Over the past several weeks, we have reached out to our readers to have them share their experiences with electronic health record (EHR) systems. Among inpatient care organizations and providers, EHR use is incredibly high (and presumably much higher than their ambulatory counterparts) and primarily motivated by money whether in the form of incentives, penalties, or business improvements. Here’s what our readers working in inpatient care revealed about their EHR experiences with implementing a system, achieving meaningful use, and keeping their systems and patient records safe from authorized access.
EHR use is high among inpatient care organizations and providers. More than 86% of hospital respondents indicated they were using an EHR system. And those not currently using a system have planned to implement an EHR system shortly, with a majority (66.6%) indicating that their hospital would be up and running within the next year (66.6%) or six months (50%) and one-third would be using an EHR system within the next two months (33.3%). Only 16.6% were planning an EHR implementation beyond the provided timeframes.
Whether in the form of incentives or penalties, money represents the motivation driving EHR adoption among hospitals. Considering payment adjustments from Medicare won’t take effect until the beginning of the 2015 fiscal year for hospitals, it makes sense that incentive payments (86.3%) rather than potential penalties (72.1%) was the top factor motivating the adoption of an EHR system as of 2012. Patient care and business improvements tied for third (59%); likewise, consolidation or acquisition and other factors were neck-and-neck (4.5%).
In terms of meaningful use, 56.5% of respondents acknowledged that they were currently in the process of planning for meaningful use while 34.7% were currently in the process of attesting at the time of the survey. Very few (8.6%) indicated no plans for attestation. Of all the hospitals surveyed, 72.4% specified that their EHR systems were certified for meaningful use, a requirement for participation in the EHR Incentive Programs. With the increasing emphasis placed on health information exchange (HIE) in future stages of meaningful use, similar number of respondents (72.4%) are connected or will connect to these network of networks, further improving their ability to receive incentives going forward. Moreover, 62% of respondents said they were already preparing for Stage 2 Meaningful Use, which kicks off in 2014.
When asked about the factors influencing the selection of a particular EHR solution, a majority of respondents indicated the system’s functionality as most decisive (57.1%). Next to functionality, these respondents were most concerned with the ability of using the system to achieve meaningful use in the EHR Incentive Programs (47.6%). Vendor reputation and the price of the system came in as the third most influential factor (38%), followed closely by vendor availability (33.3%). Other notable factors include vendor training and support resources (19%) and mobile capabilities (4.7%).
Given the size of inpatient care settings and the large number of staff they maintain, protecting EHRs requires a variety of physical and technical safeguards. Physically, these organizations have employed tools to secure computer equipment (90.4%), access to data stores (80.9%), locked offices (57.1%), views of screens (52.3%), and buildings via alarms (47.6%). In terms of physical safeguards, all measures were used by the majority of organizations with the exception of alarm systems.
Technical safeguards are much more numerous and a majority of respondents indicated their use of an array of technologies. Secure passwords (85.7%) and audit logs of user access and activities (85.7%) were the most commonly used technical safeguards, followed closely by tools managing electronic exchange (80.9%) and malicious attacks (71.4%). Even at the bottom of the table, data encryption (66.6%), backup (66.6%), and ability to edit them (61.9%) were used by most organizations
When asked about what they like about their systems, the greatest number of respondents (60%) chose improved access to patient records. Record access was followed closely by improvements to preventive care (55%) and billing (50%). At the middle of the pack (35%), respondents indicated improvements to coding and prescriptions, reduced transcription costs and chart pulls, and mobile capabilities. The only other specific benefits entailed better efficiency in handling telephone messages and refilling prescriptions (15%).
When asked about what they dislike about their systems, these inpatient providers and organizations pegged expense as the most detestable feature (75%), outstripping negative effects on clinical and administrative workflows for a few points (70%). A majority of respondents said that the learning curve associated with becoming a proficient user of the EHR system was a detriment to its adoption and use (55%). Although featured separately, a lack of standards (45%) and interoperability (20%) if combined under a single characteristic would have scored even higher. Apparently, respondents weren’t all too concerned with the privacy and security of their patients’ records (25%) or the poor support they received from their vendors (15%).