While active registrants and payments distributed by the Medicare and Medicaid electronic health record incentive programs continue to rise overall, there remain several areas where adoption of EHRs is less than stellar, according to a pair of studies published this week in Health Affairs.
In particular, small, nonteaching and rural hospitals have been slow to adopt EHRs, according to one study, while adoption has crawled by non-primary care doctors, those who are in solo or two-provider practices, and physicians 55 and older, according to another.
Authors of the first study used American Hospital Association data to determine how many hospitals in 2011 had either a basic or comprehensive EHR system in place, or enough implemented technology to meet a pre-determined "proxy standard"--12 functions implemented for at least one clinical unit--for Meaningful Use. They found that 43 percent of large hospitals had adopted at least a basic EHR, compared to 20.8 percent of small hospitals; only 19.4 percent of hospitals in rural areas could make a similar claim.
According to the first study's authors, large, urban hospitals also were more likely to meet the proxy standard than their smaller and more rural counterparts. They point out that reasons for slower adoption by the latter could range from "lack of access to capital" to "market forces."
"We continue to see a large proportion of hospitals that are making very little progress, including one in 13 institutions that have none of the 12 core measures included in our proxy standard for Meaningful Use," the first study's authors said. "We believe that federal policy makers need to redouble their efforts among hospitals that appear to be moving slowly or starting from a lower base rate of adoption."
The authors of the second study, meanwhile, examined data from 2002 to 2011, determining that adoption of basic systems decreased as physician age increased.
"By the end of the decade, physicians age 45 or younger were about 17 percentage points more likely to use any EHR system than physicians older than age 55," those authors wrote. Additionally, they found doctors in large practices of 10 or more physicians 42 percentage points more likely than those in small practices to adopt an EHR system in 2011--up from a gap of 13 percentage points in 2002.
"Federal programs initiated by the 2009 legislation are targeting primary care providers and physicians in small practices," the authors wrote. "To achieve the stated aims of widespread use, the programs will need to continue to aim incentives and support at small practices."