Small, Rural, Specialty Ambulatory Practices Lacking in EHR Use

Small, rural, and specialty ambulatory care practices are less likely to engage in advanced EHR use, according to new research published in the American Journal of Managed Care (AJMC).

The study by Rumball-Smith et al. measured differences in levels of EHR use between ambulatory care practices and addressed how these discrepancies affect the ability of the healthcare system to provide coordinated, efficient patient care.

Researchers analyzed data from 30,123 ambulatory care practices with operational EHR systems. The information was gathered during a 2014 HIMSS Analytics survey to gain insight into differing levels of EHR use. Specifically, the research team noted the extent to which providers utilized various EHR functionalities in care delivery.

Researchers categorized ambulatory care practices as super-users or under-users based on the amount of EHR functionalities the entities employed. Practices that near-fully engaged all seven observed EHR functionalities were deemed super-users, while practices that minimally engaged any EHR functionalities were considered under-users.

Overall, researchers found that 73 percent of practices were not using their EHR technology to its full potential.  Furthermore, more than 40 percent of practices were determined to be under-users.

“Among 30,123 practices that were affiliated with a health system and had an operational EHR, only 27 percent were super-users, meaning they were maximally using EHR functionalities designed to improve patient care and facilitate high-quality performance across the broader health system,” wrote researchers.

Small and rural practices were more likely to be under-users of EHR technology than their larger, more urban counterparts. Researchers also found regional differences in levels of EHR use, with practices in the West less likely to fully use EHR functionalities than any other area.

Commonalities among practices that under-utilize EHR technology indicate a systematic problem with health IT adoption and use. 

“There are likely multiple factors involved in EHR and health IT under-use by ambulatory care practices,” the researchers suggested. “Cost has been cited as the primary barrier to adopting an EHR system; similarly, upgrading a basic EHR to one more comprehensive may not be financially possible for practices with limited resources.”

Small and rural practices are particularly sensitive to financial barriers to EHR adoption, optimization, and maintenance.

“These types of practices may face financial, human resource, or structural barriers that impede their ability to use their EHR to full capacity,” researchers wrote.

Meanwhile, specialty practices were least likely to be EHR technology super-users. 

“It is possible that these practices are less well served by existing health IT functionalities and require specific tools developed for more specialized clinical scenarios,” maintained researchers.

The increasing diversity of ambulatory care practices creates a more urgent need than ever for policymakers to enable specialty care practices to fully use EHR functionalities, researchers said. The study sample included more than 50 types of ambulatory specialties.

Ultimately, researchers put the onus on policymakers to address barriers keeping small, rural, and specialty practices from engaging in more advanced EHR use. Health IT under-use can negatively affect the healthcare system at large, the research team stated.

“First, suboptimal use of critical health IT functionalities may have direct relevance for the quality of care provided by an individual practice as part of routine patient care,” researchers maintained.

“Second, under-use of these technologies (such as health information exchange) may have consequences for the quality of care provided across the ambulatory care sector,” the researchers continued.

Finally, researchers emphasized the need to ensure all ambulatory care practices engage in more advanced EHR use to improve interoperability. A lack of interoperability between some ambulatory care practices and hospitals can negatively impact transitions of care.

“Hospitals with advanced EHR systems are fundamentally limited if there are functional restrictions on their ability to interact with caregivers and organizations in the community setting,” the research team wrote.

Facilitating EHR optimization for more ambulatory care practices would likely benefit care coordination and transitions of care for the broader healthcare system.