The digital divide is still there among rural providers but it appears to be closing, according to a report by the Robert Wood Johnson Foundation and new research it references.
The percentage of rural hospitals with a basic electronic health-record system was 33.5% in 2012, up 257% from 9.8% in 2010, the year before payments started to flow from the federal EHR
incentive payment program of the American Recovery and Reinvestment Act of 2009.
In comparison, the EHR adoption rate for urban hospitals was 47.7% in 2012, up 180% from 17% in 2010.
“Although the rural hospitals are challenged, they're accelerating faster than some of the urban hospitals,” said Dr. Michael Painter, senior program officer for the foundation.
The report relies on the annual American Hospital Association survey and a study to be published online by the policy journal Health Affairs by a team headed by Catherine DesRoches, a senior scientist at Mathematica Policy Research in Cambridge, Mass.
The increases for hospitals were only slightly affected by the relative income status of their patients, the RWJF report showed. Using the CMS' disproportionate share index as a proxy for patient income levels, researchers determined that by 2012 a difference of only 5 percentage points between an EHR adoption rate of 46.5% for hospitals with the poorest patients compared with a 2012 EHR adoption rate of 51.3% for hospitals with the most well-off patients.
The incentive payment program has accelerated the adoption of EHR systems, even among those less-well-off hospitals, Painter said. “Everybody wants to get on board while the money is available and before the disincentives kick in,” he said.
Office-based physicians, meanwhile, had already narrowed the urban/rural gap, according to a Health Affairs report based on data from the National Ambulatory Medical Care Survey/Electronic Health Records Survey conducted by the National Center for Health Statistics at HHS.
In 2012, 43.5% of office-based physicians surveyed who practiced in small metropolitan or nonmetropolitan areas reported they had a basic EHR system, up from 30.8% in 2010, according to the NCHS study.
In comparison, 36% of physicians in large, central metro areas reported having a basic EHR in 2012, up from 23.4% in 2010. There is a caveat with these numbers, however. They are adjusted for multiple factors, most notably, for practice size.
“Rural practices are more likely to be in smaller practices and they (smaller practices) have lower (EHR adoption) rates,” said Dr. Ashish Jha, a professor in the department of health policy and management at the Harvard School of Public Health, Boston, and a co-author of the report. Solo practices, for example, had a basic EHR adoption rate in 2012 of 25.6%, compared with 57.7% for practices with 11 or more physicians.
But, Jha said, “With that adjustment, it was quite a pleasant surprise that rural providers are not behind on this.”
From a health IT
policy perspective, “practice size is still really important,” Jha said.
“Rural providers are still facing significant challenges, but it's not because they're in rural areas, but because they're in smaller practices. I think from a policy point of view, you need a different set of interventions.”
For example, he said, one way to address the size problem is to help pair up physicians in small practices with EHRs appropriate for their size. “If you can solve the practice size problem, along the way you'll solve the rural practice problem,” he said.
A third Health Affairs report on health information exchanges found that 30% of hospitals but only 10% of ambulatory practices participate in one or more of the nation's 119 operating HIEs. But 74% of exchanges report they are “struggling to develop a sustainable business model.” Follow Joseph Conn on Twitter: @MHJConn