RAND Study in the The American Journal of Managed Care® Finds High Variation in EHR Use

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Research in this year’s annual Health IT issue of The American Journal of Managed Care® asked a basic question: how much has use of electronic health records (EHRs) penetrated US practices? The study found wide variation by geography, with less use in Western counties.

CRANBURY, N.J.— RAND Health researchers who studied how much US medical practices were using electronic health records (EHRs) found only about a quarter using them to their full potential, while 39 percent of the practices were underusing EHRs.

The study was funded under the Agency for Healthcare Research and Quality (AHRQ) Comparative Health Systems Performance Initiative, which supports the RAND Center of Excellence on Health Systems Performance. It appears in the annual Health Information Technology (IT) issue of The American Journal of Managed Care® and found wide variation in EHR use, based on the 2014 Healthcare Information and Management Systems Society (HIMSS) Analytics survey. Counties with the least EHR use tended to be in the West, smaller in size, and located outside a metropolitan area. The full study can be found here.

Of the 38,638 health practices in the HIMSS data, 83.4 percent had a live and operational EHR; of these, 93.5 percent provided survey responses.

Use of Health IT. Researchers created a framework to rate practices’ use of EHR based on seven domains of health IT. Using this method, they found:

  • 26.6 percent of the practices, or 8003 practices, could be classified as “super-users.” The chances of being a super-user were lower for single specialty, multi-specialty, and allied health practices compared with primary or family care clinics.
  • 38.9 percent of the practices, or 11,706 practices, were health IT “under-users.” In addition to being located mostly in the West, these practices had fewer affiliated physicians and tended to be located outside metropolitan areas.

The RAND authors, Juliet Rumball-Smith, MBChB, PhD (2016/17 Harkness Fellow in Healthcare Policy & Practice, supported by The Commonwealth Fund); Paul Shekelle, MD, PhD; and Cheryl L. Damberg, PhD, acknowledge that circumstances may have changed since the 2014 data collection. But their findings echo complaints to CMS that surrounded implementation of the Medicare Access and CHIP Reauthorization Act—smaller, rural practices told officials they would struggle with reporting requirements that involved investments in technology.

The federal government has invested billions to encourage EHR, including the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which provided $27 billion. Yet there are frequent complaints of difficulty with systems, high costs, and lack of interoperability.

The authors call on policy makers to address these barriers. “It is important that policy makers and healthcare providers understand the limits of HIT functionality in ambulatory care practices, as strategies aimed at improving the coordination of care or those relying on EHR as a vehicle for intervention may be hindered by the technological capacity of ambulatory care partners,” they wrote, suggesting that smaller, rural, and specialty practices needed attention.

For more on the special annual issue on Health IT in The American Journal of Managed Care®, click here.

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Surabhi Verma