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Reviewing the State of EHR Adoption Under Meaningful Use, MACRA

While EHR adoption has grown under meaningful use and EHR incentives, how might it fare under MACRA?

By Sara Heath

- As the healthcare industry began to focus on value-based care models, EHR adoption flourished. Under the Centers for Medicare & Medicaid Services’ EHR Incentive Programs, or meaningful use, individual providers and hospitals across the country began to adopt the technology, making it a mainstay in healthcare facilities.

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But as physicians face the end of meaningful use as they know it due to the Medicare Access and CHIP Reauthorization Access, where does EHR adoption stand? How widespread is its adoption? And how are physicians faring in integrating the technology into their practices?

Below, EHRIntelligence.com discusses the state of EHR adoption and how the technology relates to physicians.

EHRs reach near ubiquitous adoption

Since the start of Stage 1 Meaningful Use in 2011, EHR adoption has reached 83 percent of basic systems, and 96 percent for certified EHR technology (CEHRT), according to the Office of the National Coordinator for Health Information Technology (ONC).

READ MORE: Value-Based Care, Political Doubt to Shape EHR Use in 2017

Although 96 percent CEHRT adoption is a high number, showing that most doctors are using an EHR, this most recent ONC data brief shows that CEHRT adoption is actually down. In 2015, the year which the data represents, CEHRT adoption was a flat 96 percent, while in 2014 CEHRT adoption was 96.9 percent.

However, basic EHR adoption did rise. In 2014 it was only at 75.5 percent, while in 2015 it was at 83 percent.

Meanwhile, a separate study published in Health Affairs in November 2015 shows 75 percent adoption for basic EHR systems. According to the study’s authors, this increase is likely a direct result of meaningful use, and shows promise for ubiquitous adoption down the road.

“This likely reflects a combination of the availability of financial incentives for the past four years and the impending penalties, at least from the Medicare part of the meaningful-use program. Our findings suggest that close to 100 percent hospital adoption of basic EHRs is possible in the near future,” the researchers wrote.

Cost remains an EHR adoption barrier

READ MORE: Proposed MACRA Rule to End Meaningful Use for Physicians

Although EHR adoption is, for the most part, climbing, barriers still remain. A study published in JMIR Medical Informatics shows that cost and hospital efficiency remain significant barriers to full adoption.

Other barriers included time consumption, providers’ perception of usefulness, transition of data, location of healthcare facility, and implementation issues.

On the flip side, the study also identified several facilitators to EHR adoption, including increased efficiency, hospital size, access to quality healthcare data, perceived value, and ability to transfer health information.

The researchers explained that several of the listed facilitators also served as barriers, and that such a result highlighted the differences in preference for various technology users. For one doctor, storing data on an EHR presents an opportunity for better health information exchange. For another, lacking technology interoperability presents a greater challenge then when records were stored in paper files.

“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.

READ MORE: What Clinical Quality Measures Mean to Healthcare Providers

Because of these conflicting views on the technology, it is possible that EHR adoption will continue to be a mixed bag. While a majority of providers may adopt EHRs due to the financial incentive payments available, they may not like using the technology and may not use it to its fullest extent.

EHRs may contribute to physician dissatisfaction

Several studies provide evidence that some users are dissatisfied with EHR use. One team from Mayo Clinic reported that computerized physician order entry (CPOE), a common EHR function, contributes to provider burnout.

"Electronic health records hold great promise for enhancing coordination of care and improving quality of care," Shanafelt told Science Daily. "In their current form and implementation, however, they have had a number of unintended negative consequences including reducing efficiency, increasing clerical burden and increasing the risk of burnout for physicians."

Another study, conducted by InCrowd, showed that EHR use plays a role in physician burnout, especially for emergency department and primary care physicians. Fifty-seven percent of survey respondents stated that EHR use contributed to their burnout, and 37 percent said they knew a colleague who had experienced burnout by the hands of an EHR.

Going forward, MACRA will continue to play a similar role as meaningful use. Through its Advanced Alternative Payment Models, the law requires providers to adopt CEHRT.

Providers are also likely to have a changing relationship with their EHRs under MACRA. Foremost, because the law repeals the sustainable growth rate, introduces the Quality Payment Program, and streamlines reporting requirements for providers, reporting on their EHR use will ideally less burdensome for providers.

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