Rapid Advances in Health IT Adoption and Use in the Safety Net
Michael A Wittie, M.P.H. | May 6, 2014
Federally funded health centers are making strides adopting and using electronic health records (EHRs) to treat some of the nation’s poorest and most at-risk patients since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act, according to a new first-of-its-kind study.
We know that health IT can help improve care quality. ONC and the Health Resources and Services Administration (HRSA) are working hard to ensure that all providers adopt and use EHRs. In the past, some researchers found that there might be a digital divide in health IT use, meaning that providers who mostly serve certain groups of people – particularly the poor and racial/ethnic minorities or people in rural areas – may be using health IT less than others.
Community health centers remain the largest provider of health care to underserved individuals in the US. They provide health care to more than 20 million Americans every year, including many who are poor, uninsured, or have no regular source of care.
In the past, health centers used health IT at a lower rate than other providers. In 2006, a survey showed that only 26% of health centers had any EHR capacity at all. To ensure that the benefits of health IT and care transformation be available to all Americans, regardless of insurance, wealth, or location, the HITECH Act provided federal resources to help health centers adopt EHRs.
Published in the Journal of Healthcare Quality , this study (Enabling Quality: Electronic Health Record Adoption and Meaningful Use Readiness in Federally Funded Health Centers) found that the majority of health centers (80% in 2011) were using EHRs at some or all of their sites. The study also found that health centers in different parts of the country, and those with different mixes of patients were not any more or less likely to have an EHR than others.
Rural health centers were just as likely to have an EHR as urban ones, and centers that served more Medicaid or uninsured patients were as likely to have an EHR as centers with more privately insured patients. Health centers that served more racial and ethnic minority patients adopted EHRs at the same rate as those who served fewer minorities. Even though health centers without EHRs in 2011 had more minority patients than centers with an EHR, we found no significant relationship between patient mix and adoption after we controlled for other factors. This indicates that the digital divide that seemed to exist before no longer exists, which is great news for health center patients.
Further, since one of the goals of adopting EHRs is to improve quality, the study looked at which EHR functions health centers use to help providers improve. They found that, among health centers using EHRs:
- 99% could maintain lists of patients’ medications and allergies
- 98% could record and chart vital sign changes
- 96% could provide warnings of drug allergies, interactions, or contraindications
- 90% could send prescriptions electronically to the pharmacy
- 88% could highlight out-of-range lab results for providers
This paper shows that health centers are adopting EHRs at least as quickly as other health care delivery organizations. It also shows that they use functions in their EHRs that can help improve care quality for all patients. Finally, and importantly, the study suggests that rural and minority health center patients are just as likely to benefit from EHR-enhanced care as other health center patients.
There is still a road ahead to make sure that all health centers – even those who did not have an EHR in 2011 – become meaningful users of their EHRs and use them to transform the healthcare they provide. These results are an encouraging sign that health centers are well on their way to achieving better health and better health care while controlling costs.