- A recent study by Julia Adler-Milstein and Ashish K. Jha found HITECH to be primarily responsible for significant increases in hospital EHR adoption rates, suggesting the law should serve as a model for ways to influence technology adoption in the future.
Researchers sought to determine whether the bill responsible for creating the EHR Incentive Programs had indeed achieved its primary goal to spur widespread EHR adoption. Prior to the study, little evidence substantiated the claims of either proponents of the act’s success nor its critics.
“Proponents argue that before the act’s passage, EHR adoption rates were low and increasing very slowly,” wrote the authors. “Without a policy intervention, it might have taken many years, if not decades, for EHR adoption to reach nationwide scale.”
Meanwhile, skeptics argued EHR adoption rates would have risen in a similar way regardless of the act due to market pressures.
To measure whether HITECH directly impacted EHR adoption rates, researchers analyzed two groups of hospitals: one comprised of short-term acute care facilities who had access to financial incentives for meaningful use, and one made up of long-term acute care, psychiatric, and rehabilitation facilities without access to financial incentives.
With ineligible hospitals as a control group, researchers examined eight years of data using a sample size of 25,210 total observations and 5,119 unique hospitals that responded to the American Hospital Association (AHA) IT supplement survey between 2008 and 2015.
Specifically, researchers evaluated the sample size according to whether each hospital had adopted a basic EHR system in each year.
Researchers completed their analysis by comparing the difference between adoption rates before and after HITECH for eligible versus ineligible hospitals.
Ultimately, researchers found strong evidence to suggest the rise in adoption rates from 2011-2015 is largely due to the implementation of HITECH.
“Among eligible hospitals, EHR adoption rates increased by an average of 3.2 percent annually in the period before implementation of the meaningful-use incentives,” wrote authors.
Following implementation, the average annual increase in EHR adoption jumped to 14.2 percent—an 11.1 percent spike.
Meanwhile, EHR adoption rates for ineligible hospitals showed an increase of .01 percent prior to the implementation of HITECH, and a subsequent increase of 3.3 percent.
In total, the difference between adoption rate changes for eligible versus ineligible hospitals amounted to 7.9 percent.
The nearly 8 percent yearly increase in adoption rates signaled to researchers that HITECH and the $20.9 billion given to hospitals as financial incentives through 2015 were effective in achieving their aim.
“Given that the level of EHR adoption among eligible hospitals in 2010 was 15 percent, an increase of 8 percentage points per year suggests that in five years the incentives moved US hospitals past the half way mark,” wrote authors. “There are likely very few other policies that have driven such substantial change in such a short period.”
Adler-Milstein and Jha determined the success of HITECH should encourage policymakers to pursue a similar approach in the future when attempting to stimulate widespread technology adoption.
However, questions remain surrounding why HITECH was so successful for hospitals. Researchers reason the financial incentive system may have been especially effective in the setting in part because of the maturity of the hospital EHR market in comparison to other EHR markets, such as ambulatory.
“More broadly, our results raise the question of why HITECH was successful in driving change among hospitals when many other policy efforts that seek to change hospitals’ and ambulatory providers’ behavior have not succeeded,” wrote authors.
“We suspect that a primary reason is the sense of inevitability: EHR adoption was likely in many hospitals’ long-term plans, and the availability of incentives may have simply moved it up on the priority list,” they reasoned.