EHR Update: Doctors (2013)

In 2009 the HITECH Act provided $30 billion to support the expansion of .  In 2011, the Medicare EHR Incentive began providing payments to providers who adopted EHRs with a minimal set of “meaningful use” capabilities.  Early indicators suggest these investments accelerated EHR adoption.

This study used the 2010–12 National Ambulatory Medical Care Survey-Electronic Health Records Survey to examine whether incentives have increased adaptation of EHRs among office based physicians, to identify gaps in EHR adaptation and utilization among physicians and practices, and to study the expansion of utilization and capabilities in practices with existing EHRs.  EHR adoption was measured on three levels: (1) the use of any type of basic EHR system, (2) adoption of a basic EHR system, and (3) the adoption of a series of computerized capabilities associated with Stage 1 core criteria for meaningful use.

Findings demonstrated that the percentage of office-based physicians using any type of EHR increased from 51% in 2010 to 72% in 2012.  During this period the number of physicians who reported adoption of EHRs meeting criteria for a basic system increased by 60 percent.  Additionally, adoption rates for basic EHR systems more than doubled among providers who traditionally demonstrated low adoption levels (e.g. older physicians, solo practitioners, doctors in community health centers).  Indicators associated with significant EHR uptake included practices with 11 or more physicians and those owned by a hospital or academic medical center.   Physicians in larger practices and those associated with HMOs demonstrated a higher level of routine use.

As of April 2013, 70% of eligible professionals were participating in the Medicare or Medicaid EHR incentive program; more than half of participants had received incentive payments.  Physicians not eligible for financial incentives were less likely to adopt EHRs suggesting HITECH played an important role in EHR uptake.

Commentary

and advancements continue toward developing digital health record infrastructure meeting the requirements of meaningful use.  As expansion fueled by financial incentives and technical assistance continues, an expanded focus on barriers beyond incentives and expertise may be necessary to spur the progress of late adapters.

EHR expansion continues to face barriers of sponsorship (buy-in from senior leaders, clinician champions), concerns over costs (upfront costs before meaningful use is achieved, vendor/product selection), sustainability (choosing products that meet provider needs while offering compatibility and longevity), productivity concerns (computer literacy, staff training, fear of lost productivity during implementation), and privacy (maintaining patient confidentiality and patient trust in the setting of new technology).

A number of the barriers listed above cannot be remedied with financial incentives and technical assistance, yet they each present significant challenges to achieving the full potential of EHRs and the ultimate goals of improved care coordination and quality.

Hsiao, C, et al. Health Affairs. 2013; 32 (8): 1470-1477.

by

Patrick Fitzgerald, MPH