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Unraveling Some of the Findings in Last Week's Health Affairs Blog

August 11, 2014
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There's mixed news revealed in the latest research on healthcare IT

Research published online last week in a Health Affairs blog brings to the industry some mixed news regarding the adoption of electronic health records (EHRs), health information exchange (HIE) development, and the forward progress of patient engagement strategies in healthcare right now.

A team of researchers led by Michael F. Furukawa, a senior staff fellow at the Center for Delivery, Organization, and Markets, at the federal Agency for Healthcare Research and Quality (AHRQ), analyzed data from the 2009 National Ambulatory Medical Care Survey (NAMCS) and the 2009-13 Electronic Health Records Survey, a mai survey designed as a supplement to the NAMCS. According to the researchers, "These surveys sampled office-based physicians who provided direct patient care, excluding radiologists, anethesiologists, and pathologists. The surveys collected information on physicians' adoption and use of EHR systems, including electronic HIE with other provides, and the routine use of computerized capabilities."

So let's unravel what the researchers found, beginning with their Conclusion. They write, "Using the latest national data, we found that since the passage of HITECH [the Health Information Technology for Clinical and Economic Health Act] in 2009, there has been a steady growth in the adoption of EHR systems among office-based physicians. Nonetheless, Furukawa and his colleagues write, "there is substantial work ahead, since about half of these providers have yet to adopt at least a basic EHR. The rates of adoption varied by practice size and ownership in 2013. However, the small differences suggest that the gaps are likely surmountable through additional policy efforts."

Further, the authros of the article write, "Paying close attention to HIE and online patient engagement will be especially important in the future to ensure that federal incentives translate into better care for patients. HITECH," the write, "focused on implementing th digial infrastructure. Policies now should address barriers to broader EHR use to support the care coordination and patient engagement objectives in new payment and delivery reforms."

Fair enough. So first, let me comment a bit on the statistical results coming out of the two surveys on which the researchers based their findings. They found that in 2013, "78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system." But they also found that many physicians in solo practices and in non-primary care specialties were lagging behind others in adopting EHRs. I don't in any way question that assertion; but I would bet good money that the overall finding of 78 percent of office-based physicians being live with an EHR will almost certainly have been revised upward by this summer. Indeed, we are in a period of extremely rapid EHR implementation now, and, with mandates coming not only out of the HITECH Act and its meaningful use process, but also out of healthcare reform-driven mandates embedded in the Affordable Care Act (ACA), it is hard to believe the percentage of primary care physicians in practice, at any rate, won't be below 90 percent in terms of EHR adoption, at least by this fall.

Now, with regard to office-based physicians' involvement in HIE and in patient engagement strategies, I believe the researchers' findings are probably still statistically very current--alas. They find that, as of last year, only 39 percent of office-based physicians reported having any electronic HIE going on with other ambulatory providers or hospitals, though rates of HIE within organizations were higher, even so, than with those outside. The news on patient engagement capabilities is even starker: the researchers found that while two-thirds of office-based physicians had the capability to electronically provide patients with visit summaries or patient-specific educational resources, and while about half had the capability to exchange messages with patients, the level of actual activity in this area was all over the map, with huge divergences among physicians based on whether they were in larger group practices or in practices owned by hospitals and health systems--not surprisingly, of course.

What's more, while "Four in 10 physicians had the capability to enable patients to view online, download, or transmit their health information electronically... only about half of these physicians routinely used this capability. Similarly," the authors noted, "only about a third of the physicians with secure messaging capability reported that it was routinely used."

There's a lot of detail to explore in this very well-researched Health Affairs blog report, and I would urge readers to read through its findings. At the same time, it's clear that healthcare IT leaders will need to help their colleagues push forward not only to finish connecting the remaining office-based physicians to EHR systems, but also to help them with HIE and patient engagement capability development, particularly in the context of broader work on all new models of healthcare delivery--accountable care organizations, bundled-payment contracting, patient-centered medical homes, population health management, and so on. A lot of this will happen naturally in the course of all these types of activities, but it will nonetheless require organization, leadership, and management, to make it all happen.

In the meantime, my hope is that if the authors of this blog report go back and do these surveys in another year or two, the statistical results in all the areas they've covered here will represent big steps forward, as clinicians and patient care organizations speed ahead to architect the new healthcare.