Health Affairs: Is excluding specialists from MU incentives creating a digital divide?

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By leaving out ineligible providers in reform efforts, the nation risks building a new digital divide where key providers, who already have low levels of electronic clinical data, may fall further behind, according to an article published in the March edition of Health Affairs.

Larry Wolf, health IT strategist at Kindred Healthcare in Louisville, Ky., and colleagues used national data provided by the American Hospital Association to determine adoption rates of EHR systems among all types of inpatient providers ineligible for federal meaningful use incentives, including long-term acute care, rehabilitation and psychiatric hospitals. They found that adoption rates were “dismally low.”

Twelve percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals and 2 percent of psychiatric hospitals.

“When we examined rates of adoption of a comprehensive EHR system (functions needed for the system to have a robust impact on quality and efficiency), we found that no psychiatric or rehabilitation hospitals met these criteria and that just 2 percent of long-term acute care hospitals had such systems,” the authors wrote. “As reported, 3 percent of short-term acute care hospitals met these criteria.”

Compared to short-term acute care hospitals, ineligible hospitals had lower rates of adoption for each of the twenty-four individual functions that make up a comprehensive or basic EHR, according to the report. For example, 30 percent of short-term acute care hospitals reported having computerized provider order entry for medications in at least one clinical unit. However, the numbers for the ineligible hospitals ranged from 19 percent to 23 percent.
 
The rate of health information exchange (HIE) with unaffiliated hospitals and physicians was also much lower for ineligible hospitals than eligible hospitals. Although 17 percent of short-term acute care hospitals reported that they were actively exchanging health information with other providers, the comparable rates were just 11 percent for long-term acute care hospitals, 5 percent for rehabilitation hospitals and 9 percent for psychiatric hospitals.

While Wolf and colleagues noted several limitations to the study, including that they focused on whether hospitals had adopted a EHR system rather than measure its use, they stated that lower levels of HIE engagement have important consequences. "Electronically exchanging health information has the ability to enhance care coordination as patients move among care settings,” they wrote.

“To develop a nationwide health IT infrastructure that provides timely and complete information at the time and place of care, electronic clinical data will need to be available across all sites of care,” the authors concluded. “Consideration should be given to measuring and advancing the use of EHR systems and HIE by providers ineligible for federal EHR incentives.”