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Are We There Yet?

In the 10 years since American hospitals started to go digital, we are only three-fourths of the way there.

In 2004, President George W. Bush launched an initiative to provide all Americans with electronic health records (EHR) by 2014. In 2009, Congress passed the HITECH Act, providing $30 billion to help get there. But as 2015 concludes, we have yet to achieve the goal. What were initially incentive payments to help providers adopt EHRs have become financial penalties for those failing to meet Meaningful Use requirements. A recent study in Health Affairs shows that the number of US hospitals with at least a basic EHR has increased to 75%, but there is still a long way to go.

Source: CDC Global (Flickr/CC)

Source: CDC Global (Flickr/CC)

The study used data from over 3,000 US hospitals of varying sizes, geographic locations, and patient demographics. EHR adoption was evaluated using two metrics: full implementation of specific functions and ability to meet Meaningful Use Stage 2 criteria. Large, major teaching, not-for-profit, non-critical access, and urban hospitals were more likely to have adopted a comprehensive EHR system. Although critical access hospitals were less likely to have adopted a comprehensive EHR, there was no difference in adoption rates for hospitals serving higher proportions of Medicaid patients, a disparity that has been observed in prior studies of physician adoption rates. For those that adopted a basic EHR, the functionalities presenting the most challenges included physician notes, discharge summaries, and providing patients with the ability to view diagnostic results. Just over 40% of hospitals reported readiness to meet Meaningful Use Stage 2. More than half of hospitals reported financial challenges with EHR implementation.

This study provides important lessons. First, it illustrates the chasm between policy and practice. Clearly, the timeline of the Meaningful Use program is out of touch with reality. But with more money, support, and time, the overall goals are achievable. Second, challenges reported by hospitals with meeting Meaningful Use Stage 2 – specifically with discharge summaries and patient ability to view results – pose barriers to information exchange, which is really the critical step to improving health outcomes. Finally, this study shows a promising trend for the impact of technology on health disparities. This study indicates that Medicaid patients may have similar access to hospital EHRs as the privately insured. However, further research is needed to look at hospitals providing high levels of uncompensated care, especially in non-Medicaid expansion states, and at the primary care and specialty practices serving these same patients.

commentary by Megan Douglas


Achieving nationwide adoption of electronic health records (EHRs) remains an important policy priority. While EHR adoption has increased steadily since 2010, it is unclear how providers that have not yet adopted will fare now that federal incentives have converted to penalties. We used 2008-14 national data, which includes the most recently available, to examine hospital EHR trends. We found large gains in adoption, with 75 percent of US hospitals now having adopted at least a basic EHR system-up from 59 percent in 2013. However, small and rural hospitals continue to lag behind. Among hospitals without a basic EHR system, the function most often not yet adopted (in 61 percent of hospitals) was physician notes. We also saw large increases in the ability to meet core stage 2 meaningful-use criteria (40.5 percent of hospitals, up from 5.8 percent in 2013); much of this progress resulted from increased ability to meet criteria related to exchange of health information with patients and with other physicians during care transitions. Finally, hospitals most often reported up-front and ongoing costs, physician cooperation, and complexity of meeting meaningful-use criteria as challenges. Our findings suggest that nationwide hospital EHR adoption is in reach but will require attention to small and rural hospitals and strategies to address financial challenges, particularly now that penalties for lack of adoption have begun.  PMID: 26561387

Adler-Milstein, J. et al. Health Affairs. Nov. 11 2015 [Epub]

Megan Douglas, JD
About Megan Douglas, JD

Megan Douglas is the Associate Director of Health Information Technology Policy in the National Center for Primary Care at Morehouse School of Medicine in Atlanta, GA. She is a licensed attorney and focuses on health policy and its impact on individuals from underserved communities. She was a 2012-13 Health Policy Leadership Fellow under Dr. David Satcher, 16th Surgeon General of the United States. Megan has worked on health policy issues related to neurodevelopmental disabilities, HIV and AIDS discrimination, racial and ethnic health disparities, and individuals identifying as LGBTQ. In her current role, she is looking at the impact of Health Information Technology (HIT) policies on healthcare providers who serve underserved communities and is identifying ways to leverage HIT to improve health outcomes for the underserved. Contact: Website | Facebook | Twitter | Google+ | More Posts