EHR Update: Hospitals (2013)

Less than half of the nation’s hospitals have met the criteria for meaningful use of electronic health records.

The US health care system is undergoing a substantial overhaul to the way clinicians, clinics, and hospitals record, track, and share health care data.  A significant component of this transformation involves the transition from paper-based health records to the meaningful use of (EHRs).  The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provided 30 billion dollars to support adoption and meeting meaningful use criteria of electronic health records.

There are three stages for meeting meaningful use criteria. Stage 1 began in 2011 with financial incentives and technical support; hospitals that have failed to obtain Stage 1 criteria by July 2014 will face financial penalties that increase over time.  Stage 2 criteria were finalized in 2012 and specific criteria for Stage 3 are now being developed. They are scheduled to go into effect in 2016.

The most recent data tracking EHR adoption was collected through the 2012 health IT supplement to the American Hospital Association’s annual survey.  The survey reports that roughly 42% of hospitals met all of the federal Stage 1 meaningful-use criteria, while 44% of acute care hospitals reported having and using a basic EHR system.  That represents an increase of 17% from 2011 and near triple the proportion reported in 2010 – the year before financial incentives were implemented.

The percentage of hospitals achieving comprehensive EHR status nearly doubled from 8.7% in 2011 to 16.7% in 2012.  Hospitals with at least a basic system were more likely to be large, Midwestern, or major teaching hospitals.  Large urban hospitals continue to outpace rural and non-teaching hospitals in adopting EHR systems.  The upward trend in EHR adoption suggests that the 2011 incentives are working as intended.  However, achieving a nationwide health information technology infrastructure may require efforts targeted to smaller and rural hospitals.

Commentary

The focus on EHR adoption is important because its success is based on the creation of an interoperable system capable of information sharing necessary to improve patient care.  The benefits of such an interconnected system would include reduced paperwork, accurate information handoffs, improved coordination of care, , and improved access to health records.

So far, however, the upward trends in EHR adoption and meaningful use certification tend to favor larger urban hospitals, larger physician groups, or clinics with hospital affiliations.  In short, EHR adoption tends to favor those with established resources for implementation and may hurt those (via financial penalties) who lack sufficient means.

Providers who have fallen through the cracks tend to be smaller, rural, more isolated clinics and hospitals lacking dollars, staff, expertise, and the benefit of nearby completing providers to spur innovation.  Current reports on EHR adoption tout the picking of low hanging fruit, but the achievement of an interoperable system meant to improve quality of care must find new ways to motivate those clinics and hospitals with the above-mentioned traditional disparities.

DesRoches, CM, et al. Health Affairs. 2013 ; 32 (8): 1478-1485.

by

Patrick Fitzgerald, MPH