Growth in EHR Adoption Rates Could Slow Before Peaking Again Ahead of 2015

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By Kendra Casey Plank  


While provider and hospital enrollment in the “meaningful use” program has steadily grown over the past two years, the government's top health IT official expects those numbers to slow before surging again in late 2014.

National Coordinator for Health Information Technology Farzad Mostashari on July 9 said he expects 2014 to be a “big year” because it is the last year eligible providers and hospitals can enroll in the Medicare Electronic Health Record Incentive Program to avoid Medicare reimbursement cuts.

“I think for this next coming year we're going to see lower [enrollment] numbers, then, an enormous rush to the finish line,” Mostashari said at a briefing about a series of health IT reports published by the journal Health Affairs.

Mostashari said federal health officials hope providers will continue enrolling in the program far ahead of the 2015 deadline, but called it “human” that some would wait. Medicare participating physicians and hospitals must have enrolled in the meaningful use program no later than 2014 to avoid the penalty phase that begins in 2015.

The Health Affairs articles--two of which Mostashari and others from the Office of the National Coordinator for Health IT helped write--addressed EHR and health information exchange uptake by physicians and hospitals since the Health Information Technology for Economic and Clinical Health (HITECH) Act created the meaningful use program.

The data reported in the three studies cement long-known facts about health IT adoption:

• Federal incentives are motivating doctors to adopt EHRs, but rates of adoption in rural areas lag far behind those in urban areas.

• EHR adoption among hospitals is rapidly growing, but half of hospitals still had less than a basic system in 2012.

• Despite growth in health information exchange organizations, concerns persist about their long-term sustainability.


Report Findings

Among key findings in the report on hospitals, titled “Adoption of Electronic Health Records Grows Rapidly, but Fewer than Half of U.S. Hospitals Had at Least a Basic System in 2012,” was that while hospital adoption of EHRs was at its highest ever, fewer than half could meet Stage 1 meaningful use criteria and just 5 percent could meet Stage 2 criteria. Researchers for the study concluded that “special efforts” were needed to help “trailing” institutions catch up.

Catherine M. Des Roches, a senior scientist at Mathematica Policy Research in Cambridge, Mass., said at the briefing it was not clear what was holding some hospitals back from meeting the incentive program criteria, but that helping them before the penalty phase of the program kicks in was a priority.

Likewise, a second report, titled “Office-Based Physicians Are Responding to Incentives and Assistance by Adopting and Using Electronic Health Records,” found that EHR adoption among providers continued to rapidly increase, but that more studies should be done to identify gaps, including those for rural providers and providers in certain specialities.

A third report, titled “Operational Health Information Exchanges Show Substantial Growth, but Long-Term Funding Remains a Concern,” cited continued growth of health information exchange organizations but raised questions about how well-positioned HIE organizations were to maintain long-term business operations.

A Robert Wood Johnson Foundation report released July 8 in conjunction with the Health Affairs articles similarly found that federal incentive programs have driven the widespread adoption of health information technologies over the past three years, but that providers and hospitals continue to struggle with advanced uses of the technology (see previous article).

More Work Ahead

Mostashari said participation numbers from the first phase of the meaningful use program indicated progress in nationwide health IT adoption, but that much work was ahead for the health care industry to achieve the goal of the incentive programs--improved health care quality.

“This is really, really hard work. But, it's just another milestone,” he said.

Stage 1 of the meaningful use program has laid the groundwork for digitization of health care, Mostashari said, and Stage 2 of the program--slated to begin in 2014--will push physicians and hospitals to increasingly use the data to shape care delivery.

Mostashari also acknowledged that adopting EHRs means more work for providers in care delivery as they use data to make decisions about patient care and said payment reforms will better reimburse providers for that extra effort.

“You've got to pay people for that extra value they're adding,” he said.

Interoperability Challenges

He also acknowledged the stumbling blocks still ahead for health IT--specifically interoperability of EHRs.

Mostashari said proprietary data standards have persisted among health IT developers but that the industry is coming together to develop single standards for packaging patient data and securely exchanging that information.

“It's right around the corner,” he said.

Julia Adler-Milstein, a researcher at the University of Michigan in Ann Arbor, likewise said at the Health Affairs briefing there appears to be progress in developing widely accepted interoperability standards for health information exchange.

However, Adler-Milstein, who co-authored the HIE article, cautioned that the “jury is still out” on whether true end-to-end interoperability could be achieved for broad sets of health data. That means, she explained, it is not clear whether vendors and hospitals will widely agree to standards for sharing more than diagnostic test results and patient summaries.

One issue, she said, is the compelling evidence that while technology barriers might be alleviated, hospitals often view patient data as a key strategic asset. She said strong financial incentives and, more broadly, cultural change was needed for those institutions to see their competitors as partners for data sharing.

“I don't know if we'll get there,” Adler-Milstein said. “But, I'm optimistic.”

The Health Affairs articles may be found at