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Study: EHR Adoption Among Urban Providers is Lacking

July 1, 2013
by Rajiv Leventhal
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Healthcare providers in large metropolitan areas are less likely to have implemented electronic health records (EHRs) than providers in smaller metro and rural areas, according to a new study in Health Services Research.

To determine whether there was a “digital divide” emerging in traditionally underserved areas, the researchers gathered data from 261,973 ambulatory healthcare sites with 716,160 providers across 50 states and the District of Columbia. Healthcare sites studied ranged from small one-physician sites to large multi-physician practices.

They found that in 2011, 43 percent of providers at ambulatory healthcare centers used an EHR with the ability to prescribe medication electronically. Areas with high concentrations of minority and low income populations and large metropolitan areas were more likely to be in the lowest quartile of EHR adoption nationally compared to rural areas.

The researchers note that efforts to promote EHR use should be targeted to areas where traditionally underserved populations live in order to avoid exacerbating existing health disparities.

Jennifer King, Ph.D., chief of research and evaluation at the Office of the National Coordinator (ONC) for Health Information Technology and lead author of the study, said in a statement that in 2011, when the study was conducted, there was a lower EHR adoption rate in underserved areas, including large metropolitan areas with high concentrations of minority and low income populations. But, she noted, “in small metropolitan and rural areas, on average, there were slightly higher EHR adoption rates.”

Interestingly, a 2012 report from the Government Accountability Agency (GAO) found that among acute care hospitals that received Medicare EHR incentive payments, the largest proportion (44 percent) was located in the South, and the lowest proportion (12 percent) was located in the Northeast. Most, two-thirds (67 percent), were in urban areas, the report said.

“This study validates that the cost of EHR implementation is still prohibitive in many communities despite efforts by the federal government to provide incentives,” Jocelyn G. DeWitt, Ph.D., chief information officer with University of Wisconsin Health, Madison, said in a statement. “Attention needs to be paid to urban areas as much as rural communities for EHR adoption. It is incorrect to assume that urban clinicians have the resources to implement EHR.”

Back in March at a HIMSS13 pre-conference symposium, it was discussed how leaders in national Native American healthcare community are facing a tremendous challenge in trying to get Indian Health Service (IHS), tribal, and urban health facilities to not only adopt EHRs, but get them meaningful use certified under the Health Information Technology for Economic and Clinical Health (HITECH) Act as well.

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