Adler-Milstein article looks at sequence of EHR adoption

The order in which hospitals implement electronic health record keeping functions may be influenced by a US government financial incentive program, researchers at the University of Michigan have found.

Julia Adler-Milstein

Results of a study on the adoption of electronic health record (EHR) functions by hospitals were recently published online by the Journal of the American Medical Informatics Association (JAMIA). “Sequencing of EHR adoption among US hospitals and the impact of meaningful use” was co-authored by Julia Adler-Milstein, assistant professor in the U-M School of Information and School of Public Health; Jordan Everson, a doctoral student in the School of Public Health; and Shoou-Yih D Lee, associate professor in the School of Public Health.

The study was funded by the University of Michigan’s MCubed program. The article was published online by JAMIA on May 22 and will be published in an upcoming print edition of the journal.

Beginning in 2011, hospitals and other health care providers began receiving financial incentives when they are able to demonstrate “meaningful use” of EHR technology to improve patient care. Meaningful use is defined in stages, with each stage requiring that providers perform increasingly advanced functions utilizing EHR technology. In Stage 1, there are 13 core criteria to be performed via EHR, from generating prescriptions electronically to providing clinical summaries for patients after each office visit.

The objective of the study was to examine whether there is a common sequence of adoption of electronic health record functions among US hospitals, if there are differences by hospital type, and the impact that “meaningful use” may have on deciding the sequence of EHR function implementation.

Using national data collected by the American Hospital Association (AHA) before the meaningful use program, they found a common sequence of EHR adoption across hospitals, with moderate-to-strong homogeneity. Patient demographic and ancillary results functions are consistently adopted first, while physician notes, clinical reminders, and guidelines are adopted last.

Small hospitals exhibited stronger adherence to the common sequence than larger hospitals. Rural hospitals and non-teaching hospitals exhibited stronger adherence than urban and teaching hospitals.

The researchers theorize that stronger homogeneity among small, rural, and non-teaching hospitals may be driven by greater reliance on vendors and less variation in the types of care they deliver.

Finally, the study found that EHR functions emphasized in Stage 1 meaningful use are spread throughout the common sequence.  Therefore, Stage 1 meaningful use is very likely changing how hospitals order their adoption of EHR functions — in particular, by moving clinical guidelines and computerized provider order entry (CPOE) for medications ahead in the sequence. Further studies may determine how such re-ordering of priorities affects patient care and the cost of EHR adoption in hospitals.

Read the paper online.

MCubed is a two-year seeded funding program of the University of Michigan designed to empower faculty to develop interdisciplinary teams to pursue new initiatives with major social impact. It provides startup money for novel, high-risk, and transformative research projects. Faculty form teams of three researchers from at least two different schools or departments, come up with an idea and agree to work together on their project. The School of Information currently has 23 faculty on 17 MCubed project teams.

Posted on June 23, 2014