Modernizing health records by making them electronic has gained momentum as technology evolves and policies push healthcare toward digital solutions. But the same trend has not been evident for physicians who remain in private practice, new research finds.
The research, led by Jordan Everson, PhD, assistant professor in the Department of Health Policy at Vanderbilt University Medical Center, finds striking differences in the use of electronic health records among more than 291,000 physicians.
Forty-nine percent of surveyed physicians who had remained independent since 2011 attested to meaningful use of EHRs, such as electronic prescribing of medications and online patient portals -- at least once, anyway. In contrast, 70% of doctors in both group practices and those working for hospitals attested to meaningful use.
WHAT'S THE IMPACT
Meaningful Use of EHRs was first defined in 2009 by the America Reinvestment and Recovery Act, and financial incentives were offered to physicians and health systems that serve Medicare and Medicaid patients. The program was voluntary, and after 2015 the Centers for Medicare and Medicaid Services began reducing payments to providers if there was no expansion in adoption of EHR meaningful use practices.
Everson said this can be interpreted in several ways. One is that independent doctors have more authority over the technology they use, and could simply choose not to continue in the program -- as opposed to doctors in integrated systems in which management could require participation.
Another interpretation is that, for independent physicians, the cost-benefit equation was worse. If true, that means the financial incentives in later years weren't able to surmount the cost of keeping up with meaningful use, as well as the time burden of using EHRs. Everson said costs are likely high for independent physicians since they can't spread the cost across a large organization.
About half of independent physicians who participated in the EHR incentive program in the first years -- 2011 through 2013 -- left the program by 2015. In the same time frame, fewer than 20% of physicians who worked for hospitals left the program.
The study highlights other possible factors in this trend, such as an aging independent physician population that is retiring in greater numbers.
And while doctors have been moving into larger, integrated health practices for decades as the U.S. health system has grown more complex, that option might not be available for physicians who haven't kept up with new technologies. The study showed that independent physicians who participated in meaningful use on their own were more likely to later join integrated systems than physicians who did not participate.
THE LARGER TREND
Hospitals spent nearly $25 billion globally on electronic health records in 2017 and that is projected to increase to $33 billion by 2023 but signs are also emerging EHR spending is starting to slow down, according to a 2018 report from Allied Market Research.
Specifically, the cost of software and implementation are inhibiting growth from being more robust. There has also been an increase in concerns related to the safety and security of the data contained therein.