EHR Adoption in US Hospitals Progresses, But Challenges Persist


Electronic health record adoption in US hospitals has progressed well, but small and rural hospitals remain behind and face financial penalties.

For the past 4 years US hospitals have been eligible for financial incentives for adopting and using electronic health records (EHRs) to meet federal rules. Beginning in 2015, however, hospitals participating in the Medicare portion of the EHR Incentive Program faced financial penalties for not meeting the requirements. A new study in Health Affairs by Julia Adler-Milstein, PhD, and colleagues at the University of Michigan analyzed the most recent nationwide data on EHR adoption from 2008 through 2014 and found that the incentive’s “carrot and stick” approach worked to increase EHR adoption, but small and rural hospitals lag behind.

The researchers analyzed data from the American Hospital Association Survey-IT Supplements from 2008 to 2014. The data show that 75% of US hospitals now have adopted at least a basic EHR system, up from 59% in 2013. In addition, 40.5% of hospitals in 2014 had the capability to meet core stage 2 meaningful-use criteria, which includes 16 core objectives eligible providers (EPs) have to achieve to demonstrate meaningful use, such as using secure electronic messaging to communicate with patients on relevant health information and providing patients with the ability to view online, download, and transmit health information within 4 business days of the information being available to the EP. In 2013 only 5.8% of hospitals had stage 2 meaningful-use capability. 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.

Large and medium-sized hospitals were more likely than small hospitals to have an EHR system in place, with large hospitals most likely to have a comprehensive system. Major teaching hospitals, not-for-profit hospitals, and urban hospitals were more likely to have a comprehensive EHR system compared with minor/nonteaching hospitals, for-profit hospitals, and rural hospitals.

The disparities between hospitals with and without EHR can be attributed to specific domains, the researchers said: the implementation of physician notes, physician resistance, up-front and ongoing costs, and the complexity of meeting meaningful-use criteria.

“Hospitals face many barriers, and it is a matter of some concern that those hospitals currently struggling to meet the next meaningful use milestone will be those that get hit with the financial penalties,” Dr Adler-Milstein said in a statement.

She added that the findings showed remarkable progress in just one year.

“This means that over 1,000 hospitals were able to rapidly implement complex changes in both technology and clinician behavior,” she said.

The study authors noted that the rapid rise in the EHR Incentive Program has been effective in increasing the meaningful use of EHR systems in US hospitals. Policy strategies are needed to target the issues holding back small and rural hospitals, however.

“With such strategies in place, nationwide hospital EHR adoption could be achieved in the near future, enabling the US healthcare system to use EHRs to improve performance,” Dr Adler-Milstein said.

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