Electronic Health Records

Adoption & Implementation News

EHR adoption depends on age group, practice size and setting, and specialty

By Kyle Murphy, PhD

- You can’t teach an old dog new tricks; you can lead a horse to water but you cannot make him drink. If I were either of these animals, I’d be a touch peeved at my widespread association with stubbornness. For those of us born in the digital age, the great value of technology is a priori — we’re born believing that technology is integral to our daily lives and overall well-being. However, our elder statesmen and stateswomen approach technology from an a posteriori perspective. For this group, the adoption and sustained use of new technologies is borne out of experience and sometimes not-so-friendly encounters with not-so-patient technophiles. But both groups recognize the central role technology plays when doing business in the information age.

Unsurprisingly, older (≥ 55 years old) and younger (< 55 years old) physicians differ in the attitudes toward the use of health technology in their treatment of patients, especially in the adoption of electronic health record (EHR) systems. A study that will appear in the print edition of Health Affairs this May reveals that age as well as practice environment make all the difference in whether physicians choose to adopt EHR technology. The research of Decker et al., “Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems” (doi: 10.1377/hithaff.2011.1121), is based on data from the yearly National Medical Care Survey 2002–2011, which comprises responses from nearly 23,000 physicians.

So what do we know? First, EHR use has grown dramatically since 2002: less than 20% compared to nearly 60%. Much of this growth is the result of the American Recovery and Reinvestment Act (ARRA) and Health Information Technology for Economic and Clinical Health Act (HITECH) in 2009. Within these adoptions distinct differences became apparent:

Adoption of any system during the decade increased more for primary care specialists compared to non–primary care specialists; for physicians age fifty-five or younger compared to those older than fifty-five; physicians in practices with ten or more providers compared to those in practices with fewer than ten providers; physicians in practices owned by organizations other than physicians or physician groups; and physicians outside of Metropolitan Statistical Areas.

There is a danger that the disparity in EHR use could affect future health information exchange (HIE), as some physicians without EHR systems or systems that are too basic cannot make use of a more robust EHR. Stage 2 Meaningful Use takes the quality of patient care beyond the level of a single provider to a network of providers. Considering that physicians under 45 years old are adopting EHR systems twice as quickly as their older counterparts, it is likely that this generational gap in EHR implementation will close significantly.

READ MORE: Updated ONC SAFER Guides Encourage EHR Usability, Safety

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READ MORE: HL7 Publishes Release 3 of HIT Standard FHIR for Trial Use

Of more importance to the widespread use of EHR technology is its use by large and small providers. In past two weeks, we’ve covered the important national initiative by the Office of National Coordinator for Health Information Technology (ONC). Through the funding of 62 regional extension centers (RECs), the ONC is working on the state level to help smaller practices achieve to achieve Stage 1 Meaningful Use via a certified EHR system. The first REC milestone (M1) is to enroll 1,000 providers in the REC’s program, the second (M2) is to get these providers to go live with their EHR systems, and the third (M3) is to get them to achieve meaningful use.

According to the study, small practices and non-primary physicians hold the key to the ultimate success of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs:

This broad initiative is intended to raise overall adoption levels. Federal programs initiated by the 2009 legislation are targeting primary care providers and physicians in small practices. To achieve the stated aims of widespread use, the programs will need to continue to aim incentives and support at small practices. Programs may also need to focus on physicians outside of primary care to narrow the persistent and widening gap in the adoption of EHR systems.

In light of what we learned from the director of Nebraska’s REC, we ought to add rural health clinics to this key group, which for some reason are ineligible for Medicare and Medicaid incentives because of legislative oversights and the unique make up of their patient population.

EHR adoption is about more than incentives, it’s also pivotal to the viability of certain clinics and small practices as it could determine their ability to keep staff and attract the next generation of techno-savvy physicians.

Related Articles:

• Why can’t rural health clinics receive EHR Medicare incentives?
• Wide River TEC reaches REC milestone
• Getting CAHs to attest to meaningful use
• Part I: The go-to resource for meaningful use in NH
• Part II: The go-to resource for meaningful use in NH
• What hospitals are eligible for EHR incentives?
• Preparing and registering for EHR Incentive Programs

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