Progress continues, challenges persist in Electronic Health Record adoption

The continued increase in hospital adoption of electronic health records (EHR) since the EHR Incentive Program’s implementation four years ago shows that the program’s “carrot and stick” approach has worked, although small and rural hospitals still lag behind.

That’s according to a new analysis of nationwide data on EHR adoption from 2008-14, led by Julia Adler-Milstein, an assistant professor and researcher at the University of Michigan School of Information and School of Public Health.

EHR systems allow patient health information to be collected and stored digitally and shared between providers over networks or other exchanges. Since 2011, the federal government has encouraged US hospitals to adopt and use EHR systems in ways that meet meaningful-use criteria by offering financial incentives to hospitals participating in the EHR Incentive program through Medicare and Medicaid. At the same time, beginning in 2015, hospitals participating in the EHR Incentive Program through Medicare face financial penalties if they fail to meet requirements. 

The researchers analyzed data for 2008-2014 from the American Hospital Association Survey-IT Supplement for information technology adoption. They found that since the incentives began, the rates of hospital EHR adoption have increased substantially, so that by 2014, 75 percent of US hospitals had adopted at least a basic EHR system. That’s up from 59 percent in 2013. Furthermore, 40.5 percent of hospitals in 2014 had the capability to meet core stage 2 meaningful use criteria, compared with 5.8 percent in 2013, they found.  Adler-Milstein notes that this is “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.”

This rapid rise suggests that the EHR Incentive Program has been effective in increasing the meaningful use of EHR systems in US hospitals, the authors say.

In spite of this progress, however, the study also found that certain types of hospitals still struggle to implement EHR systems. For example, large and medium-size hospitals were more likely than small hospitals to have an EHR system in place, with large hospitals most likely to have a comprehensive system. At the same time, 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/public hospitals, and rural hospitals, respectively.

The analysis indicates that these disparities can be attributed to specific domains in which these hospitals are struggling. These domains include the implementation of physician notes; physician resistance; up-front and ongoing costs; and the complexity of meeting meaningful-use criteria.

According to Adler-Milstein: “The rapid progress was clearly not easy. 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.” The authors suggest that policy strategies targeting these issues would benefit these hospitals and could enable the achievement of nationwide hospital EHR adoption in the near future.

The study, published November 11 as a Web First article in Health Affairs, will also appear in the December print issue of the journal.

The paper is titled “Electronic Health Record Adoption in U.S. Hospitals: Progress Continues, But Challenges Persist.” It was supported by the Robert Wood Johnson Foundation. Other contributors include Catherine M. DesRoches, a senior fellow at Mathematica Policy Research; Peter Kralovec, executive director at the Health Forum; Gregory Foster, senior data analyst at the Health Research and Educational Trust; Chantal Worzala, a director for policy at the American Hospital Association; Dustin Charles, a public health analyst at the Office of Planning, Evaluation, and Analysis in the Office of the National Coordinator for Health Information Technology (ONC); Talisha Searcy, director of research and evaluation at the Office of Planning, Evaluation, and Analysis, ONC; and Ashish K. Jha, professor of health policy and management at the Harvard T.H. Chan School of Public Health.

Posted November 11, 2015