If the rate of electronic health record adoption continues at its current pace, all hospitals in the country should have EHRs in the next four years, according to a new study.
Researchers found that 80.5% of hospitals surveyed had at least a basic EHR in place.
But when it comes to advanced EHR functions, the picture isn't so rosy, with critical-access hospitals in particular struggling to adopt features beyond basic EHR functionality. According to data from the American Hospital Association's Information Technology Supplement Survey from 2008 to 2015, just over a third of hospitals surveyed had at least eight of 10 EHR functions that involve using data for performance management, and under half had at least eight of 10 patient-engagement functions.
Providers' EHR systems must meet these advanced criteria to satisfy the Health Information Technology for Economic and Clinical Health Act that was passed eight years ago. But they're also necessary to move forward with value-based reimbursement, as they allow hospitals to measure their performance and target trouble areas and encourage patients to be more active in their own care, which is critical given the newly emphasized importance of outcomes.
"Using EHR data for performance measurement is a foundational capability for improving quality and reducing cost," wrote lead author Julia Adler-Milstein and her colleagues in the Journal of the American Medical Informatics Association. "Hospitals that lack measurement capabilities fly blind in their efforts to improve."
Hospitals must also engage patients—through functions like electronically requesting prescriptions and securely messaging providers—to ensure that those patients are making good decisions about their care, the study said.
The larger the hospital, the more likely it was to have these advanced capabilities in place as part of a comprehensive EHR system, with 55.5% of hospitals with more than 400 beds having adopted such a system compared to just 33.7% of hospitals with fewer than 100 beds. Critical-access hospitals were also less likely to have adopted comprehensive EHRs and more likely to have less than a basic EHR.
These discrepancies reflect what the study's authors refer to as a "digital divide." Such a divide might mean that new policy is necessary to get all hospitals, regardless of type, to improve patient outcomes using EHRs. Hospitals that struggled to adopt EHRs had trouble getting physicians to cooperate, the researchers found. These hospitals also had trouble with upfront costs. Both of these barriers were more likely in rural hospitals and small hospitals compared with urban hospitals and medium and large hospitals, respectively.
"Hospital characteristics associated with adoption of advanced functions suggest that resources, IT capabilities and performance incentives are potentially important drivers" to the adoption of advanced EHR functions, the study's authors wrote.
To get around the cost barrier, hospitals might enter into group purchasing arrangements, according to the study, which also suggested that more transparent vendor costs could help with advanced function adoption. Though the 21st Century Cures Act calls for more transparency, it doesn't specify performance measurement and patient engagement functions in its metrics, which could be helpful, the study's authors wrote.