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DOI: 10.4338/ACI-2011-01-RA-0001
The Impact of Geography on Hospital Electronic Health Records Implementation in Alabama
Implications for Meaningful UseCorrespondence to:
Publication History
received:
05 January 2011
accepted:
19 May 2011
Publication Date:
16 December 2017 (online)
Summary
Background: Given relatively less favorable health outcomes in rural Alabama, electronic health records (EHRs) have an even greater potential to improve quality and alleviate disparities if meaningfully used.
Objectives: We examined rural-urban differences as it pertained to perceived barriers, benefits, and motivating factors of EHR implementation.
Methods: We used multivariate logistic models to analyze data collected from a state-wide, self-completed survey of health information management directors in Alabama hospitals.
Results: Findings from our analyses indicate that fewer rural hospitals (8%) have implemented EHRs as compared with urban hospitals (18%). Rural hospitals were 71% less likely to consider reduction in costs as a benefit of EHRs (OR = 0.29), and were 75% less likely to consider lack of structured technology as a challenge factor of EHR implementation (OR = 0.25).
Conclusion: Promotion of EHRs in rural areas is challenging but necessary. Understanding perceived barriers and motivating factors of EHR implementation among rural hospitals can inform policy decisions, especially in light of recent meaningful use initiatives.
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Keywords
Electronic health records - healthcare disparities - rural health - meaningful use - hospital information system
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Conflict of Interest Statement
The authors do not have any conflicts of interest or financial interests to disclose.
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References
- 1 HIMSS.. Electronic Health Record. 2010 [cited 2010 April 11]; Available from: http://www.himss.org/ASP topics_ehr.asp.
- 2 Jha A, Ferris T, Donelan K, DesRoches C, Shields A, Rosenbaum S. et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff 2006; 25 (06) w496.
- 3 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742.
- 4 Bernstein J, Imler D, Sharek P, Longhurst C. Improved Physician Work flow after integrating sign-out notes into the electronic medical record. Jt Comm J Qual Patient Saf 2010; 36 (02) 72-78.
- 5 Odero W, Tierney W, Einterz R, Mungai S. Using an electronic medical record system to describe injury epidemiology and health care utilization at an inner-city hospital in Indiana. Int J Inj Contr Saf Promot 2004; 11 (04) 269-279.
- 6 Jha A, DesRoches C, Campbell E, Donelan K, Rao S, Ferris T. et al. Use of electronic health records in US hospitals. N Engl J Med 2009; 360 (016) 1628.
- 7 Glaser J. The electronic health record: a digital divide?. Healthc Financ Manage 2007; 61 (010) 38.
- 8 Zhang W, Mueller K, Chen L. Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals. Aust J Rural Health 2009; 17 (04) 183-188.
- 9 DesRoches C, Campbell E, Rao S, Donelan K, Ferris T, Jha A. et al. Electronic health records in ambulatory care –a national survey of physicians. N Engl J Med 2008; 359 (01) 50-60.
- 10 Menachemi N. Barriers to ambulatory EHR: who are ‘imminent adopters’ and how do they differ from other physicians?. Inform Prim Care 2006; 14 (02) 101-108.
- 11 Sequist T, Cullen T, Hays H, Taualii M, Simon S, Bates D. Implementation and use of an electronic health record within the Indian Health Service. J Am Med Inform Assoc 2007; 14 (02) 191-197.
- 12 Ward M, Jaana M, Bahensky J, Vartak S, Wakefield D. Clinical information system availability and use in urban and rural hospitals. J Med Syst 2006; 30 (06) 429-438.
- 13 Menachemi N, Langley A, Brooks R. The use of information technologies among rural and urban physicians in Florida. J Med Syst 2007; 31 (06) 488.
- 14 Brooks R, Menachemi N, Burke D, Clawson A. Patient safety-related information technology utilization in urban and rural hospitals. J Med Syst 2005; 29 (02) 103-109.
- 15 Chen L, Skinner A. Electronic health records adoption: rural providers’ decision-making process. Rural policy brief/RUPRI Rural Health Panel 2008; 4: 1.
- 16 Alabama Rural Health Association.. What is Rural?. 2009 [cited 2009 February 4]; Available from: http://www.arhaonline.org/what_is_rural.htm.
- 17 Texas Comptroller of Public Accounts.. Texas in focus: a statewide view of opportunities. 2011 [cited 2011 March 15]; Available from: http://www.window.state.tx.us/specialrpt/tif/population.html.
- 18 Rural Assistance Center.. Alabama. 2011 [cited 2011 March 15]; Available from: http://www.raconline.org states/alabama.php.
- 19 American Recovery and Reinvestment Act of 2009, H.R. 1 (Accessed December 19, 2010 at http://thomas. loc.gov/cgi-bin/bdquery/z?d111:h.r.00001:, (enacted on 6th January, 2009, 2009).
- 20 Federal Register.. 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, Page 44, (2010).
- 21 Conn J. Extension centers offer guidance on health IT. 2010 [cited 2010 June 16]; Available from: http://www.modernhealthcare.com/article/20100616/NEWS/100619958.
- 22 Gale J, Lenardson J, Race M, Gregg W, Casey M, Indira Richardson M. et al. State initiatives funded by the Medicare Rural Hospital Flexibility Grant Program. Flex Monitoring Team Briefing Paper;. 2007
- 23 Centers for Medicare and Medicaid Services.. CMS and ONC final regulations define meaningful use and set standards for electronic health record incentive program. [cited 2010 August 17]. Available from: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3787&intNumPerPage=10&check-Date=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keyword-Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
- 24 Centers for Medicare and Medicaid Services.. Medicare and medicaid health information technology: Title IV of the American Recovery and Reinvestment Act. [cited 2010 August 17]. Available from: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3466&intNumPerPage=10&check-Date=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keyword-Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
- 25 Centers for Medicare and Medicaid Services.. Secretary Sebelius announces final rules to support meaningful use of electronic health records. [cited 2010 August 17]. Available from: http://www.hhs.gov/news/ press/2010pres/07/20100713a.html.
- 26 Office of the National Coordinator for Health Information Technology.. Final rule: health information technology: initial set of standards, implementation specifications, and certification criteria for electronic health record technology. [cited 2010 August 17]. Available from: edocket.access.gpo.gov2010/pdf/2010–17210.pdf.
- 27 Kohn L, Corrigan J, Donaldson M. To err is human: building a safer health system. A report of the Committee on Quality of Health Care in America. Washington, D. C.: Institute of Medicine, National Academy Press,; 2000
- 28 Corrigan J, Donaldson M, Kohn L, Maguire S, Pike K. Crossing the quality chasm: Building a better delivery system. Washington, D. C.: Institute of Medicine, National Academies Press,; 2005
- 29 Centers for Medicare and Medicaid Services.. Meaningful Use. 2010 [cited 2010 July 16]; Available from: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp.
- 30 Jha A, DesRoches C, Shields A, Miralles P, Zheng J, Rosenbaum S. et al. Evidence of an emerging digital divide among hospitals that care for the poor. Health Aff 2009; 28 (06) w1160.
- 31 Medical Records Institute.. Sixth annual survey of electronic health record trends and usage for 2004. 2004 [cited 2006 October]; Available from: http://www.providersedge.com/ehdocs/ehr_articles/Survey_of_EHR_Trends_and_Usage_for_2004.pdf.
- 32 Jha AK, DesRoches CM, Kralovec PD, Joshi MS. A progress report on electronic health records In U S. Hospitals. Health Aff 2010; 29 (010) 1-7.
- 33 Office of Primary Care and Rural Health.. Alabama’s rural and urban counties. [updated October 2007; cited 2010 July 16]. Available from: www.arhaonline.org/PDF%20Files/Statewide.pdf.
- 34 Blumenthal D, Graham G. A letter to the vendor community: health IT and disparities. [cited 2010 October Available from: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3197.
- 35 iHealthBeat.. HHS provides $20M in funding to aid rural health IT Aadoption. California HealthCare Foundation;. 2010 [cited 2010 September 10]; Available from: http://www.ihealthbeat.org/ar ticles/2010/9/10/hhs-provides-20m-in-funding-to-aid-rural-health-it-adoption.aspx.
- 36 Sparks PJ, McLaughlin DK, Stokes CS. Differential neonatal and postneonatal infant mortality rates across US counties: The role of socioeconomic conditions and rurality. Journal of Rural Health 2009; 25 (04) 332-341.
Correspondence to:
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References
- 1 HIMSS.. Electronic Health Record. 2010 [cited 2010 April 11]; Available from: http://www.himss.org/ASP topics_ehr.asp.
- 2 Jha A, Ferris T, Donelan K, DesRoches C, Shields A, Rosenbaum S. et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff 2006; 25 (06) w496.
- 3 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742.
- 4 Bernstein J, Imler D, Sharek P, Longhurst C. Improved Physician Work flow after integrating sign-out notes into the electronic medical record. Jt Comm J Qual Patient Saf 2010; 36 (02) 72-78.
- 5 Odero W, Tierney W, Einterz R, Mungai S. Using an electronic medical record system to describe injury epidemiology and health care utilization at an inner-city hospital in Indiana. Int J Inj Contr Saf Promot 2004; 11 (04) 269-279.
- 6 Jha A, DesRoches C, Campbell E, Donelan K, Rao S, Ferris T. et al. Use of electronic health records in US hospitals. N Engl J Med 2009; 360 (016) 1628.
- 7 Glaser J. The electronic health record: a digital divide?. Healthc Financ Manage 2007; 61 (010) 38.
- 8 Zhang W, Mueller K, Chen L. Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals. Aust J Rural Health 2009; 17 (04) 183-188.
- 9 DesRoches C, Campbell E, Rao S, Donelan K, Ferris T, Jha A. et al. Electronic health records in ambulatory care –a national survey of physicians. N Engl J Med 2008; 359 (01) 50-60.
- 10 Menachemi N. Barriers to ambulatory EHR: who are ‘imminent adopters’ and how do they differ from other physicians?. Inform Prim Care 2006; 14 (02) 101-108.
- 11 Sequist T, Cullen T, Hays H, Taualii M, Simon S, Bates D. Implementation and use of an electronic health record within the Indian Health Service. J Am Med Inform Assoc 2007; 14 (02) 191-197.
- 12 Ward M, Jaana M, Bahensky J, Vartak S, Wakefield D. Clinical information system availability and use in urban and rural hospitals. J Med Syst 2006; 30 (06) 429-438.
- 13 Menachemi N, Langley A, Brooks R. The use of information technologies among rural and urban physicians in Florida. J Med Syst 2007; 31 (06) 488.
- 14 Brooks R, Menachemi N, Burke D, Clawson A. Patient safety-related information technology utilization in urban and rural hospitals. J Med Syst 2005; 29 (02) 103-109.
- 15 Chen L, Skinner A. Electronic health records adoption: rural providers’ decision-making process. Rural policy brief/RUPRI Rural Health Panel 2008; 4: 1.
- 16 Alabama Rural Health Association.. What is Rural?. 2009 [cited 2009 February 4]; Available from: http://www.arhaonline.org/what_is_rural.htm.
- 17 Texas Comptroller of Public Accounts.. Texas in focus: a statewide view of opportunities. 2011 [cited 2011 March 15]; Available from: http://www.window.state.tx.us/specialrpt/tif/population.html.
- 18 Rural Assistance Center.. Alabama. 2011 [cited 2011 March 15]; Available from: http://www.raconline.org states/alabama.php.
- 19 American Recovery and Reinvestment Act of 2009, H.R. 1 (Accessed December 19, 2010 at http://thomas. loc.gov/cgi-bin/bdquery/z?d111:h.r.00001:, (enacted on 6th January, 2009, 2009).
- 20 Federal Register.. 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, Page 44, (2010).
- 21 Conn J. Extension centers offer guidance on health IT. 2010 [cited 2010 June 16]; Available from: http://www.modernhealthcare.com/article/20100616/NEWS/100619958.
- 22 Gale J, Lenardson J, Race M, Gregg W, Casey M, Indira Richardson M. et al. State initiatives funded by the Medicare Rural Hospital Flexibility Grant Program. Flex Monitoring Team Briefing Paper;. 2007
- 23 Centers for Medicare and Medicaid Services.. CMS and ONC final regulations define meaningful use and set standards for electronic health record incentive program. [cited 2010 August 17]. Available from: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3787&intNumPerPage=10&check-Date=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keyword-Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
- 24 Centers for Medicare and Medicaid Services.. Medicare and medicaid health information technology: Title IV of the American Recovery and Reinvestment Act. [cited 2010 August 17]. Available from: https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3466&intNumPerPage=10&check-Date=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keyword-Type=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.
- 25 Centers for Medicare and Medicaid Services.. Secretary Sebelius announces final rules to support meaningful use of electronic health records. [cited 2010 August 17]. Available from: http://www.hhs.gov/news/ press/2010pres/07/20100713a.html.
- 26 Office of the National Coordinator for Health Information Technology.. Final rule: health information technology: initial set of standards, implementation specifications, and certification criteria for electronic health record technology. [cited 2010 August 17]. Available from: edocket.access.gpo.gov2010/pdf/2010–17210.pdf.
- 27 Kohn L, Corrigan J, Donaldson M. To err is human: building a safer health system. A report of the Committee on Quality of Health Care in America. Washington, D. C.: Institute of Medicine, National Academy Press,; 2000
- 28 Corrigan J, Donaldson M, Kohn L, Maguire S, Pike K. Crossing the quality chasm: Building a better delivery system. Washington, D. C.: Institute of Medicine, National Academies Press,; 2005
- 29 Centers for Medicare and Medicaid Services.. Meaningful Use. 2010 [cited 2010 July 16]; Available from: http://www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp.
- 30 Jha A, DesRoches C, Shields A, Miralles P, Zheng J, Rosenbaum S. et al. Evidence of an emerging digital divide among hospitals that care for the poor. Health Aff 2009; 28 (06) w1160.
- 31 Medical Records Institute.. Sixth annual survey of electronic health record trends and usage for 2004. 2004 [cited 2006 October]; Available from: http://www.providersedge.com/ehdocs/ehr_articles/Survey_of_EHR_Trends_and_Usage_for_2004.pdf.
- 32 Jha AK, DesRoches CM, Kralovec PD, Joshi MS. A progress report on electronic health records In U S. Hospitals. Health Aff 2010; 29 (010) 1-7.
- 33 Office of Primary Care and Rural Health.. Alabama’s rural and urban counties. [updated October 2007; cited 2010 July 16]. Available from: www.arhaonline.org/PDF%20Files/Statewide.pdf.
- 34 Blumenthal D, Graham G. A letter to the vendor community: health IT and disparities. [cited 2010 October Available from: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=3197.
- 35 iHealthBeat.. HHS provides $20M in funding to aid rural health IT Aadoption. California HealthCare Foundation;. 2010 [cited 2010 September 10]; Available from: http://www.ihealthbeat.org/ar ticles/2010/9/10/hhs-provides-20m-in-funding-to-aid-rural-health-it-adoption.aspx.
- 36 Sparks PJ, McLaughlin DK, Stokes CS. Differential neonatal and postneonatal infant mortality rates across US counties: The role of socioeconomic conditions and rurality. Journal of Rural Health 2009; 25 (04) 332-341.