While more than one-half (59 percent) of U.S. hospitals have a basic EHR, only a small percentage of hospitals are able to meet all Stage 2 Meaningful Use criteria, a ccording to a study online in Health Affairs.
National surveys have shown that the pace of EHR adoption and use of EHRs has increased rapidly across the U.S., but the study by Julia Adler-Milstein, PhD, of the University of Michigan and colleagues shows that the progress has not been distributed evenly, with small and rural hospitals lagging behind.
For this study the authors used data from the 2013 American Hospital Annual Survey—IT Supplement that was sent to the CEO of every hospital in the U.S. That survey was sent to 4,586 short-term acute care general hospitals, of which 2,674 responded.
A hospital was defined as having a basic EHR if it had implemented these 10 computerized functions in at least one clinical unit of the hospital: electronically maintaining patient demographic information, physician notes, nursing assessments, patient problem lists, patient medication lists and discharge summaries; electronically viewing laboratory reports, radiologic reports and diagnostic test results; and electronically ordering medications. A hospital was defined as having a comprehensive EHR if it had fully implemented these 10 basic functions as well as 14 additional functions in all major clinical units.
The researchers found that 58.9 percent of hospitals had adopted a basic or comprehensive EHR, which represented a four-fold increase over the percentage reported by hospitals in 2010. The share of hospitals with a comprehensive EHR reached 25.5 percent in 2013, compared to just 3.6 percent in 2010.
Between 2012 and 2013, about 25 percent of hospitals adopted a basic EHR. These recent adopters were more likely to be located in rural areas and be critical access hospitals. Of the 41 percent of hospitals that hadn't adopted a basic EHR, those that were small, for-profit, rural and critical-access were overrepresented.
While only 5.8 percent of hospitals were able to meet all measures for Stage 2 Meaningful Use readiness, most were able to meet many Stage 2 requirements. For example, at least 90 percent of hospitals were able to use their EHR to record vial signs, smoking status and patient demographic characteristics; incorporate clinical lab test results as structured data; generate patient lists by specific conditions; provide patient-specific educational resources; and track medications using electronic medication administration records.
However, only 10 percent were able to provide patients with the ability to view, download and transmit information about a hospital admission online.
“Despite the substantial increase in EHR adoption, meeting Stage 2 Meaningful Use objectives will require work for the vast majority of hospitals,” the authors wrote. “Our findings suggest that functions related to electronic data exchange, both with other providers and with patients (in particular, providing summaries of care during transitions and giving patients the ability to view online, download and transmit their health information) are critical gaps.”
The authors pointed out that since many hospitals that don’t meet Meaningful Use criteria in fiscal year 2014 will be subject to financial penalties in 2015, “it is critically important to understand both what is holding hospitals back and what policymakers can do to support these institutions through EHR adoption process.”
With small and rural hospitals lagging behind, there are several steps policy makers can take to help them along, the authors suggested. For example, policies and programs for technical assistance could be directed toward aiding all small hospitals, not jut those in rural areas. There’s also the possibility that EHRs aren’t being designed to meet the needs of small hospitals and aren’t affordable, so policymakers might want to consider making changes in certification or incentive policies that might deal with these challenges.