Study: Rural hospitals lag in EHR progression
Friday, November 20, 2015
The federal EHR incentive plan has paid dividends in getting health systems to adopt electronic health records, but small hospitals still lag behind, even after nearly five years. These are the findings from a new study featuring nationwide data collected from 2008-2014.
Julia Adler-Milstein, an assistant professor and researcher at the University of Michigan School of Information and School of Public Health, led the research, which analyzed data from the American Hospital Association Survey-IT Supplement for information technology adoption. According to Adler-Milstein's research, hospital EHR adoption has increased substantially since the incentives began.
The rate of U.S. hospitals that have adopted at least a basic EHR system increased from 59 percent in 2013 to 75 percent in 2014. Further, 40.5 percent of hospitals in 2014 had the capability to meet core Stage 2 meaningful use criteria, compared with 5.8 percent in 2013, they found.
According to Adler-Milstein, this is "remarkable progress in just one year. This means that (more than) 1,000 hospitals were able to rapidly implement complex changes in both technology and clinician behavior."
The report shows the continued increase in hospital adoption of EHRs since the EHR Incentive Program's implementation four years ago shows that the program's "carrot and stick" approach has worked, for the most part. Of course, rural health systems have not been so ready to take the bait.
Large and medium-size hospitals were more likely than small hospitals to have an EHR system in place, with large hospitals most likely to have a comprehensive system. Teaching hospitals, not-for-profit hospitals and urban hospitals were more likely to have a comprehensive EHR system compared with minor/nonteaching hospitals, for-profit/public hospitals and rural hospitals.
Since 2011, the federal government has encouraged U.S. hospitals to adopt and use EHR systems in ways that meet meaningful-use criteria by offering financial incentives to hospitals participating in the EHR Incentive program through Medicare and Medicaid. At the same time, beginning in 2015, hospitals participating in the EHR Incentive Program through Medicare face financial penalties if they fail to meet requirements.
"The analysis indicates that these disparities can be attributed to specific domains in which these hospitals are struggling," the researchers wrote. "These domains include the implementation of physician notes, physician resistance, up-front and ongoing costs, and the complexity of meeting meaningful-use criteria."
The authors suggest that policy strategies targeting these issues would benefit these hospitals and could enable the achievement of nationwide hospital EHR adoption in the near future.
"The rapid progress was clearly not easy," Adler-Milstein said. "Hospitals face many barriers, and it is a matter of some concern that those hospitals currently struggling to meet the next meaningful-use milestone will be those that get hit with the financial penalties."
The study, published Nov. 11 as a Web-first article in Health Affairs, will also appear in the December print issue of the journal. The paper is titled "Electronic Health Record Adoption in U.S. Hospitals: Progress Continues, But Challenges Persist." It was supported by the Robert Wood Johnson Foundation.
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