Do private health providers meaningfully employ electronic health records?
Health record electronation has been increasingly promoted as digital health care solutions are encouraged by health policies. However, new research suggests that private physicians are less likely to maintain these electronic records and derive benefits from them.
Digital health care solutions are being increasingly encouraged by health policy makers; this has led to the modernization of patients’ health records such as their transferal to electronic sourcing. These electronic health records (EHRs) have the purpose of improving patient care by bettering physician information and patient data quality. However, new research has observed discrepancies in physicians’ use of EHRs that varies according to their private or public practices.
Research led by Jordan Everson, an Assistant Professor in the Department of Health Policy at Vanderbilt University Medical Center (TN, USA), has assessed the EHR use patterns of 291,234 physicians.
Researchers observed that 49% of surveyed physicians who practiced privately, since 2011, reported at least one meaningful use of EHRs. By contrast, 70% of physicians who remained horizontally or vertically integrated serving group practices and hospitals reported meaningful use of EHRs.
Meaningful Use of EHRs was first defined by the 2009 America Reinvestment & Recovery Act. Until 2015, the Meaningful Use program was voluntary and financial incentives were offered to clinicians and health systems that serviced Medicare and Medicaid patients. Since 2015, the Centers for Medicare and Medicaid Services (CMS; MD, USA) lowered the financial incentives offered to health providers if evidence of their greater adoption of EHR Meaningful Use practices was lacking.
Meaningful Use practices include electronic prescription of drugs and online patient portals.
A possible explanation for the variation in EHR Meaningful Use of private physicians compared with integrated clinicians could be due to the greater authority that private physicians have over the technology they employ. By contrast, clinicians in the public sector may have management-imposed requirements that enforce their Meaningful Use of EHRs.
However, as Everson commented, the variation could also mean that: “…the cost-benefit equation was worse for independent physicians…the financial incentives in later years were not enough to overcome the cost of keeping up with Meaningful Use in addition to the time burden of using EHRs. Financial costs are likely particularly high for independent physicians who can't spread the cost across a large organization."
By 2015, approximately 50% of private clinicians who had participated in the HER Meaningful Use incentive program between 2011—2013 left the program, compared with less than 20% of hospital-serving physicians over this same period.
The study also highlights factors such as an aging private physician population as potential contributors to the observed trend.
Further, by employing multivariate regression models, researchers demonstrated that, compared with private clinicians who did not attest to Meaningful Use of EHRs, private physicians who did engage in EHR Meaningful Use practices had an increased likelihood of later joining integrated, public health systems.
Everson commented that this finding: “…may mean that physicians who are not technologically savvy do not have the option to join a bigger system to get help with new technologies."
This research supports recent studies illustrating trials faced by private physicians in adopting newer technologies, commonly referred to as ‘physician burnout’s.
In the study, the authors concluded: “These findings point toward a growing digital divide between physicians who remain independent and integrated physicians that may have been exacerbated by the MU program. Targeted public policy, such as new regional extension centers, should be considered to address this disparity.”
Everson J, Richards MR,Buntin MB. Horizontal and vertical integration's role in meaningful use attestation over time. Health Serv. Res. Doi: 10.1111/1475-6773.13193 (2019) (Epub ahead of print);