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Two New Studies Find Mixed Results In The State of EHR Adoption


Bethesda, MDSince the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009, Health Affairs has published many articles about the promise of health information technology and the challenges of broad adoption to promote "meaningful use." Today, the journal has released two new Web First studies, focusing on the latest trends in health information technology adoption among US health care providers and hospitals. Both studies, which will also appear in the September issue of Health Affairs, show that while basic electronic health record (EHR) adoption plans have moved forward, more significant implementation remains a daunting challenge for many providers and institutions. 

More Than Half Of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most
By Julia Adler-Milstein, Catherine M. DesRoches, Michael F. Furukawa, Chantal Worzala,
Dustin Charles, Peter Kravolec, Samantha Stalley, and Ashish K. Jha


Adler-Milstein is affiliated with the University of Michigan; DesRoches and Stalley are with Mathematica Policy Institute; Furukawa was previously and Charles is currently with the Office of the National Coordinator at Health and Human Services (HHS) (Furukawa is now with the Agency for Healthcare Research and Quality); Worzala is affiliated with the American Hospital Association (AHA); Kralovec is with the Health Forum; and Jha is with the Harvard School of Public Health. 
Funding for this study was provided by the Robert Wood Johnson Foundation.

This year marks an important milestone in the effort of hospitals to demonstrate stage 2 meaningful use of EHRs: Beginning in fiscal year 2015, institutions that bill the Medicare program and fail to meet that standard by the end of the current fiscal year will be subject to a penalty. To assess the current state of hospital EHR adoption, the authors used data from the 2013 AHA Annual Survey of Hospitals–IT supplement. They found that 58.9 percent of hospitals had adopted basic EHR—a fourfold increase from 2010. According to the authors, while at least 90 percent of the hospitals were able to meet many of the stage 2 meaningful-use criteria, only 5.8 percent of hospitals were able to meet them all. Of significance: The anticipated "digital divide"—a difference in adoption rates between safety-net hospitals serving poor patients compared to better-resourced hospitals—has not materialized, perhaps due to the Medicare and Medicaid EHR Incentive Program, which provided additional resources to hospitals serving a high proportion of Medicaid patients. The authors did, however, find a gap in EHR adoption among small, rural, and critical-access hospitals and other institutions: This group was overrepresented among hospitals that had still not yet adopted even a basic EHR. "The struggle of many hospitals to meet stage 2 meaningful-use criteria suggests that the path forward remains challenging, and a particular focus on building data exchange infrastructure may be needed to support the nation’s health and care improvement goals," the authors concluded.


Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings


By Michael F. Furukawa, Jennifer King, Vaishali Patel, Chun-Ju Hsiao, Julia Adler-Milstein, and
Ashish K. Jha


Furukawa was previously and King and Patel are currently with the Office of the National Coordinator at HHS (Furukawa is now with the Agency for Healthcare Research and Quality (AHRQ)); Hsiao is affiliated with the AHRQ; Adler-Milstein is with the University of Michigan; and Jha is affiliated with the Harvard School of Public Health.


In their 2013 study on EHR adoption, the authors found that the proportion of physicians using at least a basic EHR system increased from 25 percent in 2010 to 40 percent in 2012. To determine if that trend continued, the authors reviewed data from the 2009–13 Electronic Health Records Survey and the 2009 National Ambulatory Medical Care Survey. For 2013 they found significant improvement over the previous year: 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had a basic EHR system. They found continuing differences in adoption rates for some groups. One determinant was physician specialty: 53.3 percent of primary care physicians showed basic EHR adoption, compared to 42.9 percent of specialists. According to the authors, the largest basic EHR adoption rate difference was by practice size and ownership: Physicians in practices with six or more were roughly twice as likely to use EHRs compared to smaller or solo practitioners. The study also compares difference in adoption rates by physician age, practice ownership, and practice location. Finally, the authors found that routine use of computerized capability for patient engagement was also low in 2013: Only one-quarter of physicians routinely enabled patients to view, download, or transmit their health record; and patient use of patient portals has been relatively low. "Our findings point to the need to support the majority of physicians who have yet to engage in electronic exchange with other providers," concluded the authors. "Policies now should address barriers to broader EHR use to support the care coordination and patient engagement objectives in new payment and delivery reforms."



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.