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From Health Affairs: Trends in the Adoption of Health Information Technology


Bethesda, MD -- The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009. Since then, Health Affairs has published many articles about the promise of health information technology (IT) and the challenges of broad adoption. Today the journal has released three new Web First articles, focusing on the latest trends in health information technology adoption among US health care providers and hospitals. The articles, which will also appear in the journal's August issue, were supported by the Robert Wood Johnson Foundation (RWJF) and are a companion to RWJF's annual report, "Health Information Technology in the United States: Driving Toward Delivery System Change, 2013."

The RWJF report and the Web First articles will be the subject of a Health Affairs briefing at the National Press Club in Washington, D.C., today, from 9:00 AM until 11:00 AM.


The briefing will include remarks by the authors of the studies, including Dr. Farzad Mostashari, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.


Video and audio recordings will soon be available on Health Affairs' website.


Below are brief summaries of each of the Web First articles.


Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains A Concern

By Julia Adler-Milstein, David W. Bates, and Ashish K. Jha

Adler-Milstein is with the University of Michigan in Ann Arbor; Bates is affiliated with Brigham and Women's Hospital in Boston; and Jha is at the Harvard School of Public Health in Boston.


To assess a key component of national progress in health IT adoption, the authors surveyed all US organizations that facilitated the exchange of clinical data between unaffiliated organizations in late 2012. They found that 30 percent of hospitals and 10 percent of ambulatory practices participated in one of 119 operational health information exchange efforts. That is more than double the early 2010 participation rate. Seventy-four percent of these health information exchange efforts identified developing a sustainable business model as a barrier to success. For 52 percent of these operational efforts, grants and contracts were the most substantial source of support. The authors concluded that there has been substantial growth in the number of providers adopting health IT; however, for progress to continue after HITECH funding runs out, policy makers must "help these efforts identify and implement sustainable business models."


Adoption Of Electronic Health Records Grows Rapidly, But Fewer Than Half Of US Hospitals Had At Least A Basic System In 2012

By Catherine M. DesRoches, Dustin Charles, Michael F. Furukawa, Maulik S. Joshi, Peter Kralovec, Farzad Mostashari, Chantal Worzala, and Ashish K. Jha

DesRoches is at Mathematica Policy Research in Cambridge, Mass; Charles, Furukawa, and Mostashari are affiliated with the Office of the National Coordinator for Health Information Technology at the US Department of Health and Human Services in Washington, D.C.; Joshi is with the Health Research and Educational Trust in Chicago; Kralovec is with the Health Forum in Chicago; Worzala is at the American Hospital Association in Washington; and Jha is with the Harvard School of Public Health in Boston.


To measure current hospital use of electronic health record (EHR) systems, the authors used data from the 2012 health IT supplement to the American Hospital Association's annual survey. According to that data, 44 percent of hospitals report having at least a basic EHR system. This represented a 17 percent increase from 2011 and a near-tripling of the 2010 adoption rate. The authors also found that large urban hospitals continued to outpace rural and nonteaching hospitals. Although 42.2 percent of all hospitals met all the stage 1 meaningful-use criteria, only 5.1 percent had advanced to stage 2. The authors concluded, "Although our findings demonstrate considerable progress on the whole, they suggest the need for a focus on hospitals still trailing behind, especially small and rural institutions. This will be especially important as stage 2 meaningful-use criteria become the rule, and positive incentives are replaced by penalties for noncompliance."


Office-Based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health Records


By Chun-Ju Hsiao, Ashish K. Jha, Jennifer King, Vaishali Patel, Michael F. Furukawa, and Farzad Mostashari


Hsiao is with the Centers for Disease Control and Prevention's National Center for Health Statistics in Hyattsville, Maryland; Jha is with the Harvard School of Public Health in Boston; and King, Patel, Furukawa, and Mostashari are affiliated with the Office of the National Coordinator for Health Information Technology at the US Department of Health and Human Services in Washington, D.C.


Perhaps the most tangible success story of EHRs' expanded use can be told by office-based physicians. Using data from the 2010–12 National Ambulatory Medical Care Survey--Electronic Health Records Surveys, the authors found that the proportion of physicians using at least a basic EHR system increased from just 25 percent in 2010 to 40 percent last year. The highest relative increases occurred among physicians who had lower levels of adoption in the past: those who were older, in solo practices, or working at community health centers. The authors suggest that this adoption surge may have been partially due to the availability of financial incentives for providers treating Medicare and Medicaid patients. Their findings also show that EHR adoption rates for solo practitioners were less than half the adoption rates of physicians in practices with eleven physicians or more. "As providers become increasingly accountable for both costs and quality of care, having robust information systems that allow them to manage care more effectively and share information with their patients will be critical," the authors concluded.

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.