Hospitals, Practices, and EHRs - A Tale of Two Studies

Recently a comprehensive study was published by the Medical Group Management Association (MGMA) on EHR usage in medical practices, entitled "Electronic Health Records: Status, Needs and Lessons, 2011 Report Based on 2010 Data, Snapshot of an Infrastructure under Construction."

This 32-page report is full of useful information, broken down by practice size, by specialty, and by market share of the EHR system/vendor (curious to know the leading vendor by market share? – it’s “other,” with 32.5 percent of the market). But I want to focus on one statistic on page 3, which states that 52.3 percent of the respondents said they currently use an EHR. That number seems high to me, based on experience. More often than not, medical practices do not have an EHR, although they may have some electronic systems that have some healthcare data in some fashion.

There is another organization, Health Information Management Systems Society (HIMSS), with a completely different constituency, mostly hospital systems and their IT staffs. HIMSS Analytics has developed an eight-stage EMR Adoption Model (stages 0 through 7, 7 being the highest.) Without getting too much into the detail that goes into each stage in their model, it is useful to note that out of over 5,200 US hospitals in the study, only 57 of them have achieved Stage 7. That’s barely 1 percent of the total. But if you look further, 35 of the 57 hospitals come from one system, so if you take them as a single system the remaining hospitals that have achieved Stage 7 on the HIMSS Analytics model represent less than ½ of 1 percent of U.S. hospitals.

(Note that the term EMRs are used in the HIMSS study and the term EHRs are used in the MGMA study. For purposes of this discussion, we will treat them interchangeably.)

How can this be? Is it true that hospitals are in fact behind medical practices in their adoption of IT in general and in EHRs in particular? How can practices show up with greater than 50 percent adoption in the MGMA study while hospitals are less than 1 percent in the HIMSS study?

There are some fundamental differences. The eight levels in the HIMSS study are defined objectively, whereas the MGMA is survey-based on user responses to a question that could be answered more subjectively (i.e., “Do you have an EHR?”). Also, MGMA concerns itself with lots of practice management issues, ranging from HR to billing and operations, plus of course IT. HIMSS, on the other hand, is an organization that concerns itself exclusively with healthcare IT issues, and primarily those of hospitals and large provider networks/systems. And lastly, the HIMSS membership, by its makeup, is going to consist largely of full-time, professionally trained IT people. MGMA certainly has professionally trained IT people among its membership, but they would represent a subset of the larger skill set making up the medical group practice community. But it seems reasonable that IT professionals are going to understand the nuances of what constitutes a functional EMR/EHR system, versus one that is not fully functional.

Lastly, even if medical practices were in fact to be determined to be “ahead” of hospitals in their adoption of EMRs/EHRs, that’s like saying you beat the slowest kid in the class in a foot race. Healthcare has traditionally lagged all other industries in its adoption of IT and automation by a wide margin. While most other industries are on their fourth or fifth generation IT systems, and optimizing them to wring ever more efficiencies out of their back-office operations, healthcare is still arguing over whether IT and automation are even a good idea. Many people in healthcare continue to ignore the growing body of literature that is equating healthcare IT and automation to better patient outcomes, fewer medical errors, better disease reporting, and overall healthier - and more knowledgeable - patient populations.

Whether healthcare IT adoption is 1 percent or 52 percent, it is still way too low.

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