Objective measures define EMR adoption levels

AS PROVIDERS JOCKEY FOR THE $19 billion in stimulus funds for the adoption of electronic medical records (EMRs), experts agree that while progress is being made, most providers have a long way to go to become fully EMR capable.

Large, urban teaching institutions are more likely than smaller and rural hospitals to have health informatics systems, partly because they have more financial resources. Inadequate capital and high maintenance costs are the major barriers cited by most non-adopters.

However, with federal cash on the table, providers are rushing to move up the EMR ladder.

FINDING THE CASH

As with many innovations, it comes down to investment capital, says Michael Davis, executive vice president of HIMSS Analytics.

Many hospitals are struggling to keep their doors open. The U.S. Dept. of Labor notes that as of last December, 107 U.S. hospitals had reported mass layoffs of 50 employees or more.

While high implementation costs explain the small number of hospitals that have fully adopted EMRs, Davis predicts a future obstacles will include recruiting enough qualified health IT technicians to install the systems.

“Most [hospitals] have been moving themselves along because their boards or their executives want to either improve patient safety or outcomes, or it’s a competitive type of initiative for hospitals in certain markets,” Davis says. “This is the first time that hospitals have the ability to get some funding, other than grants, in this effort.”

For the past eight years, the Healthcare Information and Management Systems Society (HIMSS) has monitored how hospitals have developed workable EMR systems. Every quarter, it evaluates more than 5,000 hospitals using the HIMSS Analytics EMR Adoption Model (EMRAM), which scores hospitals and health systems on an eight-step scale on the path to a fully paperless record system.

Developed in 2005, the EMRAM has become an industry standard to measure progress in EMR implementation. As of December 2008:

• 31.2% of hospitals rank at Stage 2 with a clinical data repository;
• 35.7% are at Stage 3 with nursing documentation capabilities; and
• 6% rank at least Stage 4 with advanced EMR capabilities such as computerized physician order entry (CPOE) and data mining.

Few hospitals get beyond Stage 4 on the EMRAM scale. Only about 2% have comprehension systems featuring full electronic physician documentation capabilities, full variance and compliance and full radiology and picture archiving and communication capacity.

The U.S. Centers for Disease Control and Prevention defines a comprehensive electronic medical record system as having at least four basic computerized functions: recording physician notes; ordering medical tests; reporting test results; and ordering prescriptions.

A recent analysis by PricewaterhouseCoopers Health Research Institute shows that, on average, a 500-bed hospital could receive $6.1 million in incentives to purchase, install and maintain a government-certified, interoperable EMR system.

HIMSS offers estimates of possible Medicare incentive payments from 2011 to 2014 for hospitals meeting the “meaningful use” standards of EHRs under the American Recovery and Reinvestment Act ranging from a 75-bed hospital gaining up to $3.5 million up to a 750-bed hospital gaining up to $11.2 million.

Implementation costs are estimated to reach $255 billion by 2015.

Additionally, providers who do not implement an IT system by 2015 will see their Medicare payments reduced, starting at 1%. According to the PricewaterhouseCoopers survey, the average 500-bed hospital that fails to implement a system by 2015 could see a reduction in Medicare funding by as much as $3.2 million in the first year, depending on its volume of Medicare patients.

What providers can make in incentives and what they can afford to invest don’t always even out.

“It’s a complicating thing now because it’s tied to incentive dollars—a lot of incentive dollars,” says Zeynep Sumer, associated vice president, regulatory and professional affairs, for the Greater New York Hospital Assn. (GNYHA).

The association is surveying its nearly 300 hospitals and continuing care facilities in New York, New Jersey, Connecticut and Rhode Island on EMR adoption.

Its assessment is similar to EMRAM and was developed by David Blumenthal, MD, national IT coordinator for the U.S. Department of Health and Human Services. It’s the same tool used in a recent New England Journal of Medicinesurvey that found 4% of physicians reported having an extensive and functional electronic records system, and 13% reported having a basic, if not fully integrated, system.

Sumer predicts that technical challenges will stall a majority of hospitals on their way to a comprehensive level of EMRs over the next few years.

The typical EMR vendor selection process can take as long as two years because providers might have to research dozens of vendors.

Nationally, the criteria for evaluating how well hospitals have adopted EMR systems hasn’t been finalized, though Sumer says the federal government is moving quickly to do so.

Gerard Nussbaum, technology services director at consulting firm Kurt Salmon Associates, says overall outlay for providers could be tens of millions of dollars, including training staff and other expenses related to comprehensive EMR. “There’s a huge economies-of-scale factor in putting in an EMR system,” Nussbaum says. “Six million dollars [in incentives] may be just a downpayment. Some smaller hospitals, community hospitals, are having trouble swallowing it.”

The stimulus package established 10-year EMR adoption goals of 70% for hospitals and about 90% for physicians. But even without the stimulus, the CBO estimates that 45% of hospitals and 65% of physicians nationwide will have EMRs by 2019.

David Bennett is a senior editor in Advanstar Communications’ Centralized Content Group.

If you enjoyed this post, make sure you subscribe to my RSS feed!