Connecticut’s Health Information Technology Exchange - Physician Adoption of EHR

Rationale / Objectives

The Health Information Technology Exchange of Connecticut (“HITE-CT”) was a quasi-governmental agency of the State of Connecticut whose purpose was to create, maintain and make available information exchange technology to enrolled healthcare participants located in the State of Connecticut in order to allow such participants to transfer electronic data, documents and records regarding patients in connection with participants’ healthcare services.

Project/Program Description & Major Achievements

In 2010, the Connecticut Department of Public Health (DPH) entered into a Cooperative Agreement with the Office of National Coordinator for Health Information Technology (ONC), to create and implement a State Health Information Exchange. DPH received an award of $7.3 million to initiate and sustain HIE activities in the state of Connecticut. Researchers conducted a two-wave panel survey of 1,492 Connecticut physicians’ attitudes toward and use of health information technology and exchange.The proportion of practices using electronic billing exclusively increased significantly over time from 2011 to 2013. The rate of EHR adoption among physicians was between 53-62% based on survey research, which was lower than the national average of 78%. Gains in use of EHR technology for documenting patient demographics, public health reporting, monitoring quality of care, order entry & guideline-based interventions also significantly increased over time. 

Lessons Learned

  • Between 30% and 37% of physicians mentioned physician resistance as a major barrier to EHR adoption
  • EHR-related costs were seen as a significant barrier by the majority of physicians
  • Around half of physicians cited uncertainty about the return on their investment in an EHR as a major barrier to adoption
  • Concern about having the capacity to undertake all phases of EHRimplementation (i.e., to select, contract, install, and implement an EHR system) was mentioned by 37-47% of physicians as a barrier to adoption
  • Finding an EHR system that meets providers’ needs was mentioned as a barrier by more than half of physicians
  • A better understanding of the different value and barriers that EHR systems may hold for particular practice specialties or clinical functions is needed
  • While improvements in the use of HIE technology among physicians were noted, the HITE-CT itself was unable to adapt quickly to changing market conditions, and was unable to provide a sustainable revenue generating stream


Further Description

In 2010, eHealth Connecticut was designated as the statewide Health Information Technology Regional Extension Center (HITREC), with a $5.75 million federal grant awarded by the Office of the National Coordinator (ONC), Department of Health and Human Services.The goal of eHealthConnecticut’s HITREC is to help the state’s providers, mainly physician office practices and Federally Qualified Health Centers, select, implement, and achieve meaningful use of Electronic Health Record (EHR) systems.This includes connecting them to a statewide Health Information Exchange (HIE) to enable sharing of patient data. eHealth Connecticut’s approach was to charge providers a fee for HITREC services initially with the aim to be fully self-sufficient with three revenue streams: service fees from provider customers, membership dues, and special projects for paying customers. A technology platform providing central HIE services, enabling interfaced EHR systems to interoperate was developed by Hartford Hospital and Misys Open Source Solutions.

A two-wave panel survey was conducted of Connecticut physicians’ attitudes toward and use of health information technology and exchange. Licensed physicians who practiced in Connecticut at the time of the survey were eligible to participate. This case study summarizes the results of 1,346 responses (880 from the 2011 survey and 466 from the 2013 survey) representing 1,082 unique physicians. 616 physicians completed a survey during the first distribution (2011 Cohort 1), 202 physicians completed a survey during the second distribution (2013 Cohort 2), and 264 physicians completed surveys at both points (2011 Baseline and 2013 Follow-Up).

Major Achievements

The majority of physicians reported their practice used at least some electronic billing, with the proportion of practices exclusively using electronic billing increasing significantly over time. Selected results from the survey research are highlighted in the table below. Please see the Supporting Evidence links for more detailed information from this research. Recent media attention from a State Auditor's report, suggests some deficiencies in financial controls & legal problems associated with the now disbanded HITE-CT. Authority for HIE now rests with the State Department of Social Services.