Safety Net Hospitals and EHR Adoption

A new study published in Health Affairs details EHR adoption rates and meaningful use attestation in hospitals across the United States.  While adoption has increased steadily over the years, safety net hospitals continue to lag behind other hospitals in the types of EHR system implemented.

Specifically:

• In 2013, Critical Access Hospitals had similar rates of basic EHR systems as other hospitals, but were much less likely to have comprehensive systems
• A similar trend is seen among rural hospitals in general, as well as those with high DSH payments.
• Rural, Critical Access, and high DSH payment hospitals were all more likely to not have adopted any EHR system
• Very few hospitals met all 15 criteria for Meaningful Use Stage 2 attestation, but this was not presented by hospital type.

It is interesting, that despite the findings above, that the authors conclude:

Despite early concerns about a digital divide¹⁵ in which hospitals serving poor patients would struggle to adopt EHRs to a greater extent than better resourced hospitals, we found no evidence of such a gap. The lack of a digital divide between safety-net institutions and other hospitals is remarkable, given that safety-net hospitals usually struggle with expensive and complex changes. Policy makers were concerned about this early on and created a separate incentive structure for these institutions.

While the data demonstrate similar rates of basic EHR adoption, they clearly show higher rates of no adoption and lower rates of comprehensive adoption among rural safety net providers.  These data suggest a digital divide does indeed exist-- one of functionality that would lead to a lower rates of Meaningful Use attestation among these rural providers, not to mention the non-adopters without any EHR system at all.  The factors associated with some of the safety net hospitals--teaching status and urban location--are simply not available in these rural areas.