EHR adoption still lags for small, rural practices: researchers

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

In the first study, government researchers, using 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 from 2002 through 2011. The survey for five years asked whether providers used "any EHR" but in 2007 began asking questions about specific EHR functions to determine whether providers were using a so-called basic EHR.

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. Also, specialists lagged behind primary-care physicians in EHR adoption, and the gap for adoption of a basic EHR widened since 2007. Specialists, according to the researchers, had basic EHR adoption rates of 12.4% in 2007 and 30.9% by 2011. Primary-care physicians, meanwhile, had basic EHR adoption rates of 17.1% in 2007 and 40.2% in 2011.

The researchers noted that the "upturn in EHR system adoption among office-based physicians began around 2004” when President George W. Bush signed an executive order creating the ONC and setting a national goal that most Americans would have access to an electronic medical 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. The RECs are chartered to provide support to at least 100,000 primary-care providers and physicians in small practices and, secondarily, to help small hospitals in rural and medically underserved areas.

Meanwhile, no initiative of the ONC is aimed specifically at specialists not in primary care, they said.

The authors concluded the government will need to "continue to aim incentives and support at small practices" and "may also need to focus on physicians outside of primary care."

In the second study (PDF), researchers at Mathematica Policy Research in Princeton, N.J., and her co-authors looked at American Hospital Association annual survey data from 2,646 hospitals from 2008 through 2011.

For EHR definitions, they used an eight-function basic EHR, a “comprehensive” EHR with more than twice the function, and a 12-function standard somewhere in between that served as a proxy that “closely resembled” those functions needed to meet Stage 1 meaningful use payment threshold under the ARRA incentive program.

Their 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, none of whom works for the government, were 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,” the authors said. Also, the REC program still "needs to demonstrate its effectiveness" in helping slow adopters implement and meaningfully use EHRs, they wrote.

A lack of health information exchange infrastructure, in addition, makes it "more difficult for (rural hospitals) to coordinate care and manage population health," the authors concluded.

So far, the federal Medicare and Medicaid EHR incentive programs have paid out nearly $4.5 billion.