The digital divide between small, rural hospitals and larger, urban hospitals is closing. And that success is due, in part, to the federal electronic health-record incentive program.
At least 94% of small and rural hospitals, according to the latest CMS data, now has an EHR system, or has contracted to buy one, with top-level functionality such as computerized physician-order entry to complete orders, clinical decision support and interoperability, according to the latest CMS data..
That same data show that 4,827 hospitals, or 97% of the 4,993 hospitals eligible to participate in the program created under the American Recovery and Reinvestment Act, have been paid a share of $18.6 billion in EHR incentive payments.
More than half of all non-federal community hospitals (2,614 of 4,974, nearly 54%) have fewer than 100 beds, according to the latest American Hospital Association statistics.
The small and rural hospitals that are using EHRs are also making them work. They are attaining Stage 2 meaningful-use status at nearly the same rate as larger more urban hospitals under the federal EHR incentive payment program, according to a Modern Healthcare analysis of program data.
Experts say that EHRs improve the quality and efficiency of medical care and that they help drop rates of chronic illness and death because of the shared and flagged information that could prevent drug interactions and other troublesome issues.
“Even five years ago, 100 of our 600 acute-care hospitals had CPOE,” said David Dye, chairman and chief financial officer of Computer Programs and Systems Inc., or CPSI, a Mobile, Ala.-based EHR developer that has historically catered to small hospitals.
Customers of CPSI and five other vendors that market primarily to small and rural hospitals account for slightly more than half of all 1,638 hospitals that in 2014 attested to having met Stage 2 using a so-called “complete EHR” in an inpatient setting, federal data show.
Comparing the results of small versus larger hospitals, about 32% of hospitals with fewer than 100 beds achieved Stage 2 status using complete EHRs in an inpatient setting while 34% of large hospitals did so.
In a program under oversight by the Office of the National Coordinator for Health Information Technology, vendors submit complete EHRs to be tested and certified that their systems have the functionality to meet meaningful-use targets.
In 2010, then-ONC chief Dr. David Blumenthal and others who planned programs created under the HITECH provisions of the ARRA worried about about how to improve EHR adoption rates at smaller, typically rural hospitals where health IT was either unavailable or less advanced than in larger, city and suburban hospitals.
Since then, however, smaller hospitals have been taking advantage of available EHR incentive dollars and programs set up by the Health Resources and Services Administration to ensure adoption of the new technology didn't widen health disparities between rural and urban hospitals.
“I think the program has done a very good job of closing that gap,” Dye said
Alan Morgan, CEO of the National Rural Health Association, agrees that much of the success small and rural hospitals have had in adopting health IT can be attributed to the feds and other policymakers revising the EHR incentive payment program “to try and bring rural along.”
There also have been “a lot of successful strategies” in the private sector to get where rural health IT is today, he said.
“If the goal is Stage 2, then yeah, it would appear the data would show we've been successful from a rural standpoint,” Morgan said.
But today, Morgan says members and others in the healthcare community are asking,
“What's that next step?” and whether the next may be a step too far. “I don't know that is solely a rural hospital issue.”
Pressure is mounting by provider organizations and members of Congress on both ONC and the CMS to modify the current Stage 2 program and to delay the shift to Stage 3, whose final rules have not be released by the two federal agencies.