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Blog: Piecing together a story from EHR implementation data

The great thing about data is if you play with it, it tells you stories.

Then the question is, are the stories true?

We know from several empirical studies that a digital divide exists between large and urban healthcare providers on one hand and small and rural providers on the other.

What we don't know quite yet—empirically—is whether the federal electronic health-record system incentive payment program has begun to bridge that divide. My somewhat educated guess would be, yes, but that's not good enough. We need to know for sure.

Last week, after downloading and analyzing data from the CMS and the Office of the National Coordinator for Health Information Technology about Medicare meaningful users and the EHRs they use, what jumped out at me was that Computer Programs and Systems Inc., or CPSI, had taken over the top spot from Epic Systems among all vendors to hospitals that have used complete EHRs to meet their meaningful-use targets. CPSI focuses on small hospitals.

Toss in No. 5 on the list, Healthland—another vendor serving small hospitals—and between the two of them they provide health IT systems to 382 hospitals, or 28% of the 1,381 hospitals that have become Medicare meaningful users with complete EHRs. Add in Meditech, which also markets to small hospitals, although not to the degree that CPSI or Healthland does, and you account for 574 hospitals and 42% of the complete EHR category.

Those numbers should not be surprising, given that a little more than half (2,561) of all non-federal community hospitals (4,985) have fewer than 100 beds, according to American Hospital Association statistics.Coshocton County Memorial Hospital in Coshocton, Ohio, a county seat city of about 11,000 people, staffs 30 beds of its licensed 50 beds and is a Meditech customer, said Sherrie Eicholtz, the hospital's director of IT project management. Eicholtz said the hospital plans to apply for state Medicaid EHR incentive payments next month and attest for Medicare payments as a meaningful user sometime next year.

There are good reasons there's a digital divide, she said.

"We are in the process of implementing our physician order entry, which is our last component," Eicholtz told me over the phone last week. "It is a challenge for a small hospital. Financially, the software is expensive. And just the resources—our IT department is small compared to other facilities. We support all of our software and changes for meaningful use, HIPAA requirements and other reporting requirements and all the other things that go along with it. Everything is connected. Whenever you add on little things, there is a dollar sign attached to it. So it's dollars and resources."

Based on what's in the CMS and ONC data and on what I've heard from officials at a few small hospitals I’ve contacted recently, the incentive payment program seems to be working—even in the smallest cities and towns.

I also hear that the ONC plans to do some research to set a baseline of EHR meaningful users among small and rural community providers. I was surprised to learn in calling around for the stories I wrote last week that the ONC hadn't done so already. The ONC also needs to publish the data on Medicaid EHR incentive payments linked to vendors as soon as possible. It will be interesting to compare which vendors are most popular among the Medicaid providers, in particular among the few Medicaid-only hospitals and physicians and other "eligible professionals" who can choose to participate in either the Medicare or the Medicaid EHR incentive program, but not both.

You can't improve what you can't measure. But you knew that.
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