HITECH proves pivotal to hospital EHR adoption

Fed payment policies resulted in differences in uptake between provider organizations, says Julia Adler-Milstein.

The $21 billion in incentives paid to acute care hospitals under the HITECH Act to get them to implement electronic health records systems was a significant driver in their adoption of EHRs, and it would not have occurred without this investment by the federal government.

That’s the conclusion of new research, published in the August issue of Health Affairs, which examined the differential effect of HITECH on EHR adoption among 4,268 incentive-eligible and 851 ineligible hospitals from 2008 to 2015.

The study found that annual increases in EHR adoption rates among eligible hospitals went from 3.2 percent in the pre-period (2008–10) to 14.2 percent in the post-period (2011–15) of implementation for the Act’s Meaningful Use incentive program. Only short-term acute care hospitals were eligible for the incentive payments.

At the same time, ineligible hospitals experienced much smaller annual increases of 0.1 percent in the pre-period and 3.3 percent in the post-period—a significant “difference-in-differences” of nearly eight percentage points for those that were eligible for the payments, compared with those that were not.

“That’s the gained EHR adoption that you can attribute to HITECH,” says Julia Adler-Milstein, associate professor at the University of Michigan’s School of Information and School of Public Health, who led the study.

According to Adler-Milstein, some critics of the Meaningful Use program contend that hospitals might have adopted EHRs on their own without these incentives. However, she believes the research she conducted with a colleague from Harvard University shows that the HITECH Act drove a significant amount of EHR adoption among hospitals.

“If you look at the results by type of hospital, what you see is that HITECH really moved the needle on for-profit hospitals, which again I think is very consistent with this sense that hospitals were not investing in EHRs because they didn’t have the incentives to do so,” adds Adler-Milstein. “HITECH really changed that equation. These incentives were needed to move the market.”

Also See: HHS OIG to audit improper EHR incentive payments to hospitals

Asked if the billions of dollars in incentives for hospitals was money well spent by the federal government, Adler-Milstein says that the value of this investment is in many respects in the eye of the beholder.

“I personally believe that, while it may not feel like money well spent right now—given the many challenges with EHRs—it will a decade from now, as we continue to work to improve them,” she observes. “And, we will see HITECH as the catalyst that started the U.S. healthcare system’s IT transformation.”

Nonetheless, Adler-Milstein notes that not all hospitals were eligible for the incentive payments under HITECH, which she believes was a missed opportunity for them to benefit from EHRs.

“There’s reason to think that we should have extended this program to all hospitals,” she concludes, adding that it was a limited resource decision. “I don’t think that the architects of HITECH thought (that these other hospitals) don’t deserve the money or wouldn’t benefit from it. But there was a fixed pot of money and they had to make decisions. Now, looking back on it today, it does prove problematic, because we have this one group of hospitals that really has advanced in their EHR adoption, and this other group that really hasn’t.”

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