In 2015, 84 percent of the nation’s hospitals reported adoption of at least a basic electronic health record (EHR) system, a nine-fold increase since 2008, according to new survey data released by the Office of the National Coordinator for Health IT (ONC).
The latest ONC data brief, which is based on data from the American Hospital Association’s (AHA) Annual Survey Information Technology Supplement, also reports that certified EHR adoption among the nation’s hospitals remains high, with nearly all reported hospitals (96 percent) possessing certified EHR technology in 2015. This rate is similar to 2014, suggesting that adoption of certified EHR systems may be plateauing.
With regard to basic EHR systems, adoption rates increased by 11 percent from 2014 to 2015, according to the ONC data brief. Basic EHRs, a historical measure of EHR adoption, includes functionalities, such as viewing imaging results, which are not included in certified EHRs.
The adoption and meaningful use of electronic health records (EHRs) are key objectives of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the Federal Health IT Strategic Plan. The brief uses data from the AHA to describe trends in adoption of EHR technology among non-federal acute care hospitals from 2008 to 2015.
Certain hospitals that have traditionally lagged behind in EHR adoption are now closing the gap. Although small, rural and critical access hospitals continue to have significantly lower basic EHR adoption rates (around 80 percent) compared to all hospitals, it is noteworthy that at least eight out of 10 of these hospitals adopted a basic EHR, according to the ONC data brief. Since 2014, small and rural hospitals increased their adoption of basic EHRs by at least 14 percent and critical access hospitals increased their adoption of basic EHRs by 18 percent.
However, children’s and psychiatric hospitals continue to lag behind, as the survey data finds that basic EHR adoption among these hospitals is significantly lower than general medicine hospitals. In 2015, slightly more than half (55 percent) of children’s hospitals adopted a basic EHR system and only 15 percent of psychiatric hospitals had adopted a basic EHR.
According to the ONC data brief, this is not altogether surprising as only 69 percent of children's hospitals successfully attested to Stage 1 of the Centers for Medicare & Medicaid Services (CMS) Medicaid EHR Incentive Program and psychiatric hospitals are not eligible for the CMS Medicaid or Medicare EHR Incentive Program.
In 2008, there was no significant differences in basic EHR adoption rates between children’s and general medicine hospitals, whereas psychiatric hospitals were significantly lower. Between 2008 and 2015, adoption of basic EHR systems doubled among psychiatric hospitals, increased five-fold for children's hospitals, and increased seven-fold for general medicine hospitals.
Similar to national trends, EHR adoption is also widespread at the state-level. Basic EHR adoption was above 80 percent for 35 states in 2015; whereas no states in 2011 had basic EHR adoption rates at or above 80 percent. In 2008, all states had adoption rates of 22 percent or less. This change represents a substantial increase in EHR adoption at the state-level.
And, trends in EHR adoption indicate increasing use of advanced functionality. In 2015, eight out of 10 hospitals (84 percent) adopted EHRs with advanced levels of functionality above basic EHRs without clinician notes; this refers to the adoption of comprehensive EHRs (40 percent) and basic EHRs with clinician notes (44 percent).
While there was an 11 percent increase in the adoption of EHRs with advanced levels of functionality above basic EHRs between 2014 and 2015, there was a 42 percent decrease in the use of less advanced EHRs (basic without clinician notes functionality).
“In summary, EHR adoption is widespread across most hospitals and at the state-level. Efforts that have focused on EHR adoption now are shifting to interoperability of health information, and the use of health information technology to support care delivery system reform,” the ONC data brief states.
Realizing the full value of widespread EHR adoption will require focusing on not only hospitals' interoperability “but also examining health IT adoption and interoperability across additional settings including long-term care providers and behavioral health care providers, and beyond the care continuum, such as social services and public health.”
