Health Affairs Briefing at the National Press Club on Health IT Adoption & Use

National Coordinator for Health IT, Dr. Farzard Mostashari, delivered the opening remarks at the Health Affairs briefing on trends in the adoption of health information technology held this week at the National Press Club in Washington, D.C.

Sharing 'open data' is prominent among the accumulating good news about the progress being made in adoption of electronic health record (EHR) systems across the U.S.

Open Data Providing Value to Patient & Providers

Dr. Mostashari mentioned that he is “very optimistic that open data will make significant strides forward in arming patients” to make more informed choices about their health.  Providers are only about five percent of the way to EHRs constructively changing their health care processes and workflow, but consumer led demand for access to their electronic health data combined with incentive payment models will continue to drive change. 

Dr. Mostashari’s discussion and the Health Affairs briefing was very timely, given the recent release of the ONC report to Congress entitled “Update on the Adoption of Health Information and Related Effort to Facilitate the Electronic Use and Exchange of Health Information.”  See http://www.healthit.gov/sites/default/files/rtc_adoption_of_healthit_and_relatedefforts.pdf

Realizing cost savings and measurable quality outcomes that positively impact value, requires continued efforts according to Dr. Mostashari. He pointed out that primary care providers control much of the spending but have yet to see the benefits of health IT transformation.  Regional Extension Centers (REC) have been helpful to primary care providers in further adoption and use of EHR systems that are absolutely critical to achieving the expected downstream benefits.

Citing significant progress in adopting health information exchange (HIE) solutions, Dr. Mostashari noted that states have as much of a stake in transformation as the federal government.  The ONC report noted that as of December 2012, thirty-nine (39) states and territories have operational directed exchange mechanisms broadly available for providers to subscribe to statewide, and nine more states are pilot testing HIE networks or are testing them in regions of their state. 

HIT Trends & Research Findings

Health Affairs released three new research articles that were the subject of the briefings, focusing on the latest trends in health information technology (HIT) adoption among U.S. health care providers and hospitals. 

The Authors of the articles presented their findings which are summarized below:

-  Julia Adler-Milstein, PhD, an assistant professor at the School of Information and the School of Public Health at the University of Michigan, presented findings from, “Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains A Concern.”  See http://content.healthaffairs.org/webexclusives/index.dtl?year=2013

According to a Health Affairs press release, “To assess a key component of national progress in health IT adoption, the authors surveyed all US organizations that facilitated the exchange of clinical data between unaffiliated organizations in late 2012.  They found that 30 percent of hospitals and 10 percent of ambulatory practices participated in one of 119 operational health information exchange efforts.  That is more than double the early 2010 participation rate.  Seventy-four (74%) percent of these health information exchange efforts identified developing a sustainable business model as a barrier to success.  For fifty-two (52%) percent of these operational model efforts, grants and contracts were the most substantial source of support.”

The findings are important for the conclusion which maintains that in order to continue growth in the number of providers adopting health IT after HITECH funding runs out, policy makers must “help these efforts identify and implement sustainable business models.” 

-  Catherine DesRoches, PhD., senior survey researcher at Mathematica Policy Research, presented findings from, “ Adoption of electronic Health Records Grows Rapidly, But Fewer Than Half of US Hospitals Had At Least A Basic System in 2012.” See http://content.healthaffairs.org/content/early/2013/06/27/hlthaff.2013.0308.full

The Health Affairs press release noted, “To measure current hospital use of electronic health record (EHR) systems, the authors used data from the 2012 health IT supplement to the American Hospital Association’s annual survey.  According to the data, 44 percent of hospitals report having at least a basic EHR system.  This represented a 17 percent increase from 2011 and a near tripling of the 2010 adoption rate.  The authors also found that large urban hospitals continued to outpace rural and nonteaching hospitals.  Although 42.2 percent of all hospitals met all the Stage 1 meaningful-use criteria, only 5.1 percent had advanced to Stage 2.”

These findings are significant given the impending impact on hospitals with slower adoption that will face future penalties with regards to meaningful use Stage 2 requirements.  The authors concluded, “although our findings demonstrate considerable progress on the whole, they suggest a need to focus on hospitals still trailing behind, especially small and rural institutions.  This will be especially important at Stage 2 meaningful-use criteria become the rule, and positive incentives are replaced by penalties for noncompliance.”

-  Chun-Ju Hsiao, Senior Service Fellow, National Center for Health Statistics-Division of Health Care Statistics, Centers for Disease Control and Prevention presented findings from the article, “Office-Based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health Records”.  See http://content.healthaffairs.org/content/early/2013/06/27/hlthaff.2013.0323

The study found  “by using data from the 2010-12 National Ambulatory Medical Care Survey, Electronic Health Records, that the proportion of physicians using at least a basic EHR system increased from just 25 percent in 2010 to 40 percent last year.  The highest relative increases occurred among physicians who had lower levels of adoption in the past: those who were older in solo practices, or working at community health centers.” This likely is related to the availability of financial incentives for providers treating Medicare and Medicaid patients. 

The authors concluded, “As providers become increasingly accountable for both costs and quality of care, having robust information systems that allow them to manage care more effectively and share information with patients will be critical.”

Overall, the Health Affairs briefs emphasize finding related to these three key directions being led by ONC:

1. Achieving sustainable business models for exchange requires more work to overcome barriers;
2. Hospitals that are slower to adopt will require attention to bring them into compliance and avoid penalties; and
3. Financial incentives and provider accountability are significant for sharing information with patients.

Dr. Mostashari’s advocacy of the role “open data” play, continues to maintain that it supports constructive economic change,  increases provider accountability, and further empowers patients as they gain further access to their own personal health data.