EHR use drives health IT outlook

Meaningful use is the name of the game for EHRs

For a time, the advances in health IT that were promoted in the 2009 American Recovery and Reinvestment Act (ARRA) seemed in doubt as reactions to the proposals ranged from confusion to outright resistance. The eventual impact of the proposals was unclear and many parts of the U.S. health industry, particularly providers, pushed back against the costs and complexities involved in implementing them.

Saying that suddenly everything is much clearer is perhaps going too far, but 2011 will at least be seen as the year when the commitment to using health IT finally solidified. At the beginning of the year, a survey by the Office of the National Coordinator for Health IT (ONC) found that four-fifths of U.S. hospitals and over 40 percent of office-based physicians said they would take advantage of federal incentives for the adoption and meaningful use of certified electronic health records (EHRs).

Office-based physicians and other eligible professionals can obtain EHR incentive payments of as much as $44,000 under Medicare or $63,750 under Medicaid. Under both Medicare and Medicaid, eligible hospitals may receive millions of dollars.

It’s been known for some time that EHRs could improve patient care while lowering costs, said David Blumenthal, who was the national coordinator for health IT at the time of the study, but adoption by health care providers had remained stubbornly low. However, the survey showed “we are seeing the tide turn toward widespread and accelerating adoption and use of health IT,” he said.

Later figures for the program showed the adoption trend continuing. Participation in the meaningful-use incentive program jumped 30 percent in August to 90,000 providers from the 77,000 recorded in July, according to the Centers for Medicare and Medicaid Services (CMS). Medicare EHR incentives were paid to 1,000 physicians in August, a figure that doubled over each of the previous two months. Medicaid payments were made to 1,300, some 23 percent more than in July.

At least some of that growth has to do with the deadlines imposed on the meaningful-use program. To get the maximum incentive under the Medicare program, for example, eligible professionals have to begin their participation by 2012. And those who don’t demonstrate meaningful use of EHRs by 2015 or don’t participate will have their Medicare payments cut.

The Medicaid incentive program is voluntary by state, and the last year an eligible hospital can begin its participation is 2016. As of August, 23 states had begun their programs with larger states such as California still to announce.

EHRs are key to the future of health IT

The success of the EHR incentive program in expanding the use of health IT among providers is the key to the government’s broader plan to transform health care in the U.S.

In its "2011-2015 Federal Health IT Strategic Plan," published in September, the ONC made its first goal to “achieve adoption and information exchange through meaningful use of health IT” and called that the centerpiece of the government’s health IT strategy over the next five years.

“Meaningful use' is much more than just adoption,” ONC said in the plan. Providers "will also be required to maintain data confidentiality, share information securely with each other, engage patients with their electronic health information and improve care.”

With that and other efforts to provide support to providers, workforce training and information exchange — particularly for the small group practices, community health centers, and others such as providers in rural and underserved areas — the overall goal is to “create a tipping point — that the adoption and meaningful use of EHRs will become ubiquitous across the nation.”

However, ONC officials said, the plan should be viewed as a living document that will be updated as needed based on experience with the first stage of the EHR inventive programs. What happens with that, and particularly the essential goal of getting providers to adopt and become meaningful users of certified EHR technology, will determine how future versions of the plan might change.

However, there are more unexpected signs that the program has broader appeal than it was considered to have before. In its August report, CMS saw indications that older providers are participating much more actively than expected, even those close to retirement. This segment of the provider population was expected to largely forgo implementing EHRs, preferring to give that responsibility to younger and more tech-savvy colleagues.

And despite tough budget scenarios, states also seem committed to following through on their commitments. Many state governments are leery of or outright opposed to broader measures in the Obama administration’s health reform legislation, but they still consider health IT as necessary to drive efficiencies in health programs. Health care, including health IT, was No. 3 on state CIOs’ list of concerns for 2011, according to the National Association of State CIOs (NASCIO).

In August, the Obama administration added another support, by linking budget-constrained rural hospitals and clinicians to existing capital loan programs so they can more easily pay for health IT hardware and software.

HIT Strategy Map

To make sure the point is not lost, administration officials have been busy trying to drive home the critical nature of current health IT programs to an increasingly austerity-minded Congress.

The EHR incentive programs are not about technology for its own sake but are an essential tool for helping hospitals and physicians bring about a transformational improvement of the health care system, said Farzad Mostashari, Blumenthal’s successor as head of the Office of the National HIT Coordinator, in testimony in June to the House subcommittee on health care and technology.

There are plenty of ideas about how to improve the way care is delivered, he said, but "I would maintain that an absolutely essential component to making any of these strategies work effectively is they must be supported by the robust use of health IT.”

About this Report

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