Stalled progress

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.

Government researchers, with 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. 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. Specialists, according to the researchers, had basic EHR adoption rates of 12.4% in 2007 and 30.9% by 2011. They lagged primary-care physicians, who had basic EHR adoption rates of 17.1% in 2007 and 40.2% in 2011.

The researchers noted that EHR adoption among office-based physicians picked up in 2004 when President George W. Bush created the ONC and set a national goal that most Americans would have access to an electronic health 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. Meanwhile, no initiative of the ONC is aimed specifically at specialists not in primary care, they said.

In a separate study, researchers at Mathematica Policy Research in Princeton, N.J., and elsewhere looked at American Hospital Association annual survey data from 2,646 hospitals from 2008 through 2011. The 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, who don't work for the government and whose research was 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,” they wrote.