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Are EHRs There Yet?

Douglas, Megan JD

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doi: 10.1097/01.EEM.0000490527.68892.95

    George W. Bush while president launched an initiative in 2004 to provide all Americans with electronic health records (EHR) by 2014. ( Congress then passed the HITECH Act in 2009, providing $30 billion to help get there. But we have yet to achieve the goal. What were initially incentive payments to help providers adopt EHRs have become financial penalties for those failing to meet the meaningful use requirements.

    A recent study in Health Affairs shows that the number of US hospitals with at least a basic EHR has increased to 75 percent, but there is still a way to go to achieve 100 percent EHR adoption. (2015;34[12]:2174; The study used data from more than 3,000 U.S. hospitals of varying sizes, geographic locations, and patient populations. EHR adoption was evaluated using two metrics: full implementation of specific functions and ability to meet Meaningful Use Stage 2 criteria.

    Large, major teaching, nonprofit, noncritical access, and urban hospitals were more likely to have adopted a comprehensive EHR system. Critical access hospitals were less likely to have adopted a comprehensive EHR, but no difference was seen in adoption rates for hospitals serving higher proportions of Medicaid patients, a disparity that we recently observed in physician adoption rates. (J Health Care Poor Underserved 2016;27[1]:327 Those that adopted a basic EHR system found that the functionalities presenting the most challenges were physician notes, discharge summaries, and providing patients with the ability to view diagnostic results. Just more than 40 percent of hospitals reported readiness to meet Meaningful Use Stage 2, with significant gains in meeting some of the criteria reported as most challenging in 2013. More than half of hospitals reported financial challenges, including upfront and maintenance costs.

    As the rhetoric around the meaningful use mess continues to increase (AMA Wire;, this study provides critical analyses to inform policy. First, it sheds light on the chasm between policy and practice. Clearly, the timeline of the meaningful use program is out of touch with reality, and patience is wearing thin. The findings indicate, however, that the overall goals are achievable — with more money, support, and time.

    Second, the challenges reported by hospitals with meeting Meaningful Use Stage 2, specifically with discharge summaries and patient ability to view, pose barriers to health information exchange, which is one critical step to improving health outcomes and establishing the value of interoperability.

    This study shows promise for the impact of technology on health disparities. It indicates that Medicaid patients may have similar access to hospital EHRs as their privately insured peers. Of course, further research is needed to look at hospitals providing high levels of uncompensated care, especially in non-Medicaid expansion states and at the primary care and specialty practices serving these same patients.

    Two of the biggest obstacles to the meaningful use vision are stakeholder buy-in and mismanaged expectations. Many physicians and hospitals are unable to see value in their EHR experience. They were sold on an idea of streamlining patient interactions and exchanging data for a comprehensive picture of their patients' health care interactions, which would enable them to provide better treatment. But so far many have received expensive products that interrupt workflow, do not exchange data, and fail to improve patient care.

    It seems like government officials are listening. Acting CMS Administrator Andy Slavitt announced major changes to the meaningful use program to coincide with forthcoming Medicare Access & CHIP Reauthorization Act regulations. (Healthcare IT News; The question remains whether and how the federal government can turn the program around to advance the vision and improve provider and patient experiences.

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