While many providers have the essential EHR components required to obtain federal financial incentives and avoid penalties, about 90% of hospitals still can't allow patients to view online, download, or transmit health information.
Thousands of hospitals and physicians in small office practices will be left out of meaningful use incentive payments, and may eventually be financially penalized, unless they speed up adoption of electronic health records systems to satisfy meaningful use 2 requirements, analysis indicates.
The findings of two papers published Thursday in Health Affairs arebased on survey data showing how many providers have the essential system components required to obtain financial incentives and avoid penalties under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
The first report of hospital EHR prevalence from 2008 to 2013 as reported by the American Hospital Association Annual
Survey—IT Supplement, found that while adoption has risen steeply to 59%, small and rural hospitals "lag behind their better resourced counterparts."
And while most hospitals are able to meet some of the 15 stage 2 meaningful use requirements, nearly 60% can't use EHR to provide summary of care records for transitions, and about 90% can't allow patients to view their health record online, download, and transmit health information.
Only 5.8% of the 2,600 hospitals surveyed are able to meet all stage 2 meaningful use objectives, which is required to receive a share of $30 million in incentive payments.
The principal author for both journal analyses, Ashish Jha, MD, says the biggest challenge is that "very few doctors and hospitals are exchanging clinical data, or working on patient engagement.
"Doctors and hospitals are supposed to download and allow for patients to download and transmit and view electronic health record data, but that's not happening as robustly as it should. It's slow, but it is a requirement for MU2."
The reason is unclear. Jha, professor of Health Policy and Management at the Harvard School of Public Health, says that he and the AHA, whose senior policy associate director Chantal Worzala is a co-author, disagree on why adoption is lagging.
"The big question is, is it because these hospitals don't have the technical capability, which is what a lot of providers argue? When I talk with (EHR) vendors and others, they say they can do it, but it just hasn't been quite a priority for hospitals. So I don't think it's technical issues that are holding people back; I think the organizations have not prioritized that."
This is where the AHA co-author and Jha disagree. "They think it's because the vendors have not made those modules available, and I think it's because the hospitals have not made this a priority," Jha says.
Co-author Worzala, responding by email, said, "Hospitals want to be able to share health information to support patients and their clinical care. However, they are finding that, while certified, 2014 Edition EHRs do not share data easily, either within the hospital or across settings. They are not, generally speaking, interoperable."
She added that "many areas of the country do not have efficient and affordable information exchange networks in place. It is a bit like asking hospitals to make telephone calls when there is no telephone network in place. Some areas are more mature than others, but overall the technology and infrastructure must still improve so that exchange can be done efficiently."
In a fact sheet prepared by the AHA, the share of hospitals attesting to meaningful use has grown from 17% in 2011, to 51% in 2012 to 78% in 2013, although there is a big difference between urban hospitals and critical access hospitals.
For critical access hospitals, the rates have gone from 13% to 47% to 67%, while for urban hospitals EHR MU attestation has gone from 20% to 52% to 81% respectively.
The second, related, paper, which used data from the 2009 National Ambulatory Medical care Survey and the 2009-2013 Electronic Health Records Survey, produced by the centers for Disease Control and Prevention's National Ambulatory Medical Care Survey, also found growing adoption of EHR in physician office practices.
In 2013, survey data showed, 78% of office-based physicians adopted some type of EHR, and 48% had capabilities required for a basic system. But physicians in solo practice and non-primary care specialties "lagged behind others," the study said. And only 14% share data with providers outside their organization.
Fewer than one in three physicians use secure messaging with their patients, and 24% allow patient to view, download, or transmit their health record online.
Those percentages must grow, because the inability to use EHR in a clinical practice is "a big problem," Jha says.
"I have personally practiced medicine in paper-based systems and in electronic-based systems, and I can tell you, it's not even close. I'm a much better doctor with electronic health records, because the amount of information I have, how quickly I can find it, and incorporate it, especially if you have good decision-support tools, it just lets you practice medicine at a much better level than what paper-based records can do."