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Study of Physician Participation in Electronic Health Record Incentive Programs Signals Need for Further EHR Healthcare Policy Maintenance

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Federal programs offering financial incentives to physicians who adopt electronic health record systems have boosted the number of participants who use them, Weill Cornell Medical College researchers found in a new study. But in the process, systematic differences have emerged between physicians who consistently participated in the programs and those who did not, which could lead to disparities in patient care.

Dr. Hye-Young Jung

The study, published online June 8 and will appear in the June issue of Health Affairs, examined 26,368 physicians across New York State. The Centers for Medicare and Medicaid Services and the state Department of Health provided payment data from 2011 to 2012, the first two years that the Health Information Technology for Economic and Clinical Health Act of 2009 — the law that established the $30 billion Medicare and Medicaid EHR Incentive Programs — was in effect.

The researchers found that participation in the Medicaid incentive program rose from 6.1 percent to 8.5 percent between the two years, and that participation in the Medicare incentive program rose from 8.1 percent to 23.9 percent. Both programs are run by the Centers for Medicare and Medicaid Services. They also discovered that early and consistent participants had greater financial resources, more organizational capacity to support the use of health information technology and prior experience with technology.

The findings illuminate the challenges in moving from EHR adoption to actual use of the systems, the investigators say, which could potentially impact patient care and larger healthcare policy initiatives.

Dr. Joshua Vest
Photo credit: Carlos Rene Perez

"Those physicians who adopted the program may provide higher quality care to their patients," said lead author Dr. Hye-Young Jung, an assistant professor of healthcare policy and research at Weill Cornell. "This difference may create a digital divide."

If a digital divide develops, patients of doctors who keep paper — not electronic — records will have less reliable documentation and weaker communication between their healthcare providers. Those patients will not benefit from any quality improvements created by EHRs that are supported by the programs.

The findings can have a significant impact on healthcare policy. For example, more than half of the physicians who participated in the Medicaid incentive program in 2011 did not participate in 2012. Unlike the Medicare incentive program, the Medicaid program allows physicians to skip one year of participation, but many of these physicians likely dropped out of the program, the researchers say. This change could be because physicians didn't treat enough Medicaid patients to meet the minimum requirement for participation, or that the physicians had less money to support EHR use as a result of lower reimbursements, the investigators say.

If many of the participating physicians do not successfully maintain EHRs implemented by the program funding, the government will receive a markedly lower return on investment than anticipated, the investigators say. This highlights the need for healthcare policy that continually monitors participation in the incentive programs to ensure that all patients receive the highest possible quality of care.

Dr. Rainu Kaushal
Photo credit: John Abbott

"The expectation is that physicians and hospitals should be electronic," said senior author Dr. Joshua Vest, and assistant professor of healthcare policy and research at Weill Cornell Medical College. "How would everybody feel if only half of the banks were electronic nowadays? Without additional support to move forward there is the potential to stall out among those who don't have the resources or capability to adopt EHRs."

"Electronic health records are vital not only because of their ability to efficiently provide physicians with a comprehensive portrait of and decision support for their patients, but also to drive new healthcare delivery models that can improve the value and quality of clinical care," said Dr. Rainu Kaushal, chair of the Department of Healthcare Policy and Research and the Frances and John L. Loeb Professor of Medical Informatics at Weill Cornell, who is a study co-author. "This study highlights the crucial work that Dr. Jung and Dr. Vest are doing to advance national policy and innovation in this key area."

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