Small, Rural Health Providers Lag in EHR Adoption, Studies Find

Electronic health record adoption rates are rising faster among large physician groups and hospitals than among small, rural health care providers, according to two new studies published in the journal Health Affairs, Modern Healthcare reports (Conn, Modern Healthcare, 4/24).

The studies -- which were discussed at a briefing Wednesday in Washington, D.C. -- examined how health IT implementation is progressing among different health care providers and organizations (Fleming, "Health Affairs Blog," Health Affairs, 4/24).

First Study

In the first study -- funded by the Office of the National Coordinator for Health IT -- researchers looked at data from CDC's National Ambulatory Medical Care Survey from between 2002 and 2011. The survey initially asked health care providers whether they used "any EHR" system, but in 2007 started asking for further details to determine whether the providers were using an EHR system with basic features.

Researchers found that in 2011, the average adoption rate for a basic EHR system was:

  • 24.2% among solo and two-physician practices;
  • 37.1% among practices with three to nine physicians; and
  • 60% among practices with 10 or more physicians.

Researchers also found that the EHR adoption rate was 34.2% among physicians outside of metropolitan areas, compared with 39.4% within metropolitan areas.

Among specialists, the average EHR adoption rate increased from 12.4% in 2007 to 30.9% in 2011, while the average EHR adoption rate for primary care physicians jumped from 17.1% in 2007 to 40.2% in 2011.

Researchers noted that EHR adoption rates received a boost following the creation of ONC in 2004 and the passage of the 2009 federal economic stimulus package, which authorized incentive payments for health care providers who demonstrate meaningful use of certified EHR systems.

The study authors recommended that policymakers "continue to aim incentives and support at small practices" and consider focusing "on physicians outside of primary care."

Second Study

In the second study, a team from Mathematica Policy Research used data from the American Hospital Association's annual survey to examine EHR adoption at 2,464 hospitals between 2008 and 2011.

The researchers found that in 2011:

  • 14.7% of small hospitals had a basic EHR system, compared with 20% of medium-sized hospitals and 24.5% of large hospitals;
  • 19.4% of rural hospitals had a basic EHR system compared with 29.1% of urban hospitals.

The researchers called on federal policymakers to "redouble their efforts among hospitals that appear to be moving slowly or starting from a lower base rate of adoption."

They also criticized government-funded regional extension centers, saying that the program still "needs to demonstrate its effectiveness." They added that deficient health information exchange infrastructure has made it "more difficult for (rural hospitals) to coordinate care and manage population health" (Modern Healthcare, 4/24).

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