Adoption of EHR systems by small practices, small hospitals, and rural health providers lags behind the pace of urban-based hospitals and physician groups

As larger numbers of physicians implement electronic health record (EHR) systems, clinical laboratories are faced with the task of building interfaces that connect their laboratory information systems (LIS) to those EHRs.

Recent numbers indicate that hundreds of thousands of physicians are now enrolled in the federal EHR incentive program. This puts medical laboratories and anatomic pathology groups squarely in the midst of the drive to encourage physicians to both implement an EHR in their clinical practice and use that EHR in ways that meet “Meaningful Use” requirements.

Some 225,765 providers are participating in the Medicare and Medicaid EHR incentive programs created by the American Recovery and Reinvestment Act of 2009. The Centers for Medicare and Medicaid Services (CMS) report that almost $4.5 billion in financial incentives have been paid to hospitals and physicians for implementation of electronic health record (EHR).

A Third of U.S. Physicians Have Adopted EHRs

Actual payment of these incentives lags slightly behind enrollment. For hospitals, Modern Healthcare reported that a total of $3.1 billion has been disbursed in 2,667 payments

Physicians and/or “eligible professionals” were quick to sign up for these incentive programs. There are now 222,282 enrollees, representing 32% of the nation’s 690,000 doctors. To date 73,945 enrollees have been paid a total of $792 million. CMS reports a 29% increase in registration during the first quarter of 2012.

HIT Enabled Health Reform Chart

To spur adoption and use of electronic health record (EHR) systems by both hospitals and physicians, the federal government is offering financial incentives which will pay out each year through 2015. During this time, clinical laboratories are supporting EHR adoption by building interfaces that allow their laboratory information systems to enable fully-digital lab test ordering and lab test results reporting. (Graphic by HealthInformatics.com)

What can clinical laboratory managers expect as the federal program moves forward? Although the overall EHR adoption rate sounds promising, several recent studies suggest that smaller physician practices and rural physicians and hospitals continue to be slower to adopt EHRs. That means they are missing out on the federal government-based incentive programs.

One such study was conducted by the Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology,. It was determined that, in 2011, only 24.2% of physicians in solo or two-physician practices had adopted a basic electronic health system. The disparity is startling with this low adoption rate as compared to the adoption rate of 37.1% by medical groups with three to nine physicians, as well as the whopping 60% adoption rate for physicians in practices with 10 doctors or more.

EHR Adoption Rate Lags for Rural Physicians And Hospitals

Rural physicians also lag in their adoption and use of electronic health record systems, although not in quite as dramatic a fashion. According to the same study, just 34.2% of physicians outside of metropolitan statistical areas have adopted a basic EHRs.

A separate study conducted by Mathematica Policy Research in Princeton, NJ, focused on EHR adoption by hospitals. Utilizing American Hospital Association http://www.aha.org/ survey data of hospitals from 2008 through 2011, they found that only 14.7% of small hospitals had a basic EHR system.

Medium-size hospitals, however, had a 20% adoption rate and large hospitals had a 24.5% adoption rate. This study also confirmed the rural-versus-urban adoption rate trends, with 19.4% of rural hospitals reporting basic EHR adoption compared to 29.1% of urban hospitals.

State Programs and HIEs May Be Able To Whittle Away At HIT Disparity

Some consider these studies to be disconcerting in their suggestion that EHR incentives are causing a further disparity in the level of healthcare informatics available to patients in different economic strata. However, government policymakers are responding to these developments.

A recent article reported a collaboration between the Colorado Regional Health Information Organization www.corhio.org/ (CORHIO), the state’s official Health Information Exchange (HIE), and the Colorado Telehealth Network (CTN),.

A primary goal of the partners is to decrease the rural-urban HIT adoption disparity. Janice Whittleton, Director of Business Development and Outreach at CORHIO, pointed out that, “the biggest barrier was not technology—it was getting leaders together to hammer out a plan where CORHIO would operate on CTN’s network.”

In short, the Colorado initiative suggests that incentives are not enough to completely eliminate disparities in healthcare IT adoption, especially in rural areas. Whittleton pointed out that “the only way for rural providers to reap the benefits of information sharing and new technologies would be to deploy a secure broadband connection statewide.”

It remains to be seen whether widespread adoption and use of electronic health record systems will result in the efficiencies and improved care predicted by most experts. What is true is that a significant proportion of the nation’s physicians and hospitals have been motivated by federal incentives to take the steps required to acquire, deploy, and use EHRs.

These facts and developments indicate that most clinical laboratories and pathology groups will be busy during the next few years creating the LIS-to-EHR interfaces required for them to fully support their referring physicians and/or their parent hospital organizations.

—By Mark Terry

Related Information:

CMS: Almost $4.5 billion in HER incentive payments

CMS Posts Latest Summary of Payments Under EHR Incentive Program: Total Payments to Date Almost $4.5 Billion

EHR adoption, telemedicine feasible for Colorado’s rural providers

Stalled progress. EHR adoption lags for small, rural practices: studies