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Provider Enrollment
Health Information Technology (HIT) Survey Results
August 2019
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Table of Contents Summary ......................................................................................................................... 3 Main Results and Conclusions ........................................................................................ 3 Topics and Key Outcomes .............................................................................................. 4
Methods .......................................................................................................................... 5
Provider Enrollment HIT Survey Questions ..................................................................... 5
Detailed Findings ............................................................................................................ 6 History and Background ................................................................................................ 26 Final Summary .............................................................................................................. 26 Table 1 - Use of EHRs .................................................................................................... 6
Table 2 - Intention to Purchase an EHR .......................................................................... 8 Table 3 - Intention to Purchase an EHR = Yes and Estimated Timeframe of Purchase .. 9 Table 4 - Use of Certified Electronic Health Record Technology (CEHRT) ................... 10 Table 5 - CEHRT Version in Use .................................................................................. 11
Table 6 - Participation in EHR Incentive Program ......................................................... 11 Table 7 - Participation in the EHR Incentive Program (Yes Responses) ....................... 13
Table 8 - Participation in EHR Incentive Program (No Responses) .............................. 14 Table 9 - Interest in Submitting eCQMs to IME ............................................................. 15 Table 10 - Participation in IHIN ..................................................................................... 16
Table 11 - Participation in IHIN (Yes Responses) ......................................................... 17 Table 12 - Participation in IHIN (No Responses) ........................................................... 18 Table 13 - Participation in Other Health Information Exchange (excluding IHIN) .......... 19
Table 14 - What can Medicaid do to Assist in the Adoption and MU of EHR ................ 20
Table 15 - Provider Type ............................................................................................... 21 Table 16 - Provider Specialty ........................................................................................ 23
Figure 1 - Use of EHRs ................................................................................................... 7 Figure 2 - Intention to Purchase an EHR ......................................................................... 8 Figure 3 - Intention to Purchase an EHR = Yes and Estimated Timeframe of Purchase 9 Figure 4 - Use of Certified Electronic Health Record Technology (CEHRT) .................. 10 Figure 5 - CEHRT Version in Use ................................................................................. 11
Figure 6 - Participation in EHR Incentive Program ........................................................ 12 Figure 7 - Participation in the EHR Incentive Program (Yes Responses) ...................... 13
Figure 8 - Participation in EHR Incentive Program (No Responses) ............................. 14 Figure 9 - Interest in Submitting eCQMs to IME ............................................................ 15 Figure 10 - Participation in IHIN .................................................................................... 16 Figure 11 - Participation in IHIN (Yes Responses) ........................................................ 17 Figure 12 - Participation in IHIN (No Responses) ......................................................... 18 Figure 13 - Participation in Other Health Information Exchange (excluding IHIN) ......... 19
Figure 14 - What can Medicaid do to assist in the Adoption and MU of EHR ................ 20 Figure 15 - Provider Type .............................................................................................. 22
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Figure 16 - Provider Specialty ....................................................................................... 25
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Summary
The Centers for Medicare and Medicaid Services (CMS) Promoting Interoperability
Program (formerly, Electronic Health Records (EHR) Incentive Programs or Meaningful
Use) was established, through provisions of the American Recovery and Reinvestment
Act of 2009 (ARRA), to provide incentive payments to eligible professionals (EPs),
eligible hospitals, critical access hospitals (CAHs), and Medicare Advantage
Organizations to promote the adoption and meaningful use of interoperable health IT
and certified EHRs. The CMS Promoting Interoperability Program has accelerated the
adoption and utilization of health IT and certified EHR systems nationally. Challenges
exist as healthcare organizations and professionals attempt to adopt and meaningfully
use health IT, certified EHR systems, and participate in the Promoting Interoperability
incentive Program.
The Iowa Medicaid Enterprise (IME) is tasked to evaluate the landscape of Iowa’s
health information technology (HIT), as part of CMS’ requirements for the State
Medicaid Health IT Plan (SMHP). This provider enrollment HIT survey serves to fulfill
the annual SMHP requirement and reflects Iowa Medicaid provider adoption of EHRs
and state of health information exchange. The purpose of this document is to report the
responses to the survey questions.
Main Results and Conclusions
This report presents the results of the HIT survey which providers must complete as
part of the Medicaid provider enrollment and re-enrollment process. The report aims to
evaluate Medicaid’s HIT landscape including participation in the Centers for Medicare &
Medicaid Services’ (CMS) Promoting Interoperability Program (formerly known as the
Electronic Health Records (EHR) Incentive Programs or Meaningful Use programs), use
of EHRs, use of certified EHRs (CEHRT), interest of reporting Clinical Quality Measures
(CQMs) to the IME, and use of Health Information Exchange (HIE).
The frequency of the re-enrollment process is every five years. Prior to 2016 this was
done with all providers concurrently. In 2016 the process was changed so the date of
re-enrollment is captured in the Medicaid system and is based off of this date so the re-
enrollment is spread out (i.e. a provider who completed re-enrollment 01/01/ 2016 will
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be required to complete re-enrollment again 01/01/2021). Between 2016 and 2018 the
IME Provider Services unit worked with all Medicaid providers to complete re-
enrollment. Due to all Medicaid providers re-enrollment between 2016 and 2018, this
HIT survey has a robust set of data, especially during 2016. Subsequent HIT surveys in
2019 and 2020 may contain low numbers due to the five year re-enrollment cycle.
The IME has over 50,000 unique active providers by NPI, which includes all provider
types. The results below are reported by individual NPI.
Topics and Key Outcomes
Topics Key Outcomes
(average across 3 survey years)
Current use of EHR > 70% use an EHR
Intention to purchase an EHR > 70% who do not use an EHR do not
intend to purchase an EHR within 1-5
years
Use of certified EHR technology to meet
meaningful use
> 75% of respondents that currently
have an EHR use CEHRT
Version of CEHRT in use 7% or less of respondents use 2011
CEHRT. The majority of respondents
who are using CEHRT reported using
2014 and 2015 versions of CEHRT.
Participation in the Promoting Interoperability
Program (formerly, Electronic Health Records Incentive
Program or Meaningful Use)
>70% of respondents participate in the
Promoting Interoperability Program
Interest in submitting eCQMs (Electronic
Clinical Quality Measures) to the IME which
could be linked to payment incentives
> 70% of respondents do NOT want to
submit eCQMs to the IME
Participation in Iowa's Health Information
Exchange (HIE); the Iowa Health Information
Network (IHIN)
Majority of respondents are NOT
connected with the IHIN
Participation in any Health Information
Exchange (excluding the IHIN)
Majority of respondents are NOT
connected with any HIE
How Medicaid can assist in the adoption and
meaningful use of electronic health records?
Majority responded "Other" and "Share
best practice information"
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Provider types participating in the survey Majority responded "Physician MD"
Specialties participating in the survey Majority responded "NA" or "Family
Practice"
Methods
The HIT survey includes all Medicaid providers required to enroll or re-enroll with Medicaid. Data is collected on an on-going basis as providers enroll or re-enroll. All providers were required to re-enroll with IME beginning in 2016. The data set from 2016 is much larger compared to 2017 and 2018. The results represent data collected from November 2015 through December 2018. November and December 2015 data has been included in the 2016 data reported below, as the re-enrollment process included this timeframe. The provider enrollment HIT survey was updated fall of 2015 to better align with the HIT and Meaningful Use Landscape survey1 which was performed in 2015. The IME did not list every provider type or specialty on the survey; so many respondents chose the “Other” or “N/A” category, as the other options were not applicable when answering the questions “select your provider type” and “select your specialty.” Logic was programmed into the survey so when a question is answered the provider is skipped to the next relevant question. Some questions were asked of all providers. The detailed findings reflect providers’ answers given for each question asked in the HIT survey and results are displayed in both tables and figures. The number of responses for each question is listed in the Total Response column of the table.
Provider Enrollment HIT Survey Questions
1. Do you currently use electronic health records (EHR)? 2. Do you intend to purchase an EHR? 3. Has your EHR software been certified to meet meaningful use? 4. What version CEHRT are you running? 5. Do you participate in the Electronic Health Records Incentive Program
(Meaningful Use)? 6. Electronic Clinical Quality Measures (eCQMs) use data from electronic health
records (EHR) and/or health information technology systems to measure health care quality within the healthcare delivery system. They are defined, maintained,
1 For more information see: http://ppc.uiowa.edu/publications/iowa-health-information-technology-and-meaningful-use-landscape-2015
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and updated in order to produce standardized measures to make collection, use, and comparisons easier. Measuring and reporting eCQMs helps to make sure that care is delivered safely, effectively, equitably, and timely. eCQMs are used today with several Medicare programs including MSSP (Medicare Shared Savings Program), PQRI (Physician Quality Reporting Initiative) and MU (Meaningful Use). Would you be interested in submitting eCQMs to the IME which could be linked to payment incentives?
7. Are you connected to Iowa's Health Information Exchange (HIE); the Iowa Health Information Network (IHIN)?
8. Are you connected to a Health Information Exchange? (excluding the IHIN) 9. What can Medicaid do to assist you in the adoption and meaningful use of
electronic health records? (Check all that apply) 10. Please select your provider type. 11. What is your specialty?
Detailed Findings
The following data presents each question asked in the HIT survey and the responses given. Logic was programmed into the survey so when a question was answered the provider is skipped to the next applicable question. Some questions were asked of all providers. The number of responses for each question is listed in the Total Response column.
Table 1 - Use of EHRs
Do you currently use electronic health records (EHR)?
Total Response Yes No
2016 17561 15668 1893
2017 9230 6688 2542
2018 1388 1128 260
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Figure 1 - Use of EHRs
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If the response to “Do you currently use electronic health records (EHR)?” was “No,” the question “Do you intend to purchase an EHR?” was asked.
Table 2 - Intention to Purchase an EHR
Do you intend to purchase an EHR? Total Response Yes No
2016 1900 511 1389
2017 2543 741 1802
2018 260 69 191
Figure 2 - Intention to Purchase an EHR
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Table 3 - Intention to Purchase an EHR = Yes and Estimated Timeframe of Purchase
Do you intend to purchase an EHR? Yes…
Yes Total Response
Yes within 1
year
Yes within 3 years
Yes within 5 years
2016 511 213 168 130
2017 741 144 457 140
2018 69 48 8 13
Figure 3 - Intention to Purchase an EHR = Yes and Estimated Timeframe of Purchase
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Table 4 - Use of Certified Electronic Health Record Technology (CEHRT)
Has your EHR software been certified
to meet meaningful use? Total Response Yes No N/A
2016 15988 13708 550 1730
2017 6714 5897 315 502
2018 1128 606 11 511
Figure 4 - Use of Certified Electronic Health Record Technology (CEHRT)
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Table 5 - CEHRT Version in Use
What version CEHRT are you running? Total Response 2011 2014 2015
2016 14624 1031 8370 5223
2017 6479 478 1257 4744
2018 1117 12 116 989
Figure 5 - CEHRT Version in Use
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Table 6 - Participation in EHR Incentive Program
Do you participate in the Electronic Health Records Incentive Program (Meaningful Use)? Total Response Yes No
2016 14604 11259 3345
2017 6520 5284 1236
2018 1119 673 446
77% 81%
60%
23% 19%
40%
0%
20%
40%
60%
80%
100%
120%
2016 2017 2018
Do you participate in the Electronic Health Records Incentive Program (Meaningful Use)?
Yes No
Figure 6 - Participation in EHR Incentive Program
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Table 7 - Participation in the EHR Incentive Program (Yes Responses)
Do you participate in the Electronic Health Records Incentive
Program (Meaningful Use)? Yes
Yes, Both dually
eligible for Medicaid
and Medicare
Yes
Medicaid
Yes
Medicare
2016 11259 9320 295 1644
2017 5284 3258 498 1528
2018 673 546 16 111
Figure 7 - Participation in the EHR Incentive Program (Yes Responses)
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Table 8 - Participation in EHR Incentive Program (No Responses)
Do you participate in the Electronic Health Records Incentive
Program (Meaningful Use)? No
No I am not
eligible to
participate
No I do not have
enough
information on
this program
No not
interested
2016 3345 346 1321 1678
2017 1236 278 448 510
2018 446 49 102 295
Figure 8 - Participation in EHR Incentive Program (No Responses)
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The following explanation was presented to all providers, which preceded the question: Electronic Clinical Quality Measures (eCQMs) use data from electronic health records (EHR) and/or health information technology systems to measure health care quality within the healthcare delivery system. They are defined, maintained, and updated in order to produce standardized measures to make collection, use, and comparisons easier. Measuring and reporting eCQMs helps to ensure that care is delivered safely, effectively, equitably, and timely. eCQMs are used with several CMS programs including the Promoting Interoperability Program. More information about eCQMs can be found on the eCQI Resource Center (https://ecqi.healthit.gov/). Table 9 - Interest in Submitting eCQMs to IME
Would you be interested in submitting eCQMs to the
IME which could be linked to payment incentives? Total Response Yes No
2016 16691 5797 10894
2017 9332 2636 6696
2018 1386 274 1112
35%28%
20%
65%72%
80%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2016 2017 2018
Would you be interested in submitting eCQMs to the IME which could be linked to payment incentives?
Yes No
Figure 9 - Interest in Submitting eCQMs to IME
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Table 10 - Participation in IHIN
Are you connected to Iowa's Health Information Exchange
(HIE); the Iowa Health Information Network (IHIN)? Total Response Yes No
2016 21751 10074 11677
2017 10453 2376 8077
2018 1400 66 1334
Figure 10 - Participation in IHIN
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Table 11 - Participation in IHIN (Yes Responses)
Are you connected to Iowa's Health
Information Exchange (HIE); the Iowa
Health Information Network (IHIN)?
Response = YES Yes Total Response
Yes
Cancer
Reporting
(cancer registry)
Yes
Direct Secure
Messaging
Yes
Electronic Lab
Reporting
(smartlab)
Yes
Query
Functionality
2016 10074 2807 3015 1522 2730
2017 2376 156 844 465 911
2018 66 4 18 7 37
Figure 11 - Participation in IHIN (Yes Responses)
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Table 12 - Participation in IHIN (No Responses)
Are you connected to Iowa's Health
Information Exchange (HIE); the Iowa
Health Information Network (IHIN)?
Response = NO No Total Response
No plans to
exchange
information
No but plan
to within 1
year
No but plan to
within 2-3 years
2016 11677 9496 842 1339
2017 8077 5794 590 1693
2018 1334 948 39 347
Figure 12 - Participation in IHIN (No Responses)
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Table 13 - Participation in Other Health Information Exchange (excluding IHIN)
Are you connected to a Health Information Exchange? (excluding the IHIN)
Total Response Yes No
2016 8628 6387 2241
2017 3617 2068 1549
2018 438 45 393
Figure 13 - Participation in Other Health Information Exchange (excluding IHIN)
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Table 14 - What can Medicaid do to Assist in the Adoption and MU of EHR
What can Medicaid do to
assist you in the adoption and
meaningful use of electronic
health records? (Check all
that apply)
Total
ResponseOther
Share best
practice
information
Identify
products
Provide
technical
assistance for
implementation
Connect me with
similar providers
who have
adopted EHR for
information
Provide
technical
assistance
for product
selection
2016 39058 17263 11689 4028 3255 1705 1118
2017 21517 9090 6184 2558 1442 1300 943
2018 3162 1386 795 397 133 349 102
Figure 14 - What can Medicaid do to assist in the Adoption and MU of EHR
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Table 15 - Provider Type
Provider Type 2016 2017 2018
Adult Rehab 520 7 8
Audiologist 59 15 0
Behavioral Health 731 473 73
Certified Nurse Midwife 0 1 0
Chiropractor 182 797 92
Clinical Social Worker 191 53 4
CRNA 51 118 7
Dentist 344 491 7
Family Planning 57 22 0
Habilitation Services 1294 31 5
Independent Speech Pathologist 0 8 0
Maternal Health Center 18 4 0
Medical Supplies 45 95 9
Mental Health Substance Abuse Plan 28 6 0
N/A 5298 1754 402
Nurse Practitioner 56 35 3
Occupational Therapist 25 4 0
Optician 9 4 3
Optometrist 174 255 31
Other Practitioner - General 971 450 142
Para Professional 27 7 0
Pharmacy 150 261 13
Physical Therapist 431 220 31
Physician Assistant 35 0 0
Physician DO 307 748 41
Physician MD 7186 3411 502
Podiatrist 45 78 10
Psychologist 26 22 3
Therapeutic Treatment Service 0 1 0
TOTAL RESPONSE 18260 9371 1386
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Figure 15 - Provider Type
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Table 16 - Provider Specialty
Specialty 2016 2017 2018
Addiction Medicine 402 17 0
Allergy 14 25 2
Ambulance 34 83 8
Anesthesiology 623 355 8
Cardiac Surgery 0 0 4
Cardiovascular 49 26 148
Chiropractic 155 731 89
Critical Care 97 5 10
Dentist 239 339 4
Dermatology 9 45 5
Endocrinology 0 5 0
Family Practice 3909 1436 109
Gastroenterology 97 82 11
General Practice 726 544 240
General Surgery 408 72 6
Geriatric Medicine 24 18 1
Gynecological 6 6 14
Hematology 0 1 0
Independent Lab 31 24 3
Infectious Disease 0 5 6
Internal Medicine 385 375 38
Maxillofacial Surgery 12 1 0
Medical Oncology 0 32 0
N/A 7889 2802 209
Nephrology 1 85 17
Neuro Surgery 0 3 0
Neurology 27 37 2
Neuropsychiatry 0 1 0
OB/GYN 81 76 11
Oncology 14 147 5
Ophthalmology 44 155 8
Optometry 173 246 35
Oral Surgery 11 30 0
Ortho Surgery 187 122 13
Orthodontist 24 14 0
Otolaryngology 38 75 10
Pain Management 22 49 10
Pathology 5 68 29
Pediatrics 1137 251 8
Pedontist 7 2 0
Physical Medicine 7 11 0
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Rehab
Physical Therapy 475 226 32
Plastic Surgery 0 6 3
Podiatrist 45 78 10
Portable Xray 0 1 0
Preventive Medicine 6 3 0
Proctology 0 3 0
Psychiatry 545 137 23
Pulmonary 2 40 4
Radiology 268 370 237
Rheumatology 15 10 1
Thoracic Surgery 0 0 2
Urology 70 71 8
Vascular Surgery 0 87 3
TOTAL RESPONSE 18313 9433 1386
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Figure 16 - Provider Specialty
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History and Background
The CMS Promoting Interoperability Program was established, through provisions of the American Recovery and Reinvestment Act of 2009 (ARRA), to provide incentive payments to eligible professionals (EPs), eligible hospitals, critical access hospitals (CAHs), and Medicare Advantage Organizations to promote the adoption and meaningful use of interoperable health IT and certified EHRs. The IME is tasked to evaluate the landscape of Iowa’s health information technology, as part of CMS’ requirements for the State Medicaid Health IT Plan (SMHP). This provider enrollment HIT survey serves to fulfill the annual SMHP requirement and reflects Iowa Medicaid provider adoption of EHRs and state of health information exchange. The provider enrollment HIT survey began in May 2013, however, the IME has been collecting and reporting various HIT survey results through the SMHP since program inception. Other surveys performed include:
E-Health: Baseline Assessment of Health Information Technology Use by Providers In Iowa2
Iowa Health Information Technology and Meaningful Use Landscape in 20153 Other benefits and results of electronic health records and the Promoting Interoperability Program can be found on www.HealthIT.gov, and CMS’ Promoting Interoperability Programs website.4
Final Summary
The IME will continue to conduct and report on the provider enrollment/re-enrollment HIT survey through December 2021. As the HIT landscape changes in Iowa or nationally the survey may be updated as appropriate. The Medicaid Promoting Interoperability Program closes December 31, 2021 and will cease incentive payments on this date per statute. The objectives of the program and stages of Meaningful Use include:
Stage 1 – Data capture and sharing
Stage 2 – Advanced clinical processes
2 More information regarding the assessment can be found here: http://ppc.uiowa.edu/health/study/e-health-baseline-assessment-health-information-technology-use-providers-iowa 3 More information regarding the HIT Landscape survey in 2015 can be found here: http://ppc.uiowa.edu/publications/iowa-health-information-technology-and-meaningful-use-landscape-2015 4 More information on the Promoting Interoperability program can be found here: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
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Stage 3 – Improved outcomes CMS and ONC continue to propose rulemaking to increase the use and sharing of data captured within CEHRT, and establish national governance to share the data. Through the IME’s Provider Enrollment HIT survey, we can see the majority of Iowa Medicaid providers in Iowa have adopted an EHR technology. However, broadly sharing the data through health information exchange is yet to be determined. Proposed rules from CMS5 and ONC6 may impact the broader goal of health information exchange and patient engagement.
5 More information on CMS’ proposed rule can be found at https://www.cms.gov/newsroom/fact-sheets/cms-advances-interoperability-patient-access-health-data-through-new-proposals 6 More information on ONC’s proposed rule can be found at https://www.healthit.gov/sites/default/files/draft-trusted-exchange-framework.pdf and https://www.healthit.gov/topic/laws-regulation-and-policy/notice-proposed-rulemaking-improve-interoperability-health
