Health Affairs studies: EHR incentives work, but challenges remain

Two reports from Health Affairs point to a strong increase in health IT adoption among hospitals and physicians groups due to federal incentives, but amid uneven progress with considerable barriers to overcome—especially in achieving Meaningful Use (MU) Stage 2.

In one report, “Adoption Of EHRs Grows Rapidly, But Fewer Than Half Of U.S. Hospitals Had At Least A Basic System In 2012,” author Catherine DesRoches, senior scientist at Mathematica Policy Research, in Cambridge, Mass., and colleagues reported that 44 percent of hospitals have what they define as a “basic EHR system,” with 42.2 achieving Stage 1 MU. Meanwhile, a sparse 5.1 percent could meet Stage 2 criteria.

“The increase in adoption overall suggests that the positive and negative financial incentives currently in place across the U.S. healthcare system are working as intended. However, achieving a nationwide health IT infrastructure may require efforts targeted at smaller and rural hospitals,” DesRoches et al wrote, noting that large urban hospitals continue to outpace rural and nonteaching hospitals in adopting EHR systems.

For office-based physicians, as reported in the accompanying report, “Office-Based Physicians Are Responding To Incentives And Assistance By Adopting And Using EHR,” 72 percent had adopted some type of system and 40 percent had adopted capabilities required for a basic EHR system. Notably, author Chun-Ju Hsaio, senior service fellow at the National Center for Health Statistics, and colleagues found that the highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community centers.

The report also found that small practices lag behind larger practices in adoption; however, the majority of physicians across all specialty groups and backgrounds that have adopted EHR systems to obtain incentives are using them routinely.

“As providers become increasingly accountable for both costs and quality of care, having robust information systems that allow them to manage care more effectively and share information with their patients will be critical,” Hsaio et al wrote. “Our findings suggest that although the U.S. healthcare system still faces important challenges, the rapid growth in the IT infrastructure can create a platform for delivery of high-quality, efficient care.”

Summarizing the report findings, Jennifer King, PhD, from the Office of the National Coordinator for Health IT's Office of Economic Analysis, Evaluation and Modeling, said at the Health IT Policy Committee on July 9 that the definition of “basic EHR” in the Health Affairs articles does not exactly correspond with ONC's definition of Meaningful Use. “Having a basic EHR does not mean you qualify for Meaningful Use Stage 1, and just because you have achieved Meaningful Use does not mean you have a basic EHR.”

She added, however, that the reports are “useful for examining trends over time.”