199 Harris Interactive study of use of computing by physicians--the most comprehensive of its times (and probably to this day)

1. A Survey of Over 750 Physicians Conducted by Harris Interactive Inc. Data collected: October 14, 1999 - December 31, 1999 Revised presentation of findings March 13, 2000 Computing in the Physician’s Practice “ 40% of physicians use Internet for clinical or medical business use”

5. Preface: Practice Issues and Experience with Patient Care “ Utilization review, patient relationship continuity, and time pressure on patient care are all concerns”

7. Since 1997: A big jump in the number of managed care patients Q.A2 What percentage of your patients are in each of the following insurance categories? Mean percent of patients in each category Asked of all physicians (n = 769)

8. Besides managed care, physicians are concerned about administrative costs and systems hassles Q.A1 Please indicate how much of a problem the following has been for you in your practice. Percentage of physicians who experienced serious problems with: Asked of all physicians (n = 769)

9. Practice income: 1997 - 1999 Q.F1 Which of the following income categories best describes your last year’s pre-tax income from your medical practice? Asked of all physicians (n = 769)

10. Geographic setting of practice Q.F4 How would you describe the geographic setting of your practice? Is it an urban center, a suburb, a small town or a rural location? Asked of all physicians (n = 769)

11. Part One: Attitudes about Computing and Internet Use “ Over one-third of physicians have access to the Internet in their clinical work area”

13. Physicians have a positive attitude towards computing Q.A7 Which one of the following statements best reflects how you feel about the use of computers in medicine? Asked of all physicians (n = 769)

14. Hindrances to information technology use Q.A8 To what extent is your current use of information technology hindered by each of the following - to a great extent, some extent, or hardly at all? % Responding “Great/Some Extent” Asked of all physicians (n = 769)

15. Nine in ten physicians are online % currently accessing Internet in following places: Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places?

16. The vast majority of physicians now have access to the Internet at home . . . most of the rest will soon Will have access within 18 months Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access at home

17. Will have access within 18 months Half of physicians’ offices have Internet access in their administrative areas . . . Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying their office staff has Internet access in their administrative areas

18. . . . and half of physicians have access to the Internet in their personal office area Will have access within 18 months Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access in their personal office area

19. Will have access within 18 months But only one-third of physicians have Internet access in their clinical work area . . . Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying they have Internet access in their clinical work area

20. Will have access within 18 months . . .although slightly more of their clinical staff have Internet access in their clinical work area Asked of all physicians (n = 769) Q.B1 Among all the people in your practice, who currently accesses the Internet (including online services like AOL) in each of the following places? Physicians saying their clinical staff has Internet access in their clinical work areas

21. The average online physician uses the Internet 6 hours per week Q.B3 In the past week, how many hours did you personally spend using the Internet (or other online services) for all purposes, including business, personal, email, etc.? Hours spent online in past week by physicians with Internet access Mean = 6 hours Median = 5 hours Asked of all physicians with Internet access (n = 687)

22. Why are physicians accessing the Internet? It’s mostly personal Average number of hours on Internet in past week = 6 % of physicians’ Internet use for different functions Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Asked of all physicians who used Internet in past week (n = 612)

24. Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: Physicians are on E*trade, ESPN and Match.com, especially at home Calculated from physicians who used Internet for personal use in the past week (n = 573) Personal use = 61% of all Internet use % of time physicians spend on Internet for personal use in the following locations:

25. Specific clinical work relating to individual patients = 8% of all Internet use The little Internet clinical work about individual patients that is done, happens mostly in physicians’ personal office area Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physicians spend on Internet for specific clinical work relating to individual patients in the following locations:

26. Both at home and at work, doctors are using the Internet for the business of medicine . . . Business, administrative and organizational issues relating to practice = 16% of all Internet use Calculated from physicians who used Internet for business, administrative and organizational issues relating to practice in the past week (n = 335) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physician spends on Internet for business administrative and organizational issues relating to practice in the following locations:

27. . . .and it’s also used for to look for general clinical information Specific clinical work relating to individual patients = 16% of all Internet use Calculated from physicians who used Internet for specific clinical work relating to individual patients in the past week (n = 219) Q.B3b Of those hours spent on the Internet during the past week, what percentage of the time did you use the Internet (or other online services) to do each of the following? Q.B4 For each of the following purposes shown, record the percentage of time you used the Internet: % of time physician spends on Internet for specific clinical work relating to individual patients in the following locations:

28. Websites: Not all physicians have them . . . Q.B5 Does your practice have a website? Asked of physicians who have Internet access somewhere in their practice (n = 706) % of physicians with a website

29. Practice will have web site within 18 months . . . but many more will get them Q.B5 Does your practice have a website? Q.B5A If your practice does not currently have a website, do you anticipate getting one within the next 18 months? Asked of physicians who have Internet access somewhere in their practice (n = 706)

32. Part Two: Computers and Networks in Office “ 95% of physicians have computers in their practice”

34. The average physician has 15 computers in their office or practice setting Q.C1 How many computers are there in your office or practice setting? Include all computers used by administrative and clinical staff. Number of computers in physicians’ office Mean # of computers = 15 Median # of computers = 5 Asked of all physicians (n = 769)

39. Like the rest of us, physicians’ offices get their Net access through ISPs Q.B2 Who provides Internet access at your office or clinical workplace? Asked of physicians who have Internet service somewhere in their practice (n = 534)

44. Part Three: Administrative Use of Computing “ Physicians’ practices use computers for billing information, claims submission and scheduling ”

46. Physicians on their practice’s use of computing for administration: Only billing, claims, and scheduling are ubiquitous Q.C4 Does your practice use a computer for the following activities? Asked of all physicians who have computer in their office or practice setting (n = 708) Percent physicians responding uses a computer in their practice

47. Plan to use within 18 months Physicians on their practice’s use of computing for administration: Most practices use computers for recording billing information and generating patient bills Q. C4 Does your practice use computers for any of the following functions? Proportion of patients for which practices are using computers for recording billing information and generating patient bills Asked of physicians who have computer in their office or practice setting (n = 708)

48. Physicians on their practice’s use of computing for administration: Most offices submit the majority of their claims online . . . Proportion of patients for which practices are using computers to submit claims electronically Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

50. Proportion of patients for which practices are using for computers for scheduling and other practice administration Physicians on their practice’s use of computing for administration: Over half use computers for patient scheduling Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

51. Proportion which practices are using computer for looking up billing codes, CPT information, Medicare information, etc. Physicians on their practice’s use of computing for administration: Over half look up billing codes on a computer Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

52. Proportion for which practices are using computers to submit claims status inquiries to health plans Physicians on their practice’s use of computing for administration: Nearly half submit claims status inquiries to health plans online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

53. Proportion for which practices are using computers to inquire about patient eligibility verification from health plans Physicians on their practice’s use of computing for administration: Only one third use a computer for inquiring about patient eligibility, but this should see modest growth Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

54. Proportion which practices are using computers to receive electronic payments from health plans, IPAs and payers Physicians on their practice’s use of computing for administration: Nearly one in three receive electronic payments Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

55. Proportion which practices are using computers to document patient encounters for reporting to health plans or IPAs Physicians on their practice’s use of computing for administration: Three in ten use a computer for documenting patient encounters to report to health plans or IPAs Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

56. Proportion for which practices use computers to authorize referrals from health plans Physicians on their practice’s use of computing for administration: Less than one quarter authorize referrals online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

57. Proportion for which practices are using computers to receive earned remittance advice from health plans, IPAs and payers Physicians on their practice’s use of computing for administration: One in five receive earned remittance advice from payers Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

58. Proportion for which practices are using computers to look up directories of providers supplied by health plans or IPAs Physicians on their practice’s use of computing for administration: Fewer than one in five look-up provider directories on a computer Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

59. Proportion for which practices are using computers to pre-certify hospital admissions Physicians on their practice’s use of computing for administration: Only a tiny minority pre-certify hospital admissions online Asked of physicians who have computer in their office or practice setting (n = 708) Plan to use within 18 months Q. C4 Does your practice use computers for any of the following functions?

61. Part Four: Services for Patients “ Most physicians’ practices provide very few information services for patients ”

63. For patients, most practices only offer information on videos or paper Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Asked of all physicians (n = 769) Percent physicians offer in their practice setting

64. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Pamphlets and handouts Almost all physicians offer pamphlets and handouts Asked of all physicians (n = 769)

65. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Informational videos that can be viewed in the office Asked of all physicians (n = 769) Nearly half offer informational videos

66. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Patients have ability to complete histories or health risk assessments at home on paper before they visit the office Asked of all physicians (n = 769) Two in five practices offer patients the ability to complete histories or HRAs at home before they visit the office

67. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Directions to pre-selected healthcare websites that can be accessed from home One in six suggest healthcare websites to patients Asked of all physicians (n = 769)

68. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Access to computer-based information in office Asked of all physicians (n = 769) One in ten offer computer-based information for patients in their offices

69. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Ability to complete health risk assessments on computer in office Asked of all physicians (n = 769) Few patients have the ability to complete HRAs on computers in their offices . . .

70. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Ability to complete histories on computer in office Asked of all physicians (n = 769) … and fewer offer patients the ability to complete histories on computers in their office

71. Plan to offer within 18 months Q.D3 Which of the following types of educational materials and activities are patients offered in your practice setting? Offer patients ability to complete histories or health risk assessment from home via the Internet before they visit the office Asked of all physicians (n = 769) … and none of this is offered over the Net yet!

72. Part Five: Practice and Office Use of “ Administrative Clinical Computing” “ More than half of practices access lab test results online”

74. Clinical transactions done online in physicians’ practices: Viewing lab results is the only commonly-used application Asked of all physicians (n = 769) Percentage of physicians whose practice uses a computer for the following function Q.E1 Does your practice use computers for any of the following functions?

75. Plan to use within 18 months Proportion for which computers are used to access lab tests and/or other diagnostic results Asked of all physicians (n = 769) More than half of practices access lab test results online, and more will soon Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

76. Plan to use within 18 months Proportion for which an automated system is used to verify HCFA E&M coding accuracy Asked of all physicians (n = 769) Only one in ten practices use the computer to verify E&M coding accuracy Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

77. Plan to use within 18 months Proportion of hospital discharge/medical attestations signed off on computer Asked of all physicians (n = 769) Few physicians are in practices using computers to sign off on hospital discharges or Medicare attestations Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

78. Plan to use within 18 months Proportion for which prescription refills are ordered online Asked of all physicians (n = 769) Few practices order prescription refills online Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

79. Plan to use within 18 months Proportion of patients for whom hospital admission forms are completed online Asked of all physicians (n = 769) Hospital admission forms are rarely completed online Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

80. Plan to use within 18 months Proportion for which computers are used to communicate with pharmacies, pharmacy benefits management companies or health plans Asked of all physicians (n = 769) Despite the rhetoric about formularies, few practices communicate online with pharmacies, PBMs or health plans Q.E1 Does your practice use computers for any of the following functions as opposed to phone, fax, mail, etc?

81. Part Six: Physician‘s Use of Computing for Clinical Purposes “ Physicians want better access to test results, and easier ways to generate notes ”

84. Physicians biggest desires? Immediate access to patients’ results, and a better way to take notes Q.A9 Assuming the underlying technologies worked well, which two solutions from the following list would you find most helpful? Asked of all physicians (n = 769)

86. Share of patients used for Q.E-3 In the past week, did you personally use a computer or handheld device like a Palm Pilot to access clinical information about individual patients? Q.E-A (If Yes,) For what share of patients did you do this? Overall, one in four physicians is accessing clinical information about specific patients using a computer Asked of all physicians (n = 769)

89. After 30 years of the “Electronic Medical Record”, clinical notes stay on paper . . . Q.E5 On your most recent full day of treating patients, what percentage of your clinical notes did you take by each of the following methods? Asked of all physicians (n = 769) Percentage who said they used any of the following ways to take clinical notes (multiple answers allowed)

90. . . . but the majority don’t expect it to stay that way for too long; voice recognition is the great (white coat) hope Q.E5A If you are mainly taking notes via an assistant, handwriting, and/or dictating onto a tape, do you expect to use a computer, handheld device, or voice recognition software in 18 months?….in five years? Asked of all physicians who mainly record notes manually or dictate into tape (n = 676) 44% 85%