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Cost, Hospital Efficiency Still Major Barriers to EHR Adoption

A recent study highlights the persisting effects of cost and hospital efficiency on EHR adoption rates.

By Sara Heath

- Despite potential for incentive payments, cost, as well as other challenges, remains a significant barrier to EHR adoption, finds a recent study published in JMIR Medical Informatics.

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In the study, lead author Clemens Scott Kruse, MBA, MSIT, MHA, PhD, examined a bevy of literature regarding EHR adoption in order to determine the various barriers and facilitators that influence providers years following the implementation of the HITECH Act.

The literature review revealed a set of 25 adoption facilitators, which included increased efficiency, hospital size, quality, access to health data, perceived value, and ability to transfer health information.

The review also showed 23 EHR adoption barriers, including cost, time consumption, provider’s perception of usefulness, transition of data, location of healthcare facility, and implementation issues.

Kruse and colleagues specifically noted the cost barrier. In 2009, right after the passage of the HITECH Act, critics sited cost as a challenge in EHR adoption, the research team explained. It was notable that cost should still serve as a hindrance considering the EHR Incentive Program payments that are frequently awarded to successful technology adopters.

However, when one looks to real world examples of very costly EHR adoption and implementation projects, it becomes apparent that cost-associated fears still linger.

Earlier this year, an Epic EHR implementation cost Southcoast Hospital in Massachusetts significant financial turmoil, resulting in the layoffs of 95 hospital employees.

The Epic implementation cost the hospital a hefty sum and contributed to the $9.9 million operating loss the hospital experienced the previous year.

Kruse and colleagues also viewed the reported cost apprehensions as an indicator of the importance of perception in EHR adoption and use.

The team noted that cost was listed as both a barrier and a facilitator of EHR adoption – the difference, they said, was in how providers perceived cost. Some feared they would experience the same fate as Southcoast Hospital, while others saw potential for financial gain through the EHR Incentive Programs.

A similar pattern emerged with regard to hospital efficiency. Some respondents thought it would increase efficiency because all aspects of operations would go digital; others thought it would hinder workflow because the technology could be difficult to use.

“We found it interesting how often perception plays into interviews and surveys, and in the case of this review, resulted in one or more factors appearing as both an enabler and a barrier, based on the perception of the interviewee,” Kruse and his team reported.

Several difficult-to-overcome barriers also arose, such as hospital location or size. These challenges are out of control of the healthcare facility, and serve as true roadblocks for small, rural hospitals. Because these challenges are very difficult to overcome, the researchers suggest polices be enacted to help small, rural hospitals.

Location is a difficult barrier to overcome. It is not a mystery to anyone that rural communities often struggle to overcome barriers such as cost, bandwidth, and user/patient acceptance, a point supported by the literature. Unfortunately, very few solutions are offered to this group; at a minimum policy should look to assist those who lag behind the rest of the adopters. Small, rural communities are the slowest to adopt, and their size is a major disadvantage in terms of budget and technical agility. Policy should look to a range of factors to lever, such as organizational, cultural, technological, and financial considerations.

Other healthcare experts have taken their hand at identifying EHR adoption barriers. Most recently, the Office of the National Coordinator for Health Information Technology reported four barriers in their report to Congress.

ONC reported inconsistent ERH adoption across specialty providers, lack of health IT transparency, lack of national standards for health information exchange, and data blocking.

Several of ONC’s reported hindrances overlap with those found by Kruse and colleagues, including lack of HIE standards and data blocking.

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