 22 (16%) outweigh its cost Strongly Agree 3 (30%) 7 (16%) 1 (33%) 7 (70%) 6 (50%) 4 (57%) 1 (100%) 6 (75%) 2 (15%) 2 (9%) 39 (28%) Do Not Know 6 (14%) 1 (100%) 1 (8%) 8 (6%) Not Applicable 11 (25%) 1 (8%) 3 (23%) 1 (14%) 1 (4%) 17 (12%)

55

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 13 shows the perception of the organizational and practice outcomes that have occurred as a result of CEHRT usage. Specifically, 45% (n=63) of clinicians indicated that their EHR systems “alert clinicians to potential medication errors”; 42% (n=59) “create reminders to provide preventative care services”; and 41% (n=57) “create reminders for care that meets clinical guidelines for patients with chronic conditions.” While most clinicians (29%; n=41) noted that the EHR does not “facilitate direct communication with a patient”; 42% (n=58) said EHR “facilitated direct communication with other providers.” Just over half (51%; n=70) of providers said that EHR allows them to “assess a patient’s chart outside of the office”; and 50% (n=69) believe that the EHR “enhances overall patient care.”

Table 13. Perception of Organizational and Practice Outcomes Resulting From EHR Usage by Provider Type (Q38)

Community Federally Home Hospital, Hospital, Freestanding Hospital, Nursing Home Nursing Mental Dentist, Dentist, Qualified Health and New Non- Hospital, Practice, Function Urgent Care Critical & Skilled Home, Total Health General Pediatric Health Hospice Hampshire Critical Rehabilitation Other Center Access Nursing Facility County Center Center Agency Hospital Access Never 5 (11%) 1 (33%) 2 (15%) 4 (17%) 12 (9%) Alerted clinicians to a Yes 5 (50%) 10 (22%) 1 (33%) 10 (100%) 7 (58%) 6 (86%) 1 (100%) 7 (88%) 1 (100%) 2 (15%) 1 (17%) 12 (52%) 63 (45%) potential medication error Do Not Know 3 (30%) 9 (20%) 1 (100%) 1 (8%) 1 (14%) 1 (13%) 3 (23%) 1 (17%) 4 (17%) 24 (17%) Not Applicable 2 (20%) 21 (47%) 1 (33%) 4 (33%) 6 (46%) 4 (67%) 3 (13%) 41 (29%) Never 4 (40%) 4 (9%) 2 (17%) 2 (15%) 6 (26%) 18 (13%) Alerted clinicians to a critical Yes 10 (100%) 6 (86%) 8 (100%) 12 (52%) 36 (26%) lab value Do Not Know 3 (30%) 8 (18%) 1 (33%) 1 (100%) 1 (14%) 1 (100%) 1 (100%) 4 (31%) 1 (17%) 2 (9%) 23 (16%) Not Applicable 3 (30%) 33 (73%) 2 (67%) 10 (83%) 7 (54%) 5 (83%) 3 (13%) 63 (45%) Never 8 (18%) 3 (100%) 2 (20%) 4 (33%) 1 (14%) 3 (23%) 1 (17%) 4 (17%) 26 (19%) Led to a less effective Yes 4 (40%) 4 (9%) 3 (30%) 3 (25%) 3 (43%) 4 (50%) 13 (57%) 34 (24%) communication during a Do Not Know 6 (60%) 15 (33%) 5 (50%) 1 (100%) 3 (25%) 3 (43%) 1 (100%) 4 (50%) 1 (100%) 3 (23%) 1 (17%) 4 (17%) 47 (34%) patient visit Not Applicable 18 (40%) 2 (17%) 7 (54%) 4 (67%) 2 (9%) 33 (24%) Never 4 (40%) 4 (9%) 2 (67%) 1 (8%) 2 (15%) 3 (13%) 16 (12%) Created reminders to provide Yes 1 (10%) 18 (40%) 1 (33%) 10 (100%) 3 (25%) 5 (71%) 7 (88%) 2 (15%) 12 (55%) 59 (42%) preventive care services (e.g. Do Not Know 2 (20%) 6 (13%) 1 (100%) 2 (29%) 1 (100%) 2 (15%) 2 (33%) 1 (5%) 17 (12%) vaccine, cancer screening) Not Applicable 3 (30%) 17 (33%) 8 (67%) 1 (13%) 1 (100%) 7 (54%) 4 (67%) 6 (27%) 47 (34%) Created reminders to provide Never 2 (20%) 3 (7%) 4 (33%) 2 (15%) 3 (13%) 14 (10%) care that meets clinical Yes 2 (20%) 10 (22%) 1 (33%) 10 (100%) 1 (100%) 5 (42%) 6 (86%) 1 (100%) 7 (88%) 1 (8%) 1 (17%) 12 (55%) 57 (41%) guidelines for patients with Do Not Know 4 (40%) 5 (11%) 1 (14%) 2 (15%) 1 (17%) 1 (5%) 14 (10%) chronic conditions Not Applicable 2 (20%) 27 (60%) 2 (67%) 3 (25%) 1 (13%) 1 (100%) 8 (62%) 4 (67%) 6 (27%) 54 (39%) Never 4 (40%) 1 (2%) 1 (8%) 2 (15%) 7 (32%) 15 (11%) Resulted in ordering fewer Yes 7 (70%) 1 (14%) 7 (88%) 3 (14%) 18 (13%) tests due to better Do Not Know 3 (30%) 7 (16%) 3 (30%) 1 (100%) 6 (86%) 1 (100%) 1 (13%) 1 (100%) 3 (23%) 2 (33%) 6 (27%) 34 (24%) availability of lab results Not Applicable 3 (30%) 37 (82%) 3 (100%) 11 (92%) 8 (62%) 4 (67%) 6 (27%) 72 (52%)

56

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Community Federally Home Hospital, Hospital, Freestanding Hospital, Nursing Home Nursing Mental Dentist, Dentist, Qualified Health and New Non- Hospital, Practice, Function Urgent Care Critical & Skilled Home, Total Health General Pediatric Health Hospice Hampshire Critical Rehabilitation Other Center Access Nursing Facility County Center Center Agency Hospital Access Never 2 (20%) 4 (9%) 1 (33%) 1 (8%) 1 (17%) 5 (23%) 14 (10%) Resulting in ordering more Yes 1 (10%) 5 (50%) 1 (100%) 1 (8%) 4 (57%) 8 (100%) 1 (8%) 1 (17%) 8 (36%) 30 22%) on-formulary drugs Do Not Know 5 (50%) 7 (16%) 1 (33%) 5 (50%) 3 (43%) 1 (100%) 1 3 (23%) 6 (27%) 32 (23%) Not Applicable 2 (20%) 34 (76%) 1 (33%) 11 (92%) 8 62%) 4 (67%) 3 (14%) 63 (45%) Facilitated direct Never 6 (60%) 2 (4%) 1 (33%) 2 (20%) 1 (100%) 4 (33%) 1 (14%) 1 (100%) 2 (15%) 1 (17%) 8 (36%) 29 (21%) communication with a Yes 15 (33%) 2 (67%) 7 (70%) 4 (57%) 5 (63%) 8 (36%) 41 (29%) patient (e.g., email or secure Do Not Know 1 (10%) 6 (13%) 2 (29%) 1 (100%) 1 (13%) 3 (23%) 3 (14%) 17 (12%) messaging) Not Applicable 3 (30%) 22 (9%) 1 (10%) 8 (67%) 2 (25%) 8 (62%) 5 (83%) 3 (14%) 52 (37%) Never 1 (10%) 1 (2%) 2 (67%) 2 (18%) 1 (14%) 1 (8%) 1 (17%) 3 (14%) 12 (9%) Facilitated direct Yes 6 (60%) 18 (41%) 1 (33%) 8 (80%) 3 (27%) 4 (57%) 1 (100%) 6 (75%) 1 (8%) 10 (45%) 58 (42%) communication with other Do Not Know 3 (30%) 6 (14%) 1 (10%) 2 (29%) 2 (25%) 2 (15%) 1 (17%) 5 (23%) 22 (16%) providers Not Applicable 19 (43%) 1 (10%) 1 (100%) 6 (55%) 1 (100%) 9 (69%) 4 (67%) 4 (18%) 45 (33%) Never 4 (9%) 1 (33%) 1 (10%) 1 (8%) 1 (100%) 1 (8%) 6 (27%) 15 (11%) Helped clinicians access a Yes 9 (90%) 13 (30%) 2 (67%) 9 (90%) 7 (58%) 5 (71%) 8 (100%) 1 (100%) 3 (23%) 2 (33%) 11 (50%) 70 (51%) patient’s chart outside the Do Not Know 1 (10%) 6 (13%) 1 (100%) 2 (29%) 2 (15%) 2 (9%) 14 (10%) office 21 (48%) 4 (33%) 7 (54%) 4 (67%) 3 (14%) 39 (28%) Not Applicable Helped clinicians access a Never 5 (50%) 5 (11%) 1 (33%) 2 (20%) 2 (17%) 1 (14%) 1 (100%) 1 (100%) 2 (15%) 1 (17%) 9 (41%) 30 (22%) patient’s chart through a Yes 2 (20%) 9 (20%) 1 (33%) 5 (50%) 4 (33%) 2 (29%) 5 (63%) 8 (36%) 36 (26%) personal digital device (e.g., Do Not Know 2 (20%) 7 (16%) 1 (100%) 3 (43%) 3 (23%) 1 (17%) 1 (5%) 18 (13%) smart phone, tablet) Not Applicable 1 (10%) 23 (52%) 1 (33%) 3 (30%) 6 (50%) 1 (14%) 3 (38%) 8 62%) 4 (67%) 4(18%) 54 (39%) Never 2 (5%) 1 (33%) 1 (8%) 2 (10%) 6 (4%) Enhanced overall patient Yes 3 (30%) 17 (39%) 1 (33%) 10 (100%) 8 (67%) 5 (71%) 8 (100%) 1 (100%) 4 (31%) 1 (17%) 11 (52%) 69 (50%) care Do Not Know 7 (70%) 10 (23%) 1 (33%) 1 (100%) 1 (8%) 2 (29%) 1 (100%) 3 (23%) 1 (17%) 6 (29%) 33 (24%) Not Applicable 15 (34%) 3 (27%) 5 (38%) 4 (67%) 2 (10%) 29 (21%)

[Remainder of Page Left Intentionally Blank]

57

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 14 summarizes the MU objectives for all providers with a second EHR system. Overall, the second designated EHR system for providers is used routinely for most of the MU use objectives examined including “recording patient history and demographic information” (86%; n=19); “patient problem lists” (86%; n=19); “recording clinical notes” (95%; n=21); “sending prescriptions electronically to the pharmacy” (87%; n=13); “warnings of drug interaction or contraindications” (93%; n=14); or “drug formulary checks performed” (87%; n=13).

Table 14. Number and Percentage of Organizations with Computerized Capabilities to Meet Selected MU Objectives for Providers with a Second EHR (Q43)

Yes, but not Yes, but No, but Yes, used Not EHR Function used turned off or No currently Unknown routinely applicable routinely not used planned Recording patient history and demographic information 19 (86%) 3 (14%) Recording patient problem lists 19 (86%) 3 (14%) Recording and charting vital signs 16 (76%) 1 (5%) 2 (10%) 2 (10%) Recording patient smoke status 17 (77%) 1 (5%) 1 (5%) 3 (14%) Recording clinical notes 21 (95%) 1 (5%) Recording patient's medications and allergies 17 (81%) 1 (5%) 3 (14%) Reconciling lists of patients medications to identify the 18 (86%) 3 (14%) most accurate list Providing reminders for guidline-based interventions and 16 (80%) 1 (5%) 1 (5%) 2 (10%) screening tests Ordering prescriptions 15 (71%) 1 (5%) 2 (10%) 3 (14%) Prescriptions sent electronically to the pharmacy 13 (87%) 1 (7%) 1 (7%) Warnings of drug interactions or contrindications provided 14 (93%) 1 (7%) Drug formulary checks performed 13 (87%) 1 (7%) 1 (7%) Ordering lab tests 12 (57%) 2 (10%) 1 (5%) 1 (5%) 5 (24%) Orders sent electronically 7 (58%) 3 (25%) 1 (8%) 1 (8%) Viewing lab results 13 (62%) 2 (10%) 1 (5%) 1 (5%) 4 (19%) EHR / EMR automatically graphs a specific patient's lab 10 (77%) 2 (15%) 1 (8%) results over time

58

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 15 further outlines the total MU capabilities for all organizations that indicated that they had a second EHR system. Of the capabilities listed, organizations most commonly use their second EHR system for “identifying educational resources for patient’s specific conditions” (71%; =15); “reporting clinical quality measures to federal or state agencies” (71%; n=15); and “identifying patients due for preventative or follow-up care” (71%; n=15). Several organizations indicated that they plan to implement “electronic reporting to immunization registries” (5%; n=1); “providing patients with summaries for each visit” (10%; n=2); “exchanging secure messages with patients” (10%; n=2); and “providing patients the ability to view online, download, or transmit information from their medical records” (10%; n=2).

Table 15. Number and Percentage of Organization with Computerized Capabilities to Meet Selected MU Objectives for Providers with a Second EHR (Q43)

Yes, used Yes, but not Yes, but turned No, but currently EHR Function No Unknown Not Applicable routinely used routinely off or not used planned Ordering radiology tests 11 (55%) 3 (15%) 1 (5%) 5 (25%) Viewing imaging results 13 (62%) 1 (5%) 2 (10%) 1 (5%) 4 (19%) Identifying educational resources for patients' specific 15 (71%) 2 (10%) 1 (5%) 1 (5%) 2 (10%) conditions Reporting clinical quality measures to federal or state 15 (71%) 2 (10%) 1 (5%) 1 (5%) 2 (10%) agencies (such as CMS or Medicaid) Identifying patients due for preventative or follow-up care in 15 (71%) 2 (10%) 2 (10%) 2 (10%) order to send patients reminders Generating lists of patients with particular health conditions 13 (62%) 3 (14%) 1 (5%) 1 (5%) 3 (14%) Electronic reporting to immunization registries 4 (19%) 7 (33%) 1 (5%) 3 (14%) 1 (5%) 1 (5%) 4 (19%) Providing patients with clinical summaries for each visit 12 (57%) 2 (10%) 2 (10%) 2 (10%) 3 (14%) Exchanging secure messages with patients 8 (38%) 4 (19%) 2 (10%) 1 (5%) 2 (10%) 1 (5%) 3 (14%) Providing patients the ability to view online, download or 9 (43%) 3 (14%) 3 (14%) 1 (5%) 2 (10%) 3 (14%) transmit information from their medical record

[Remainder of Page Left Intentionally Blank]

59

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

4.5 Health Information Exchange Capabilities

Table 16 shows, by type of provider, whom that provider is sharing patient health information with via their existing EHR system. Specifically, 32% (n=53) of providers indicated sharing data with “ambulatory providers outside their office”; 29% (n=48) “within their office/group”; 24% (n=40) for “hospitals with which they are affiliated”; and 24% (n=39) with “pharmacies.”

Table 16. Types of Providers With Which Patient Health Information is Shared via Current EHR System (Q44)

Ambulatory Ambulatory Hospitals Hospitals None of Behavioral Long- Home providers providers with which with which the Provider Type health term care health Laboratories Pharmacies Other inside your outside your you are you are not above providers providers providers office/group office/group affiliated affiliated apply Community Mental Health Center (n=10) 2 (20%) 3 (30%) 1 (10%) 2 (20%) 2 (20%) 4 (40%) 3 (30%) 1 (10%) Dentist, General (n=58) 8 (14%) 15 (25%) 3 (5%) 2 (2%) 2 (3%) 1 (2%) 3 (5%) 7 (12%) 22 (38%) 17 (29%) Dentist, Pediatric (n=3) 1 (33%) 1 (33%) 1 (33%) Federally Qualified Health Center (n=10) 7 (70%) 4 (40%) 8 (80%) 1 (7%) 4 (40%) 2 (20%) 3 (30%) 7 (70%) 7 (70%) 1 (10%) Freestanding Urgent Care Center (n=2) 2 (100%) 1 (50%) 1 (33%) 1 (50%) 1 (50%) Home Health and Hospice Agency (n=17) 2 (12%) 6 (35%) 7 (41%) 9 (41%) 3 (18%) 4 (24%) 5 (29%) 2 (12%) 1 (6%) 6 (35%) Hospital, Critical Access (n=7) 7 (100%) 5 (71%) 4 (57%) 4 (57%) 2 (29%) 1 (14%) 3 (43%) 1 (14%) Hospital, New Hampshire Hospital (n=1) 1 (100%) Hospital, Non-Critical Access (n=8) 8 (100%) 6 (75%) 4 (50%) 3 (38%) 3 (38%) 3 (38%) 5 (63%) 3 (38%) 3 (38%) 1 (13%) Hospital, Rehabilitation (n=2) 1 (50%) 1 (50%) Nursing Home & Skilled Nursing Facility (n=16) 1 (6%) 6 (38%) 1 (6%) 3 (19%) 3 (19%) 3 (19%) 8 (50%) 2 (13%) 2 (13%) Nursing Home, County (n=7) 2 (29%) 1 (14%) 1 (14%) 2 (29%) 2 (29%) 2 (29%) 1 (14%) 2 (29%) 2 (29%) Practice, Other (n=24) 10 (40%) 12 (48%) 5 (20%) 3 (8%) 3 (13%) 2 (8%) 2 (8%) 5 (21%) 6 (25%) 8 (33%) Total (n=165) 48 (29%) 53 (32%) 40 (24%) 26 (9%) 21 (13%) 19 (12%) 24 (15%) 27 (16%) 39 (24%) 46 (28%) 22 (13%)

Expand ing on the table above, Table 17 (next page) shows the types of patient data exchanged electronically by provider type via current EHR systems. Providers reported using their EHR system(s) to share “laboratory results” (58%; n=33); “imaging reports” (40%; n=25); “patient problem lists” (54%; n=31); “medication lists” (49%; n=34); and “medication allergy lists” (45%; n=30) with hospitals with which they are affiliated. Fewer providers share the following types of patient information with hospitals with which they are not affiliated: “laboratory results” (28%; n=16); “imaging reports” (16%; n=10); “patient problem lists” (30%; n=17); “medication lists” (26%; n=18), and “medication allergy lists” (24%; n=16). However, providers share a similar amount of patient information with ambulatory providers inside, and outside of, their practice

60

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

groups including: “laboratory results” (61%; n=35 and 53%; n=30, respectively); “imaging reports” (51%; n=32 and 57%; n=36, respectively); “patient problem lists” (65%; n=37 and 58%; n=33, respectively); “medication lists” (62%; n=43 and 55%; n=38, respectively); and “medication allergy lists” (45%; n=30 and 56%; n=37, respectively).

Table 17. Types of Data Exchanged Shared With Other Providers via Current EHR System by Type of Data (Q45)

Hospitals with Ambulatory Hospitals with Ambulatory Type of Data Exchanged which you are providers inside your which you are not providers outside affiliated office/group affiliated your offices/groups Community Mental Health Center (n=2) 2 (100%) 1 (50%) Dentist, General (n=7) 1 (14%) 1 (14%) 1 (14%) 6 (86%) Federally Qualified Health Center (n=6) 4 (67%) 5 (83%) 1 (17%) 2 (33%) Home Health and Hospice Agency (n=6) 4 (67%) 2 (33%) 3 (50%) 4 (67%) Hospital, Critical Access (n=7) 6 (86%) 6 (86%) 4 (57%) 5 (71%) Laboratory results Hospital, Non-Critical Access (n=8) 5 (63%) 8 (100%) 3 (38%) 6 (75%) Hospital, Rehabilitation (n=1) 1 (100%) Nursing Home & Skilled Nursing Facility (n=5) 5 (100%) 1 (20%) Nursing Home, County (n=2) 1 (50%) 1 50%) Practice, Other (n=13) 7 (54%) 10 (77%) 1 (8%) 7 (54%) Total (n=57) 33 (58%) 35 (61%) 16 (28%) 30 (53%) Community Mental Health Center (n=1) 1 (100%) Dentist, General (n=24) 2 (8%) 6 (25%) 1 (4%) 20 (83%) Dentist, Pediatric (n=1) 1 (100%) Federally Qualified Health Center (n=5) 3 (60%) 4 (80%) 1 (20%) 1 (20%) Home Health and Hospice Agency (n=3) 2 (67%) 1 (33%) 1 (33%) 1 (33%) Imaging reports Hospital, Critical Access (n=7) 6 (86%) 6 (86%) 1 (14%) 2 (29%) Hospital, Non-Critical Access (n=7) 3 (43%) 7 (100%) 3 (43%) 6 (86%) Nursing Home & Skilled Nursing Facility (n=4) 4 (100%) 1 (25%) Nursing Home, County (n=1) 1 (100%) Practice, Other (n=10) 5 (50%) 8 (80%) 5 (50%) Total (n=63) 25 (40%) 32 (51%) 10 (16%) 36 (57%)

61

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Hospitals with Ambulatory Hospitals with Ambulatory Type of Data Exchanged which you are providers inside your which you are not providers outside affiliated office/group affiliated your offices/groups Community Mental Health Center (n=3) 3 (100%) 2 (67%) 2 (67%) Dentist, General (n=10) 2 (20%) 2 (20%) 7 (70%) Federally Qualified Health Center (n=7) 5 (71%) 5 (71%) 2 (29%) 3 (43%) Freestanding Urgent Care Center (n=1) 1 (100%) 1 (100%) Home Health and Hospice Agency (n=7) 6 (86%) 3 (43%) 5 (71%) 5 (71%) Patient problem lists Hospital, Critical Access (n=6) 4 (67%) 6 (100%) 3 (50%) 3 (50%) Hospital, Non-Critical Access (n=7) 5 (71%) 7 (100%) 4 (57%) 5 (71%) Nursing Home & Skilled Nursing Facility (n=3) 3 (100%) Nursing Home, County (n=1) 1 (100%) Practice, Other (n=12) 5 (42%) 10 (83%) 1 (8%) 7 (58%) Total (n=57) 31 (54%) 37 (65%) 17 (30%) 33 (58%) Community Mental Health Center (n=3) 3 (100%) 2 (67%) 2 (67%) Dentist, General (n=16) 1 (6%) 6 (38%) 11 (69%) Federally Qualified Health Center (n=7) 5 (71%) 5 (71%) 1 (14%) 2 (29%) Freestanding Urgent Care Center (n=1) 1 (100%) 1 (100%) Home Health and Hospice Agency (n=9) 8 (89%) 4 (44%) 6 (67%) 7 (78%) Medication lists Hospital, Critical Access (n=6) 4 (67%) 6 (100%) 3 (50%) 3 (50%) Hospital, Non-Critical Access (n=8) 5 (63%) 8 (100%) 4 (50%) 5 (63%) Nursing Home & Skilled Nursing Facility (n=4) 4 (100%) Nursing Home, County (n=2) 1 (50%) 1 (50%) 1 (50%) Practice, Other (n=13) 5 (38%) 10 (77%) 1 (8%) 7 (54%) Total (n=69) 34 (49%) 43 (62%) 18 (26%) 38 (55%) Community Mental Health Center (n=3) 2 (67%) 2 (67%) Dentist, General (n=17) 1 (6%) 1 (6%) 1 (6%) 12 (71%) Federally Qualified Health Center (n=7) 5 (71%) 5 (71%) 1 (14%) 2 (29%) Freestanding Urgent Care Center (n=1) 1 (100%) 1 (100%) 1 (100%) Home Health and Hospice Agency (n=6) 5 (83%) 5 (83%) 4 (67%) 4 (67%) Medication allergy lists Hospital, Critical Access (n=6) 4 (67%) 4 (67%) 3 (50%) 3 (50%) Hospital, Non-Critical Access (n=8) 5 (63%) 5 (63%) 4 (50%) 5 (63%) Nursing Home & Skilled Nursing Facility (n=4) 4 (100%) 4 (100%) Nursing Home, County (n=1) Practice, Other (n=13) 5 (38%) 5 (38%) 1 (8%) 8 (62%) Total (n=66) 30 (45%) 30 (45%) 16 (24%) 37 (56%) 62

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 28 reveals which types of providers are sharing information via a MU summary of care record. The majority of providers (61%; n=101) are not sharing information in this format; 25% (n=41) are sharing; and 8% (n=13) reported not knowing. The highest rates of sharing were seen by the non-CAHs (100%; n=8) and CAHs (86%; n=6); whereas, the lowest rates were seen by pediatric dentists (2%; n=3); New Hampshire Hospital (0%; n=1); and the rehabilitation hospitals (0%; n=2). County nursing homes (14%; n=1) and CMHCs (20%; n=2) also had low rates of sharing health information via a summary care record.

Figure 28. Number and Percentage of Provider Types Sharing Data via a Summary Care Record (Q46)

Status of Sharing Health Informa7on Using a Summary Care Record Among Providers 100% 4% 6% 8% 11% 14% 13% 90% 30% 80% 50% 44% 70% 53% 80% 60% 61% 71% 30% Percentage 50% 100% 100% 100% 100% 81% 69% 86% 40%

30% 50% 44% 20% 40% 35% 25% 10% 20% 14% 16% 0% 2% Federally Nursing Home Community Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Nursing Den7st, Qualified & Skilled Prac7ce, Mental Health General Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Home, County Total (n=165) Pediatric (n=3) Health Center Nursing Other (n=25) Center (n=10) (n=57) Center (n=2) Agency (n=17) (n=7) Hospital (n=1) (n=8) (n=2) (n=7) (n=10) Facility (n=16) Provider Type Unknown 6 3 1 2 1 13 No 8 46 3 3 1 9 1 1 2 11 5 11 101 Yes 2 1 4 1 6 6 8 1 1 11 41

63

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 18 provides a view into the vendor partners with whom each provider type currently exchanges data with electronically. There are a multitude of entities for which providers can exchange data including Surescripts (ePrescribing); various state-led HIEs; and private HIEs. Sixteen percent (n=23) of respondents stated that they were exchanging data with Surescripts. The majority of those connected to state-led HIEs are connected to New Hampshire’s HIE, the New Hampshire Health Information Organization (NHHIO) (24%; n=35). Three percent (n=5) stated that they were using other ONC Direct HIE connections including EHealthLine, RelayHealth, and Multum Rx. Six percent (n=9) stated that they were connected to private HIEs; these private HIEs included RelayHealth, Curaspan, Wellport, and Nextgen, among others.

Table 18. Vendors to Whom Providers are Connected for HIE Transactions (Q47)

Surescripts NHHIO (New VITL Other ONC HealthInfoNet Private None of Provider Type (pharmacy Hampshire’s (Vermont’s Direct HIE (Maine’s HIE) HIE these data) HIE) HIE) Connections Community Mental Health Center (n=10) 4 (40%) 4 (40%) 1 (10%) 4 (40%) Dentist, General (n=52) 1 (2%) 1 (2%) 2 (4%) 48 (92%) Dentist, Pediatric (n=3) 3 (100%) Federally Qualified Health Center (n=9) 2 (22%) 5 (56%) 4 (44%) Freestanding Urgent Care Center (n=2) 2 (100%) Home Health and Hospice Agency (n=16) 5 (31%) 3 (19%) 10 (63%) Hospital, Critical Access (n=6) 2 (33%) 5 (83%) 1 (17%) 1 (17%) Hospital, New Hampshire Hospital (n=1) 1 (100%) Hospital, Non-Critical Access (n=8) 4 (50%) 7 (88%) 1 (13%) 1 (13%) 4 (50%) Hospital, Rehabilitation (n=2) 2 (100%) Nursing Home & Skilled Nursing Facility (n=11) 2 (18%) 9 (82%) Nursing Home, County (n=5) 5 (100%) Practice, Other (n=23) 9 (39%) 6 (26%) 1 (4%) 9 (39%) Total (n=148) 23 (16%) 35 (24%) 2 (1%) 0 (0%) 5 (3%) 9 (6%) 95 (64%)

64

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 29 shows which provider types are employing a HISP to meet their direct messaging requirements. Overall, 21% (n=34) reported using a HISP, while 79% (n=125) did not. Freestanding urgent care centers (100%; n=2); non-CAHs (100%; n=7); CAHs (86%; n=7); and FQHCs (30%; n=3) had the highest rates of HISP usage.

Figure 29. Number and Percentage of Organizations Using a HISP for Direct Messaging (Q48)

Health Informa7on Service Provider (HISP) Used for Direct Messaging 100%

14% 90%

80%

70% 70% 60% 80% 78% 79% 87% 88%

50% 100% 100% 100% 100% 100% 100% 100%

Percentage 100% 40%

30%

20% 30% 10% 20% 22% 21% 13% 12%

0% Community Federally Nursing Home Den7st, Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Nursing Mental Qualified & Skilled Prac7ce, General Pediatric Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Home, County Total (n=159) Health Center Health Center Nursing Other (n=23) (n=55) (n=3) Center (n=2) Agency (n=17) (n=7) Hospital (n=1) (n=7) (n=2) (n=7) (n=10) (n=10) Facility (n=15) Provider Type No 8 48 3 7 15 1 1 2 15 7 18 125 Yes 2 7 3 2 2 6 7 5 34

65

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Table 19 contains the HISP vendor brands being used by providers. Of the thirty-one total respondents, NHHIO/Medallies is the most frequently cited HISP solution with 35% (n=11) of providers using it followed by Relay Health that is used by 13% (n=4) of responding providers.

Table 19. HISP Brands Being Used by Providers (Q49)

Community Federally Freestanding Home Health Hospital, Mental Dentist, Hospital, Non- Practice, Name of HISP Being Used Qualified Urgent Care and Hospice Critical Total Health General Critical Access Other Health Center Center Agency Access Center Athena health/Athena Net 1 1 (3%) Cerner MobileMD 1 1 (3%) Inpriva 1 1 (3%) Lighthouse 1 1 (3%) MacPractice DDS 1 1 (3%) McKesson Relay Health 1 1 2 (6%) MD Office 1 1 (3%) Medhost 1 1 (3%) NHHIO/Medallies 1 2 1 3 4 11 (35%) Relay health 1 1 1 1 4 (13%) [email protected] 1 1 (3%) Sendic 2 2 (6%) SureScripts 1 1 1 2 (6%) Updocs 1 1 (3%) Total 2 6 3 1 2 6 7 4 31 (100%)

[Remainder of Page Left Intentionally Blank]

66

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

5.0 Results: Broadband, Payment Arrangements, Security, and Future State 5.1 Broadband Broadband access is a concern as more providers are using remotely hosted (cloud-based) clinical solutions, running bandwidth intensive applications (e.g., imaging servers), and operating in remote service areas.

[Remainder of Page Left Intentionally Blank]

67

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 30 addresses provider perception of Internet access as posing a challenge. Over a third (36%; n=67) of respondents stated that they “strongly agree” or “agree” that they perceived broadband access as posing a challenge to HIT and HIE. Forty percent (n=74) indicated being “neutral,” while 23% (n=44) “disagree” or “strongly disagree.” The highest proportion of those citing broadband access issues were the CMHCs with 60% (n=6) reporting “strongly agree” or “agree” and the county nursing homes with 50% (n=3) reporting “strongly agree” or “agree.” The eight non-CAHs that responded had the highest proportion of answers as “disagree” or “strongly disagree” totaling 53% (n=5) of the respondents. Half (50%) of the responses for both pediatric dentists (n=3) and the FQHCs (n=5) also reported “disagree.”

Figure 30. Broadband Access as a Challenge to Provider HIT/HIE (Q57)

Percep7on of Broadband Internet Access Posing as a Challenge to HIT/HIE for Providers 100% 9% 7% 7% 7% 9% 14% 90% 17% 25% 7% 30% 33% 80% 24% 40% 14% 27% 37% 70% 13% 33% 53%

Percentage 60% 50% 29% 17% 30% 10% 50% 100% 100% 38% 40% 40% 53% 17% 37% 30% 20% 50% 50% 27% 17% 20% 43% 29% 10% 18% 25% 15% 10% 11% 7% 17% 10% 7% 7% 5% 0% 4% 4% Community Federally Nursing Home Den7st, Den7st, Home Health Hospital, Hospital, New Hospital, Hospital, Nursing Mental Qualified & Skilled Prac7ce, General Pediatric and Hospice Cri7cal Access Hampshire Non-Cri7cal Rehabilita7on Home, Total (n=185) Health Center Health Center Nursing Other (n=27) (n=80) (n=6) Agency (n=15) (n=7) Hospital (n=1) Access (n=8) (n=1) County (n=6) (n=10) (n=10) Facility (n=14) Provider Type Strongly agree 3 7 1 1 1 2 2 17 Agree 3 19 1 4 8 1 2 1 1 10 50 Neutral 2 42 2 1 4 2 1 1 1 7 1 10 74 Disagree 1 9 3 5 1 3 3 4 1 4 34 Strongly disagree 1 3 1 2 1 1 1 10

68

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

5.2 Security Increasingly, healthcare organizations are facing data risks and vulnerabilities to their electronic health information. Figure 31 shows the number of practices that have assessed these vulnerabilities in the last 12 months. Seventy-three percent (n=90) reported that they had assessed potential risks and vulnerabilities associated with their electronic health information; 12% (n=15) reported that they were unsure; and 15% (n=18) reported that they had not performed a vulnerability assessment in the last 12 months.

Figure 31. Number and Percentage of Practices That Have Assessed Potential Electronic Health Information Risks and Vulnerabilities (Q59)

Prac6ce Assessment of Poten6al Risks and Vulnerabili6es of Electronic Health Informa6on Within the Last Year 100% 7% 6% 12% 18% 6% 90% 22% 20% 25% 13% 33% 80% 15%

70% 20% 22% 60%

50% 33% 100% 100% 100% 100% 100% 100%

Percentage 80% 88% 40% 80% 75% 73% 30% 61% 56%

20% 33% 10%

0% Federally Nursing Home Community Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Den6st, Den6st, Qualified & Skilled Nursing Home, Prac6ce, Other Mental Health Urgent Care and Hospice Cri6cal Access Hampshire Cri6cal Access Rehabilita6on Total (n=123) General (n=49) Pediatric (n=3) Health Center Nursing Facility County (n=5) (n=17) Center (n=8) Center (n=1) Agency (n=15) (n=4) Hospital (n=1) (n=4) (n=1) (n=6) (n=9) Provider Type Unsure 9 1 1 2 1 1 15 No 2 10 1 2 2 1 18 Yes 6 30 1 6 1 12 4 1 4 1 5 4 15 90

69

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

5.3 Payment Arrangements Payment reform efforts are taking place across the State within Medicare, Medicaid, and commercial payers. The information systems that providers use will need to be able to adapt to these new payment arrangements. This section of the report examines a few statistics to begin to understand HIT readiness.

[Remainder of Page Left Intentionally Blank]

70

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 32 examines the participation rates in any type of pay for performance arrangement categorized by provider type. Overall, a majority of providers (63%; n=124) reported that they are not participating in a P4P arrangement. However, 63% (n=5) of the responding non-CAHs and 56% (n=5) of the FQHCs indicated participation in a P4P arrangement. Of the 15 responding nursing homes and SNFs, 13% (n=2) plan to engage in a P4P arrangement within 6 to 12 months.

Figure 32. Provider Participation in a Pay for Performance (P4P) Arrangement (Q60)

Par7cipa7on in a Pay for Performance (P4P) Arrangement 100% 10% 11% 12% 13% 90% 2% 23% 6% 29% 1% 80% 3% 56% 27% 70% 63% 50% 14% 60% 83% Percentage 90% 59% 63% 50% 100% 100% 100% 100% 47%

40% 11%

30% 13% 60% 11% 57%

20% 40%

24% 25% 27% 10% 22% 23% 17% 10% 0% Nursing Community Federally Freestanding Home Health Den7st, Den7st, Hospital, Hospital, New Hospital, Hospital, Home & Nursing Mental Qualified Urgent and Hospice Prac7ce, General Pediatric Cri7cal Access Hampshire Non-Cri7cal Rehabilita7on Skilled Home, Total (n=197) Health Center Health Center CareCenter Agency Other (n=30) (n=86) (n=6) (n=7) Hospital (n=1) Access (n=8) (n=1) Nursing County (n=6) (n=10) (n=9) (n=1) (n=17) Facility (n=15) Provider Type Yes 1 5 2 2 5 7 22 Will do so in 6-12 months 1 1 2 4 Will do in 6 months 1 1 2 No plans 5 77 6 1 10 1 1 4 5 14 124 Unsure 4 9 2 1 4 4 1 2 9 1 8 45

71

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 33 outlines provider satisfaction with the CHERT that enables implementation and management of their P4P arrangement. More than half of respondents (58%; n=12) expressed that they were “very satisfied” or “somewhat satisfied” with the ability of their CEHRT to facilitate P4P arrangements. Fifteen percent (n=4) remained “neutral” on the issue while 5% (n=1) said that they were “somewhat dissatisfied.”

Figure 33. Satisfaction with CEHRT Ability to Enable and Manage P4P Arrangements (Q61)

Sa@sfac@on with CEHRT Ability to Enable and Manage P4P Arrangements 100% 10% 90% 20% 29% 10% 80% 40% 50% 10% 70% 14% 60% 50% 100% 100% 14% Percentage 48% 40% 80% 40%

30% 29% 50% 20% 15% 10% 20% 14% 0% 5% Federally Community Home Health Hospital, Hospital, Non- Qualified Prac@ce, Mental Health and Hospice Cri@cal Access Cri@cal Access Total (n=21) Health Center Other (n=7) Center (n=1) Agency (n=1) (n=2) (n=5) (n=5) Provider Type N/A 2 2 No opinion 1 1 2 Very sa@sfied 1 1 2 Somewhat sa@sfied 1 4 1 2 2 10 Neutral 1 2 1 4 Somewhat dissa@sfied 1 1

72

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 34 details current or future plans to participate in an ACO or similar arrangement categorized by provider type. While overall, 62% (n=122) cited no plans to participate in an ACO or similar arrangement, the CAHs (71%; n=5); FQHCs (70%; n=7); and non-CAHs (63%; n=5) were more likely than any other provider type to say that they were currently, or would be, participating in these arrangements within the next year.

Figure 34. Provider Participation in an ACO or Similar Organization (Q62)

Par7cipa7on in an ACO or Similar Organiza7on 100% 6% 10% 10% 12% 14% 90% 6% 25% 3% 7% 3% 6% 33% 80% 14% 7% 50% 22% 70% 60% 60% 25% 20%

Percentage 60%

50% 100% 100% 43% 100% 100% 50%

88% 13% 40% 10% 67% 30% 62% 56% 57% 25% 20% 40% 20% 29% 25% 10% 10% 13% 0% Federally Nursing Home Community Den7st, Den7st, Freestanding Home Health Hospital, Hospital, New Hospital, Non- Hospital, Nursing Qualified & Skilled Prac7ce, Grand Total Mental Health General Pediatric Urgent Care and Hospice Cri7cal Access Hampshire Cri7cal Access Rehabilita7on Home, County Health Center Nursing Other (n=30) (n=197) Center (n=10) (n=85) (n=6) Center (n=1) Agency (n=16) (n=7) Hospital (n=1) (n=8) (n=1) (n=6) (n=10) Facility (n=16) Provider Type Yes 6 1 1 4 4 3 19 Will do in 6-12 months 1 1 1 1 2 6 Will in 6 months 1 3 2 6 Unsure 6 10 2 1 4 2 1 2 8 2 6 44 No plans 4 75 6 1 9 1 1 4 4 17 122

73

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 35 shows how satisfied providers are with the ability of their respective CHERT to enable implementation and management of ACO arrangements. Of those who were considered satisfied, 53% (n=11) said that they were either “somewhat satisfied” or “very satisfied”; 21% (n=4) were “neutral”; and 5% (n=1) stated that they were “very dissatisfied.”

Figure 35. Provider Satisfaction with CHERT Ability to Enable and Manage ACO Arrangements (Q63)

Sa?sfac?on With CEHRT Ability to Enable and Manage ACO Arrangements 100% 11% 90% 25% 25% 33% 11% 80% 50% 70% 16% 60% 50% 100% 100% 50% 50% 37% 40% Percentage 67% 30% 50% 20% 21% 10% 25% 25% 0% 5% Federally Nursing Home Home Health Hospital, Hospital, Non- Qualified & Skilled Prac?ce, Other and Hospice Cri?cal Access Cri?cal Access Total (n=19) Health Center Nursing (n=3) Agency (n=1) (n=1) (n=4) (n=6) Facility (n=4) Provider Type N/A 1 1 2 No opinion 2 2 Very sa?sfied 3 3 Somewhat sa?sfied 3 1 1 2 7 Neutral 1 2 1 4 Very dissa?sfied 1 1

74

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

5.4 Health Information Technology (HIT) and Health Information Exchange (HIE) Future State Questions 14.7 and 14.8 were asked in order to better understand survey respondents’ HIT and HIE plans. Of the 266 total survey respondents, 35% (n=92) answered Q14.7: “Please take a moment to describe the current and future desired states of health information technology (HIT) across your organization. This would include items such as electronic health records, telemedicine, remote patient monitoring, broadband, etc.” Of the 266 total survey respondents, 37% (n=99) answered Q14.8: “Please describe the current and future desired states of health information exchange (HIE) across your organization. This would be the ability to do such things as submitting prescriptions to pharmacies electronically and sharing medical records or visit summaries electronically (not fax or email).”

The responses to each question are summarized below by provider type.

5.4.1. Desired and Future States of HIT (Q64) Q64 “Please take a moment to describe the current and future desired states of health information technology (HIT) across your organization. This would include items such as electronic health records, telemedicine, remote patient monitoring, broadband, etc.”

Q64. Community Mental Health Centers (n= 7)
Electronic Health Records. One cited poor workflow functionality and performance of current EHR and the need to add new EHR features at significant cost. The same respondent was also examining non-EHR solutions to make up for the lack of EHR functionality. One cited that there is a current EHR solution being implemented to include scheduling, ePrescribing, billing and EHR functionality; current solution has separate EHR and billing/scheduling solutions. One cited a recent EHR upgrade that is not yet taking full advantage of all features.
Health Information Exchange. One cited current implementation with statewide HIE and current connectivity with one lab and the desire to connect with a broader set of trading partners including more lab partners.
Telemedicine. Two cited desire to implement telemedicine, and another cited a current implementation with a national vendor partner.
Patient Access. One cited desire to use telemedicine for counseling visits.
Broadband. One cited desire to implement fiber optic broadband, and another cited the need for expansion due to telemedicine and EHR-driven bandwidth.
Mobile. One cited the desire to have mobile EHR applications but has not done so to date due to cost barriers.
Funding/Budget. Multiple respondents cited funding as a large barrier to implementing technology solutions.

75

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Q64. Federally Qualified Health Centers (n=6)
Electronic Health Records. One stated that it was beginning a discussion regarding migration to a new EHR vendor platform in order to achieve higher level provider satisfaction, population health management functionality, and interoperability with other providers.
Health Information Exchange. One desired HISP and application program interfaces (API) connections with local provider partners.
Analytics. One cited the need to invest in analytic capabilities.
Telemedicine. One cited the need to implement telemedicine functionality.
Patient Access. One cited the implementation of a new, secure email module in the next two years as well as a waiting room, tablet- based system for form data entry.
Broadband. One cited the need for “adequate broadband across all sites.”

Q64. Dentists (n=33)
Electronic Health Records. Four cited the need to implement EHRs. One cited the need to move beyond its current imaging system to an EHR in 2016. Four cited no need to implement an EHR as they rely on imaging systems as their primary electronic platform. One cited the need to upgrade to a new EHR vendor in the next few years.
Health Information Exchange. One cited a desire to eliminate the emailing of documents between practices and move towards HIE integration with other dental practices. One cited need for HIE with medical providers. One cited current sharing of images via secure email.
Practice Management System (PMS). One cited the need for an upgrade of its existing PMS.
Patient Access. One cited the desire to implement scheduling and EHR access for patients. Another cited no plans to allow patient access.
Provider Remote Access. One cited the need to implement this functionality.
Broadband. One cited the need to improve slow digital subscriber line (DSL) broadband connections.
Security. One cited the need for increased security and protection of EHRs. Another cited concern about liability for electronic data.
Secure Email. Multiple providers cited currently using secure email platforms; several wanted to implement secure email.
Funding/Budget. Multiple cited concerns about technology investments and budget.

Q64. Home Health and Hospice Agency (n= 10)
Electronic Health Records. One cited the need to move its current EHR system to a mobile platform. Two cited the need for an EHR upgrade to CEHRT but currently had no funds to do this. Another cited the need to choose and implement an EHR.
Health Information Exchange. One cited the need to be interoperable with agency partners. Another cited high vendor interface costs for HIE connections. 76

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Physician Portal. One cited current implementation of this feature for secure communication.
Telemedicine/Patient Monitoring. One cited current functionality. Another cited a current implementation. Two others cited the need to invest. Another cited lack of Medicare reimbursement.
Mobile/Tablets/iPads. Three cited current implementations. One cited issues with cellular coverage.

Q64 Hospital, Critical Access (n=4)
EHR Implementation and Consolidation. Two cited that they are currently moving from multiple EHRs to one EHR. One cited being committed to implementation of ambulatory EHR in 2016.
Telemedicine. Three respondents cited desire but no clear plans. Another cited the current use of telemedicine in a limited capacity.
Telepharmacy. One cited that they are exploring options.
Analytics. One cited the expectation of needing more analytics capacity.
Virtual Desktop Infrastructure (VDI) deployment. One cited as being in the final implementation stages.
Remote patient monitoring. One cited integration with its current EHR vendor is planned.
Broadband. One cited the need for expansion of broadband.

Q64. Hospital Non-Critical Access (n=7)
EHR Implementation and Consolidation. Four facilities cited moving toward a future state in which a new EHR vendor will replace one or more existing EHRs. Their expectations are that this will “enhance collaboration and workflow, eliminate many integration points, and reduce duplication of efforts.” One facility cited the desire for a single record but does not plan to pursue this prior to 2018 at the earliest.
Telemedicine. Two cited they were working on telemedicine (e-ED, e-ICU, e-Psych, e-Stroke).
Remote Health Monitoring. One cited the desire to implement remote health monitoring technologies.
Precision Medicine. One cited the desire to implement precision medicine technologies.
Picture Archiving and Communication System (PACS)/Image HIE. One cited the desire to expand HIE capabilities for PACS/images.

Q64. Nursing Homes, Skilled Nursing Facilities, and County Nursing Homes (n=8)
Future EHR. One cited that EHR will be implemented and organization is looking forward to it for efficiencies it will bring across departments improving information access for medical providers and improving the day-to-day care residents will receive.
Corporate Office. Two respondents cited that their corporate offices are driving the EHR implementation decisions.
Health Information Exchange. One cited that it needs to be able to share data between nursing home, and local hospital, EHRs especially for patient transfers. One cited being a “stand alone” provider when it comes to electronic data. 77

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Electronic Prescribing. One cited the need to implement electronic prescribing capabilities.

Q64. Practice, Other (n=13)
Disaster Recovery. One cited reliance on internet access and the need for a backup plan when internet access is not available.
Lack of Physician Interest. One cited that administrative staff would like an EHR but there is no physician interest. Another cited that due to impending physician retirement, no EHR is planned. Another cited that it “ruins patient interaction, costs too much, and obstructs good patient care.”
Automation. One cited the need for a higher level of automation of manual tasks and processes.
Moving to EHR. One cited the current use of billing and scheduling software and a move to EHR by end of 2016.
Meaningful Use. Once cited administrative burden of achieving MU and workflow delays caused by data capture requirements. Their EHR does not have easy to use search functions to wade through their dataset.

5.4.2 Current and Future States of HIE (Q65) Q14.8 “Please describe the current and future desired states of health information exchange (HIE) across your organization. This would be the ability to do such things as submitting prescriptions to pharmacies electronically and sharing medical records or visit summaries electronically (not fax or email).”

Q65. Community Mental Health Centers (n=8)
Desire to Implement Community Provider Health Information Exchange – Method Unspecified: 3 responses
Implementing Community Provider Health Information Exchange via NHNIO: 2 responses
Plan to Share Visit Summaries with Community Health Providers: 1 response
Desire Consumer Data Exchange/Access – Method Unspecified. 2 responses
Desire ePrescribing Capability: 3 responses
Desire to Add Event Notification Function: 1 response Q65. Federally Qualified Health Centers (n=7)
Desire to Implement Community Provider Health Information Exchange – Method Unspecified: 3 responses
Desire to Implement Community Provider Health Information Exchange via NHHIO: 1 response
Plan to Implement Further Transactions for Community Provider Health Information Exchange via NHHIO: 1 response
Desire ePrescribing Capability: 2 responses

78

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Q65. Dentists (n= 33)
No Health Information Exchange Capabilities Planned: 15 responses
Desire to Implement Community Provider Health Information Exchange – Method Unspecified: 8 responses
Desire ePrescribing Capability: 8 responses

Q65. Home Health and Hospice Agency (n= 10)
Plans to Implement Community Provider Health Information Exchange: 5 responses
Desire to Leverage NHHIO: 1 response
No Plans to Implement Health Information Exchange or Not Applicable: 1 response
Desire Physician Portal Capability: 4 responses
Desire Patient Portal Capability: 1 response

Q65. Hospital, Critical Access (n=4)
Plans to Leverage NHHIO: 1 response
Electronic Prescribing of Controlled Substances: 1 response
Desire for Greater Community Health Information Exchange Using Direct Protocols: 2 responses
Desire for State of NH to Accept Electronic Immunization Records: 1 response
Desire for HIE to Fully Replace Faxing: 1 response

Q65. New Hampshire Hospital (n=1)
Plans to Implement Community Provider Health Information Exchange: 1 response

Q65. Hospital, Non-Critical Access (n= 7)
Plans to Leverage NH Health Information Organization: 1 response
Plans Do Not Include NHHIO: 1 response
Desire to Share Lab Results: 1 response
Desire to Add Event Notification Function: 1 response

Q65. Nursing Homes, Skilled Nursing Facilities, and County Nursing Homes (n=9)
Plans to Implement Community Provider Health Information Exchange: 1 response

79

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

No Plans to Implement HIE or Not Applicable: 1 response
Unsure of Plans to Implement HIE: 1 response
Electronic Prescribing: 2 cited plans to implement

Q65. Practice, Other (n=12)
Plans to Implement Community Provider Health Information Exchange: 4 responses
No Plans to Implement HIE or Not Applicable: 3 responses
Unsure of Plans to Implement HIE: 1 response
Desire Electronic Prescribing Capability: 3 responses
Desire Problem List Summary Sharing Capability: 1 response
Desire Allergy Summary Sharing Capability: 1 response
Desire Patient Access Capability: 1 response

[Remainder of Page Left Intentionally Blank]

80

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

6.0 Appendices 6.1 Appendix A: Index of Tables and Figures

Table 1. Percent of Respondents by Provider Type (Q3) ...... 12 Table 2. Distribution of Dentists with Regard to Medicaid ...... 13 Figure 1. Distribution of Survey Respondent Titles (Q2) ...... 14 Figure 2. Types of Hospital Respondents (Q4) ...... 15 Figure 3. Rural Health Clinic Ownership Status by Hospital Type (Q5) ...... 16 Figure 4. Skilled Nursing Facility by Type (Q6) ...... 17 Figure 5. Number and Percentage of EHR Systems by Provider Type (Q7) ...... 18 Figure 6. Number and Percentage of Providers Without an EHR Who Intend to Implement One Within Two Years (Q8) ...... 19 Figure 7. Reasons Driving Providers to Implement EHR Systems Within Two Years (Q9) ...... 20 Figure 8. Brand of EHR Organizations Plan to Implement within Next Two Years (Q24) ...... 21 Figure 9. Number and Percentage of Organizations That Attested for the Medicare EHR Incentive Program Prior to 2015 (Q14) ...... 23 Table 4. Number and Percentage of Primary Reasons Organizations Did Not Attest to the Medicare EHR Incentive Program Prior to 2015 (Q15) ...... 24 Table 5. Number and Percentage of EPs That Attested for the Medicare EHR Incentive Program Prior to 2015 Program Year (Q16) .. 25 Table 6. Primary Reasons EPs Did Not Attest to Medicare EHR Incentive Program (Q16i) ...... 26 Figure 10. Number and Percentage of Organizations That Plan to Attest for the Medicare EHR Incentive Program for 2015 or 2016 (Q17) ...... 27 Figure 11. Number and Percentage of EPs That Intend to Attest for a Medicare EHR Incentive Program for 2015 or 2016 (Q18) ...... 28 Figure 12. Number and Percentage of Organizations That Attested to the Medicaid EHR Incentive Program Prior to 2015 (Q19) ...... 29 Figure 13. Number and Percentage of Reasons Organizations With EPs Did Not Attest to the Medicaid EHR Incentive Program Prior to 2015 (Q19i) ...... 30 Figure 14. Number and Percentage of Organizations With EPs That Attested to the Medicaid EHR Incentive Program Prior to 2015 (Q20) ...... 31 Table 7. Reasons EPs Did Not Attest for the Medicaid EHR Incentive Program (Q20i) ...... 32

81

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 15. Number and Percentage of Organizations Planning to Attest for the Medicaid EHR Incentive Program for 2015/2016 (Q21) ...... 33 Figure 17. Provider Awareness of Medicaid and Medicare EHR Incentive Programs for Those With No Intention of Implementing an EHR Within the Next Two Years (Q8 and Q11) ...... 35 Figure 18. Practice Interest in EHR Incentive Programs for Those with No Intention of Implementing an EHR Within the Next Two Years (Q12) ...... 36 Figure 19. Provider Perception of State Assistance with EHR Adoption for Those with No Intention of Implementing an EHR Within the Next Two Years (Q13) ...... 37 Table 8. Current Brand of EHR by Provider Type (Q25 and Q26) ...... 38 Figure 20. Number and Percentage of Organizations That Currently Use, or Plan to Use, CEHRT Within the Next Two Years (Q23) ... 39 Table 9. Reasons by Provider Type for Not Implementing CEHRT Within the Next Two Years (Q23i) ...... 40 Figure 21. Plans to Consolidate Multiple EHR Systems (Q27) ...... 41 Figure 22. EHR Brands to Which Providers Plan to Consolidate (Q28) ...... 42 Figure 24. Provider Plans to Upgrade CEHRT System within the Next Two Years (Q39) ...... 43 Table 10. Percent of Organizations with Computerized Capabilities to Meet Selected MU Objectives (Q43) ...... 48 Table 14. Number and Percentage of Organizations with Computerized Capabilities to Meet Selected MU Objectives for Providers with a Second EHR (Q43) ...... 58 Table 15. Number and Percentage of Organization with Computerized Capabilities to Meet Selected MU Objectives for Providers with a Second EHR (Q43) ...... 59 Table 16. Types of Providers With Which Patient Health Information is Shared via Current EHR System (Q44) ...... 60 Table 17. Types of Data Exchanged Shared With Other Providers via Current EHR System by Type of Data (Q45) ...... 61 Figure 28. Number and Percentage of Provider Types Sharing Data via a Summary Care Record (Q46) ...... 63 Table 18. Vendors to Whom Providers are Connected for HIE Transactions (Q47) ...... 64 Figure 29. Number and Percentage of Organizations Using a HISP for Direct Messaging (Q48) ...... 65 Figure 30. Broadband Access as a Challenge to Provider HIT/HIE (Q57) ...... 68 Figure 31. Number and Percentage of Practices That Have Assessed Potential Electronic Health Information Risks and Vulnerabilities (Q59) ...... 69 Figure 32. Provider Participation in a Pay for Performance (P4P) Arrangement (Q60) ...... 71 Figure 33. Satisfaction with CEHRT Ability to Enable and Manage P4P Arrangements (Q61) ...... 72 82

The State of Health Information Technology and Exchange in New Hampshire Survey Results May 27, 2016

Figure 34. Provider Participation in an ACO or Similar Organization (Q62) ...... 73 Figure 35. Provider Satisfaction with CHERT Ability to Enable and Manage ACO Arrangements (Q63) ...... 74

6.2 Appendix B: Survey Instrument

See next page.

83