Stalled progress

EHR adop­tion lags for small, ru­ral prac­tices: stud­ies

Modern Healthcare - - THE WEEK IN HEALTHCARE - Joseph Conn

Adop­tion of elec­tronic healthrecord sys­tems re­mains higher among large physi­cian groups and hos­pi­tals than among smaller ones, ac­cord­ing to two stud­ies pub­lished in the jour­nal Health Af­fairs.

Gov­ern­ment re­searchers, with fund­ing from HHS’ Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy, ex­am­ined data from the Cen­ters for Dis­ease Con­trol and Preven­tion’s Na­tional Am­bu­la­tory Med­i­cal Care Sur­vey. By 2011, 24.2% of physi­cians in solo or two-physi­cian prac­tices had adopted a ba­sic EHR, com­pared with 37.1% of groups of three to nine physi­cians and 60% of physi­cians in groups of 10 or more.

Ru­ral physi­cians trailed their ur­ban coun­ter­parts in EHR adop­tion as well, with 34.2% of physi­cians out­side of met­ro­pol­i­tan sta­tis­ti­cal ar­eas hav­ing ba­sic EHRS in 2011, while 39.4% in met­ro­pol­i­tan ar­eas did. Spe­cial­ists, ac­cord­ing to the re­searchers, had ba­sic EHR adop­tion rates of 12.4% in 2007 and 30.9% by 2011. They lagged pri­mary-care physi­cians, who had ba­sic EHR adop­tion rates of 17.1% in 2007 and 40.2% in 2011.

The re­searchers noted that EHR adop­tion among of­fice-based physi­cians picked up in 2004 when Pres­i­dent Ge­orge W. Bush cre­ated the ONC and set a na­tional goal that most Amer­i­cans would have ac­cess to an elec­tronic health record by 2014. The re­searchers also point out the Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009 pro­vided fund­ing for EHR in­cen­tives and for a na­tion­wide sys­tem of health IT re­gional ex­ten­sion cen­ters. Mean­while, no ini­tia­tive of the ONC is aimed specif­i­cally at spe­cial­ists not in pri­mary care, they said.

In a sep­a­rate study, re­searchers at Math­e­mat­ica Pol­icy Re­search in Prince­ton, N.J., and else­where looked at Amer­i­can Hospi­tal As­so­ci­a­tion an­nual sur­vey data from 2,646 hos­pi­tals from 2008 through 2011. The sur­vey found that by 2011, 14.7% of small hos­pi­tals had a ba­sic EHR, com­pared with 20% of medium-size hos­pi­tals and 24.5% of large hos­pi­tals. Ru­ral hos­pi­tals are lag­ging as well. By 2011, 19.4% of ru­ral hos­pi­tals re­ported hav­ing a ba­sic EHR com­pared with 29.1% of ur­ban hos­pi­tals.

The au­thors, who don’t work for the gov­ern­ment and whose re­search was funded by the Robert Wood John­son Foun­da­tion, were more pointed in their cri­tique of gov­ern­ment IT booster pro­grams. “We be­lieve that fed­eral pol­i­cy­mak­ers need to re­dou­ble their ef­forts among hos­pi­tals that ap­pear to be mov­ing slowly or start­ing from a lower base rate of adop­tion,” they wrote.

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