As electronic medical records begin to spread across the clinical environment, federal incentives intended to drive uptake among physician practices might be rewarding those who already have made the transition to the digital age.
The ability of electronic health records (EHRs) to improve health care quality, safety, and efficiency through improvements in care coordination and reductions in medical errors and duplicative care is widely accepted. These benefits contribute to the anticipated uptake of EHRs beyond large organizations by smaller providers, but barriers to buy-in still exist.
The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 provides incentive payments through Medicare and Medicaid to clinicians and hospitals to move beyond health information technology implementation barriers to meet standards of “meaningful use” for EHRs by delivering specified improvements in care delivery.
To further identify common barriers of EHR use, the researchers employed a cross sectional survey conducted between August and October 2010 of 8,801 Florida physicians who deliver care to Medicaid participants. The survey assessed physicians’ current use of electronic health records and their intention to participate in the HITECH incentive programs. Physicians who reported no intention to seek funding were asked to elaborate by selecting from a list of eight possible reasons why they did not plan to participate.
2,386 physicians responded to the survey. Sixty-six percent expressed interest in applying for the HITECH financial incentives. Twenty-five percent reported being unsure whether they would seek funding. Of those planning to seek funding, 84.5 percent intended to do so in year one (fiscal year 2011) or year two (fiscal year 2012). Only 2.5 percent of respondents planned to start seeking funding in years three through six of the program. Eighty-six percent of providers with some form of EHR already in use intended to apply for funding compared to 54.8 percent of non-EHR users. Among those not planning to seek incentives, 69 percent cited the “costs involved,” 42 percent said they “need more information about incentive program,” 42 percent were uncertain about which system to purchase, and 26 percent highlighted “concerns about privacy/security.”
Overall the current use of electronic health records was still positively and significantly associated with intentions to seek HITECH funding (OR 3.77). As the volume of either Medicare or Medicaid patients increased, the odds of physician-reported intention to seek HITECH funding also increased. Physicians’ self-reported knowledge of information technology and those practices that employed or contracted with information technology staff had higher odds of seeking funding (OR 1.4 and 1.8, respectively). Physicians who had ownership in the practice were more likely to report seeking funding (OR 2.39), as were practices that employed more than one physician.
The adoption of EHRs will decrease cost and improve the quality of healthcare delivery over time, but not without a significant, sometimes prohibitory upfront investment of time and financial resources. While the system-wide adaptation of EHRs is inevitable, the ability of incentive payments to facilitate their adoption is unclear. These data suggest that incentive payments may only be targeting those who are already operating EHRs at a high level. In other words, those organizations with sufficient resources to devote upfront toward quality improvement, and arguably in less need of financial incentives, are being rewarded. Those lacking financial means or technical savvy are being left to their own devices. While the authors mention incentives for year one adoption, it is unclear whether these payments offset the measurable costs of initial implementation.
While upfront costs may play a role in decisions on whether or not to adopt EHRs, the perceived value of EHRs may also be a key contributor to health IT investment. Physicians or practices performing at a high level without the use of EHRs may see only marginal benefit, if not harm, from such a dramatic shift in organizational culture. Others may see EHRs as a distraction to doctor-patient interaction. For these practices, the system-wide benefits may not outweigh the direct localized cost.
Cedric Dark, MD, MPH