As spring quickly blends into summer, we at the Office of the National Coordinator for Health Information Technology (ONC) continue to see signs that providers and hospitals nationwide understand why electronic health record (EHR) adoption and achieving meaningful use is critical to improving patient care.

The number of providers and hospitals trading in their old fashioned paper records for EHRs and taking advantage of the assistance provided by the Medicare and Medicaid EHR Incentive Programs continues to climb each month with hundreds of thousands of additional providers registered and in queue to participate in the EHR Incentive Programs and get paid. Preliminary data show that during the month of April alone, more than 17,000 eligible professionals and 280 eligible hospitals received payments under the EHR Incentive Programs. Since the EHR Incentive Programs started a little over a year ago, a total of approximately 90,000 eligible professionals and 2,250 hospitals—which is 42 percent of all eligible hospitals—have successfully participated in the program!

This success is attributable to the hard work of providers across the country who are diligently using the Stage 1 meaningful use criteria as a roadmap for improving patient care.

Broad and Strong Interest from Primary Care Providers

A lot of hard work is going into the dramatic success of the EHR Incentive Programs. The ONC Regional Extension Center (REC) program is an important vantage point from which we are able to observe strong interest among providers in EHR adoption and registering for the EHR Incentive Programs. For the past two years, 62 RECs across the country have identified primary care providers in priority settings, such as small practices, community health centers, and critical access hospitals, interested in achieving meaningful use and have helped them get there. Collectively, the RECs are now working with 132,000 primary care providers, which is more than 40 percent  of all the primary care providers in the country. REC providers are in every state and include more than 70 percent of the small practice providers in rural settings and more than 75 percent of federally funded health centers. REC staff develop customized EHR implementation plans to help every practice in its pursuit toward achieving meaningful use because they know no two practices are the same, and each practice has its own challenges in making the important transition to EHRs.

Success in Supporting Small Practices to Implement EHR Systems

It’s important to take a moment to consider just how far we’ve come over the last several years in the national movement toward EHR adoption the adoption of basic EHRs has doubled since 2008 from 17 percent to 34 percent in 2011. In addition, the REC program has provided subsidized technical assistance to support small practices, which often have the most difficult time in implementing EHR systems because they don’t have the capital, staff, and expertise that exist in larger organizations. To-date, RECs have had considerable success in getting these small practice providers up and running on an EHR system. Of the 67,000 providers working with RECs who are currently or were recently in small practices of less than 10 providers, 58% or 39,000 have implemented an EHR system that can e-prescribe (helping to reduce medical errors) and generate quality measurement reports (helping providers benchmark and measure a patient’s care outcomes). And, interestingly, while it’s striking that physicians 35 and younger adopting basic EHRs has increased from 24 percent to 52.8 percent between 2008 and 2011, the EHR adoption rates among physicians 65 and older has increased even more rapidly from 8 percent to 23.9 percent during the same time period! RECs will continue to work hard with the remaining providers to help them select the right EHR system so they can adopt and start achieving meaningful use within the next two years.

As part of an ongoing effort to improve how they serve providers’ needs, the RECs are working with ONC to identify the most critical barriers providers face to switching to EHRs so we can continue to work together to develop solutions and best practices that assist in the transition. Experience tells us that among the most common barriers small practices confront are:

1. Which EHR vendor to select;
2. Difficulties in prioritizing adoption among other pressing practice needs; and
3. The need for practice transformation support, specifically related to redesigning workflows.

Tools to address these issues are currently being posted on healthIT.gov, and ONC and the RECs would welcome feedback to help us further improve how we can help providers get there.

Helping Critical Access and Rural Hospitals Adopt and Achieve Meaningful Use

In 2010 and 2011, ONC provided an additional $30M to RECs to help increase EHR adoption rates in critical access and rural hospitals. These facilities are vital to health care access in rural parts of the country. The RECs are currently working with 963 critical access hospitals (CAHs) and 85 small rural hospitals (RHs). These facilities are located in remote areas with even more acute staff, capital, and other resource challenges than other providers, and RECs are helping to identify innovative ways of helping these hospitals with achieving meaningful use.  Memorial Hospital of Layette County  in Wisconsin, for example, is one of these early-adopting hospitals. It is a critical access hospital with less than 25 beds, but also one of the first facilities in Wisconsin to achieve meaningful use and receive payment under the EHR Incentive Programs.   Memorial Hospital began to implement an EHR system in 2007 with the support of a Health Resources and Services Administration Critical Access Hospital Health IT (CAHHIT) grant.  According to Dr. Louis Wenzlow, who leads the Wisconsin REC’s efforts to support CAH/RHs in achieving meaningful use, Memorial Hospital reports more complete charting, enhanced compliance with ordering, and better access to patient records as some of the benefits it has experienced since EHR adoption. And, we’re happy to report the share of hospitals using EHRs has more than doubled from 16 percent in 2009 to 35 percent in 2011!

States Continue to Invest in Medicaid EHR Incentive Programs

The number of providers able to participate in the EHR Incentive Programs will get an additional boost as the remaining states that haven’t launched Medicaid EHR Incentive Programs do so over the course of the next several months. As of May, 44 states have active Medicaid EHR Incentive Programs. At least four more states plan to launch their EHR Incentive Programs by August, while the remaining states anticipate launching shortly thereafter in 2012. States continue to develop their health IT infrastructures in order to facilitate Medicaid providers’ demonstration of meaningful use. Apart from the State Health Information Exchange Cooperative Agreement Program grants administered by ONC to the states for the development of state-level Health Information Exchanges (HIEs), state Medicaid agencies are also requesting federal matching funds to contribute to “standing up” HIEs. States understand that HIEs are essential tools for promoting the timely and secure exchange of health information across physicians, hospitals, specialists, patients, and health care insurers, and therefore, can significantly assist providers in achieving meaningful use.

Hard Work Ahead—Bright Future

While it is exciting to see the progress of so many diverse and varied providers and hospitals across the country, we recognize many are still experiencing challenges with EHR adoption and achieving meaningful use.. ONC and the RECs are collecting and sharing best practices andtools on what is working, and by helping facilitate communication among providers, we at ONC believe we can make it easier for the tens of thousands of other providers who will be achieving meaningful use of EHRs this year and into the future. The path to adopting and meaningfully using EHRs is not always easy for everyone, but it is the roadmap to better health and health care at lower costs. The national transition to EHRs through the EHR Incentive Programs is foundational to building a truly 21^st Century health care system.

We’re seeing great progress, and we’re working with providers and hospitals across the country to keep the momentum going!

For More Information

To learn more about health information technology, visit HealthIT.gov.

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