EHR adoption jumped sharply following the passage of the HITECH Act and the start of EHR incentive payments. In 2008, 48 percent of independent hospitals and 55 percent of system hospitals had an EHR capable of either physician documentation or computerized physician order entry. By 2011, 77 percent of both types of hospitals had at least one of these capabilities.
However, the EHR incentive payments may not have caused some of these hospitals to adopt EHR systems, only possibly moving forward the time at which they did so, according to a new paper published by the National Bureau of Economic Research.
In the paper, four Northwestern University researchers argue at least some of the EHR adoption seen in the years since the HITECH Act was a continuation of a preexisting trend of hospitals and health systems moving toward electronic records. Additionally, the $27 billion in incentive funds was not directed solely at new adopters or those on the fence about implementing an EHR system, meaning part of the money went to hospitals and health systems that already had an EHR system and therefore did not need an incentive to implement one.
Using EHR implementation and incentive payment data, researchers estimated about 67 percent of hospitals would have had either physician documentation or CPOE capabilities by 2011. Since 77 percent of hospitals actually had one of these capabilities by that time, researchers concluded the HITECH Act played a part in fostering adoption among 10 percent of hospitals. However, the researchers also estimated the 77 percent adoption level would have been reached absent of EHR incentive payments by 2013.
Additionally, because some of the incentive money went to either pre-HITECH adopters or those that would have adopted by 2011 anyway, researchers determined the cost for each marginal adopter to be $48 million, based on an average total incentive payment per hospital of $6.2 million by 2011.
"[N]otwithstanding meaningful use, the expenditures of HITECH appear to have simply provided two additional years of EHR use at facilities that may have been unsure about the product's ultimate value," wrote the researchers. "Given that hospitals are still trying to figure out how to systematically use health IT to boost quality and reduce costs, briefly accelerating adoption at this juncture is not obviously desirable."
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