Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.
The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their "meaningful use." The survey, whose results were published online by Health affairs, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.
Those criteria include a set of 14 "core" objectives and an additional 10 "menu" criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.
In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.
The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).
Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.
However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.
Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.
The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. "Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection," they wrote.
In addition, they noted, "If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion."
They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.
"Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer," they wrote.
The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.