New report shows incentives have significantly spurred adoption – but still finds room for improvement

RWJF sees 'unprecedented' IT growth

By Mike Miliard
09:43 AM
health IT

The HITECH Act has had its desired effect so far, according to the latest annual report from the Robert Wood Johnson Foundation, which finds heartening adoption levels of health IT across the board, from small physician practices to academic medical centers, over the past three years.

The study, “Health Information Technology in The United States: Driving Toward Delivery System Change, 2013," was co-authored by Mathematica Policy Research and the Harvard School of Public Health. It shows that in 2012, 44 percent of hospitals reported having a basic electronic health record system – up 17 percentage points from 2011.

Indeed, since 2010 – when providers started getting federal stimulus funds – the proportion of hospitals with at least a basic EHR system has nearly tripled, according to the RWJF report.

Physician practices, meanwhile, have also made substantial progress, with more than 38 percent reporting the adoption of basic EHR functionalities in 2012.

Of those providers who've made investments in IT, many have already made significant strides in putting it to work: some 42 percent of hospitals reported the implementation of all functionalities required to meet Stage 1 meaningful use this past year – up from 18.4 percent in 2011 and just 4.4 percent in 2010.

“Hospitals, physicians and other health care providers are clearly taking advantage of recent incentives to embrace the promise of technology,” said RWJF Senior Vice President John R. Lumpkin, MD, in a press statement. “It’s particularly encouraging to see that more doctors and hospitals are using electronic health records, which contribute to better care at the bedside."

Still, the study spotlights several areas where there's room for improvement. While U.S. physicians reported increased use of EHRs in 2012, the United States lags behind several other developed countries. In addition, researchers found room for improvement in using HIT to develop effective patient education tools that track progress and meaningfully engage patients.

"There is still a significant amount of work to be done to ensure that our health care system is as up-to-date as it can be," said Lumpkin. "These kinds of technologies can lead to safer, higher-quality care.”

The study suggests that, with EHRs now in place, more and more providers are using them as building blocks for bigger IT initiatives and broader partnerships across their communities.

More than a quarter (27 percent) of hospitals are now participating in health information exchange initiatives – up from 14 percent in 2010. As for ambulatory practices, just 10 percent participate in an HIE – but that's up from just 3 percent in 2010.

And that shared data is being put to strategic use, the RWJF report shows, with 33 percent of HIEs supporting accountable care organizations and 45 percent supporting patient-centered medical homes.

Encouragingly, rural hospitals are also closing the EHR adoption gap with their urban counterparts. The proportion of rural hospitals with at least a basic EHR increased from 9.8 percent to 33.5 percent from 2010-12; during the same period, urban hospitals saw their EHR adoption rates rise from 17 percent to 47.7 percent.

"Much has changed in the world of health information technology since our inaugural report in 2006," write the report's authors. "At that time, there was a dearth of methodologically rigorous data on health information technology adoption, the Office of the National Coordinator for Health Information Technology was relatively small with a limited budget and very few hospitals or physician offices had functional electronic health records."

Since then, the HITECH Act and the Affordable Care Act have worked in tandem to point the way forward for health IT, offering "unprecedented levels of financial support for health information technology adoption and implementation, primarily in the form of financial incentives for providers, and (emphasizing) the importance of this technology in delivery system reform," they write.

"We have seen the rate of electronic health record adoption among physicians and hospitals begin to increase more rapidly and the focus has begun to shift from simply turning on the technology to using it in a way that improves the quality and efficiency of care."

[See also: HITECH Act 'lit a fire' under health systems]

The report is divided into five sections, examining progress on EHR adoption; looking at efforts to mitigate disparities in adoption among providers; comparing international rates of health IT adoption; tracking health information exchange progress and challenges and looking at ways EHRs improve patient education.

Other findings from the RWJF study:

  • In 2012, 40 percent of office-based physicians had adopted at least a basic EHR. These physicians were most likely to be primary care physicians, in a practice
of 11 or more physicians owned by a hospital, academic medical center, health maintenance organization, or other health care organization in rural practices.
  • At least 50 percent of respondents adopted each meaningful use stage 1 core criteria, with the exception of one: reviewing data on quality of care measures, which was adopted by 43 percent of respondents.
  • In 2012, 42 percent of hospitals reported implementing all 14 core functionalities for stage 1 meaningful use, increasing substantially from 4 percent in 2010
and 18 percent in 2012. Like those most likely to have a basic EHR, hospitals meeting stage 1 meaningful use objectives are large, major teaching, private nonprofit hospitals located in urban areas.
  • Only 5 percent of hospitals could meet all 16 core objectives for stage 2 meaningful use; however, 63 percent reported meeting 11–15 of the functionalities, suggesting a large proportion of hospitals are close to meeting these objectives. The functions least likely to be implemented are functions that require health information exchange and patient access to health information.
  • Of the six states Medicaid agencies interviewed, all reported the importance of partner organizations and other stakeholders, such as Regional Extension Centers (RECs), in successfully implementing the Medicaid EHR Incentive Program.
  • The primary barriers to implementing the Medicaid EHR Incentive Program identified by states were the availability of resources within the Medicaid agency and adapting quickly to CMS guidance. Overall, these states believe the Medicaid EHR Incentive Program payments are going to providers who serve vulnerable populations.
  • Test results and patient summary care records were the most common type of data exchanged (in 82 percent and 79 percent of HIE efforts, respectively), while public heath reports were the least common type of data exchanged (30 percent).
  • Most HIE efforts reported using a query model as their technical approach, where users actively search for available data. Other common technical approaches include a push model, where data is actively sent out to users; end- to-end integration, where data is included in the user’s electronic system; and Direct, which facilitates point-to-point transport of health information.
  • The majority of HIE efforts enabled participants to meet the core stage 1 meaningful use criteria of demonstrating the capability to exchange key clinical information electronically. The two public health-related stage 1 meaningful use criteria (syndromic surveillance and reportable lab results) were least likely to be supported by the HIE efforts. A small subset of HIE efforts supported all six HIE-related meaningful use functionalities.
  • HIE efforts continue to struggle with financial viability, with 74 percent of efforts identifying that developing a sustainable business model was a moderate or substantial barrier. Currently, grants and contracts are the most substantial source of support for the majority of operational HIE efforts.

Access the full report here.