A study of hospital EHR use shows a pattern of EHR functionality implementation influenced by hospital type and its participation in Stage 1 Meaningful Use.
“We find stronger homogeneity among small, rural, and non-teaching hospitals, which is likely driven by greater reliance on vendors and less variation in the types of care that they deliver compared to larger, urban, teaching hospitals,” write Adler-Milstein et al. “Perhaps most importantly, we find that stage 1 meaningful use may change how hospitals sequence EHR adoption.”
The study uses data on nearly 2800 hospitals in the United States, supplemented with information from the 2008 American Hospital Association (AHA) annual survey.
Of the top-ten EHR functionalities listed in the study, half play an essential role in the first phase of the EHR Incentive Programs:
- Patient demographics (1)
- Medication lists (5)
- Drug-drug interaction alerts (6)
- Drug-allergy alerts (7)
- Discharge summaries (9)
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Of the top-20 EHR functionalities, five fall into the category of clinical decision support (CDS), which the authors contend bears the mark of meaningful use. “This suggests that meaningful use may cause hospitals to change their planned order of EHR function adoption, and move these functions ahead in sequence,” they maintain.
Given the value of EHR incentives to small and rural hospitals, these facilities must abide by meaningful use requirements or risk losing out on millions of dollars. However, this pursuit of incentive payments could lead to poorly sequenced EHR technology.
“Each of these functions must work with others to create a functional system, and the interdependencies between them require complex decisions regarding which functions to adopt, and in what order,” Adler-Milstein et al. observe.
According to the authors, the incentivized adoption of certain EHR functionalities could negatively influence the features hospitals are willing to choose and implement:
“For example, nursing assessments—important for patient handoffs and care continuity—are typically adopted in the middle of the sequence, but ahead of clinical reminders and medication CPOE. Since such assessments are not part of stage 1 meaningful use, hospitals may deprioritize their implementation, dampening their effort to improve the quality of care coordination.”
Ultimately, the study emphasizes the need for policymakers and stakeholders to consider the downstream implications of meaningful use incentives or payment adjustments (i.e., penalties) on hospital EHR adoption strategies. Having all the right components in place does not guarantee that they are being used meaningfully or at the very least appropriately to deliver safe and effective patient care.
Date: January 19, 2015