The database is kept by the CMS and the Office of the National Coordinator for Health Information Technology at HHS and is updated through August.
It contains summary records of 101,385 hospitals, physicians and other eligible professionals that have attested to having met the meaningful-use criteria of the Medicare EHR incentive payment program created under the American Recovery and Reinvestment Act of 2009.
While the providers themselves are unnamed, and the data do not include hospital bed counts or location in a rural or urban area, their records include the name of the EHR vendor and the certified health IT product each provider used to achieve meaningful use, whether the provider was a hospital or a physician or other “EP,” along with whether they used a complete or modular EHR.
Thus, EHR vendors' names, marketing strategies and the degree of success they have had in seeing their customers cross the finish line as meaningful users can serve as a proxy for more specific EHR market data. Those successes indicate some narrowing is occurring in the historic gaps between the larger and urban hospital IT haves and the smaller and rural IT have-nots.
Although CPSI has several hospital clients with 300 or more beds, the company focuses on smaller community, rural and federally designated critical-access hospitals, said Boyd Douglas, its president and CEO. “Our sweet spot certainly is under 100 beds,” he said. “Ninety percent of our clients are under 100,” including several hundred critical-access hospitals. By definition, those hospitals have no more than 25 beds.
CPSI nosed out several of its far larger EHR developer competitors in the complete EHR category, firms that heretofore have focused on major metro, academic medical centers and larger community hospital markets, including former No. 1 Epic Systems—which has 251 hospital clients that have met meaningful use with complete EHRs, or 18% of the total.
Meditech, a midsize hospital specialist that also serves smaller hospitals, placed third with 173 hospital clients, representing 13% of meaningful users with complete EHRs. Healthland, which specializes in IT for small hospitals, came in fifth, with 116 hospitals and 8% of meaningful users with complete EHRs.
Restricted access to capital and limited technical resources make health IT adoption more of a challenge for small and rural hospitals than for their larger, city-based counterparts, but the meaningful-use numbers do indicate the vendors and hospitals in this market niche are “making some progress” at closing the divide, Douglas said.
“I think it's encouraging that some of these small-market vendors are getting good results,” said Brock Slabach, senior vice president for member services with the National Rural Health Association. “There is a correlation between the companies and their markets.”
There are 1,329 federally designated critical-access hospitals and about 638 other small and rural hospitals of 50 beds or fewer, Slabach said. How many of them are meaningful users is not yet known, he said, and the association is working with the ONC to find that out.
In September, the ONC issued a call for 1,000 small, rural and critical-access hospitals to become meaningful users by 2014. More than 1,220 rural and critical-access hospitals had signed up for advice and support from regional health IT extension centers, an ONC-funded program.
Mathematica Policy Research reported in April that its hospital survey showed that significantly more large hospitals had adopted an EHR in 2011 than had small hospitals (24.5% versus 14.7%) while a similar 10-percentage-point gap existed in the EHR adoption rates between rural and urban hospitals (19.4% vs. 29.1%).