CMS demands technology utopia in hospitals

The advancement of health information technology is surely becoming one of the foremost changes in the American health care system. Assuming the adoption of more advanced technologies will improve quality and efficiency, several recent federal policies have encouraged (if not demanded) that hospitals and into their clinical practice. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, meaningful use requirements for electronic health records (EHRs), and the Affordable Care Act’s increasing focus on quality, efficiency, and care coordination all aim to advance health IT.

On the surface, it appears to be working, with more and more hospitals adopting EHRs. Gone are the days when a patient file consisted of a mound of scribbled physician notes. However, with new technology comes new questions and new metrics for hospitals: Are safety-net hospitals able to keep up with advancing technologies with their limited resources? Will hospitals try to avoid the upcoming penalties associated with meaningful use requirements?

A study by Adler-Milstein et al. attempted to answer these questions. Using information from the American Hospital Association (AHA) Annual Survey-IT Supplement between 2008 and 2013, they characterized hospitals according to whether they met basic or comprehensive meaningful use criteria for their EHRs, including trends among early and late adopters. They were further able to characterize hospitals according to size, location, non-profit, academic, and safety-net status.

The study shows that there’s . The authors found that 58.9% of hospitals had either a basic or comprehensive EHR in 2013, four times the number in 2010. About a third of hospitals had a basic EHR—meaning they met general criteria for having electronic clinical documentation, test results, and ordering of medications. Another 25% met standards for comprehensive EHRs, taking the technology a bit further with tools such as electronic images of diagnostic tests, consultant notes, and more advanced clinical decision-making tools such as clinical guideline reminders and drug-drug interaction alerts. The first adopters of basic EHRs tended to be large, academic, non-profit hospitals, while late adopters are medium-sized hospitals. Safety-net hospitals, likely due to supporting provisions in HITECH, do not appear to be lagging behind in basic EHR adoption, but hospitals servicing rural populations have been slowest to adopt. Overall, most hospitals seem to be on the right track.

Ultimately, the study results raise some serious concerns about the readiness of hospitals to meet meaningful use standards. To meet Stage 2 meaningful use criteria, hospitals must meet all of 16 core objectives, including providing patient access to their records online and being able to transmit plans of care between providers during care transitions. The authors found that most hospitals could not meet all of these standards: Hospitals met criteria for recording patient records and tracking, but only 10.4% could allow patients to view, download and transmit their records online. This may mean that though most hospitals have invested a lot of money into the adoption of EHR, they will likely still face financial penalties for not meeting meaningful use criteria beginning in fiscal year 2015.

Meaningful use criteria were meant to improve health care quality and efficiency, while improving the overall patient experience. It is great to have lofty goals, but if most hospitals can’t meet these standards, one has to ask if the suggested timeline is reasonable. Policymakers must consider what further resources and assistance are needed to help hospitals meet their goals, and should consider postponing meaningful use penalties. All hospitals want to improve quality of care for their patients, but should they be penalized for not meeting an unrealistic goal?

This Policy Prescriptions^® review is written by Joneigh S. Khaldun, MD, MPH. 

Abstract*
The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. We used recent data from the American Hospital Association Annual Survey of Hospitals–IT Supplement to assess progress and challenges. EHR adoption among US hospitals continues to rise steeply: 59 percent now have at least a basic EHR. Small and rural hospitals continue to lag behind their better resourced counterparts. Most hospitals are able to meet many of the stage 2 meaningful-use criteria, but only 5.8 percent of hospitals are able to meet them all. Several criteria, including sharing care summaries with other providers and providing patients with online access to their data, will require attention from EHR vendors to ensure that the necessary functions are available and additional effort from many hospitals to make certain that these functionalities are used. Policy makers may want to consider new targeted strategies to ensure that all hospitals move toward meaningful use of EHRs.

Health Aff (Millwood). 2014 Sep;33(9):1664-71. PMID 25104826

*This post has been corrected to display the appropriate abstract.