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Digital divide for electronic health records worth investigating, researcher says

Over the past several years, most hospitals have adopted electronic health records — a digital version of a patient’s medical chart that can contain information from all clinicians involved in a patient’s care. The goal is to provide better, more coordinated care using EHRs, although they are also increasingly cited as a source of physician burnout.

But there may be another problem with the implementation of EHR systems: although EHR adoption is widespread, the use of the records varies at different hospitals. According to a recent presentation at the 2017 American Medical Informatics Association’s annual meeting, hospitals with fewer resources are less likely to use the advanced functions of EHRs for measuring performance and engaging patients.

The University of Michigan researchers analyzed data from almost 3,000 medical-surgical acute care hospitals in the United States, based on the 2008 to 2015 American Hospital Association Annual and IT Supplement surveys.

First, they evaluated which hospitals have adopted “basic” verses “comprehensive” EHR functions. They found larger, urban hospitals participating in payment reforms were far more likely to use a comprehensive system than small, rural and safety-net hospitals — creating a digital “use” divide of EHRs.

Next, the researchers analyzed questions newly available on the 2015 supplement to further assess hospital use of EHRs for 10 performance measurement and patient engagement functions. Over all hospitals, the most commonly adopted performance measurement functions were used to monitor patient safety and create dashboards of individual provider performance. Similarly, the most common patient engagement function allowed patients to view data online and download it.

However, critical access hospitals overall were less likely to have adopted eight or more of the ten EHR functions of either category.

The conference speaker, Julie Adler-Milstein, PhD, was an associate professor at the University of Michigan during this research and is now at the University of California, San Francisco. She said she is concerned about this emerging divide because advanced EHR functions are essential for improving hospital performance. “We do need to consider what we can be doing to help safety-net hospitals make sure that they are able to continue their adoption trajectory and invest in some of these more substantive and important capabilities,” said Adler-Milstein in a recent news piece.

Specifically, the authors recommended in the conference abstract that policymakers drive greater EHR adoption using direct funding for health IT and indirect incentives to promote value-based payment and delivery models. They concluded, “Policymakers may need to consider specific actions to target safety-net hospitals, which could include funding as well as technical assistance with implementation.”

Previously: Commentary expresses “building resentment against the shackles” of electronic health records and How efforts to mine electronic records influence clinical care
Photo by mcmurryjulie

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