Engaging Providers in Underserved Areas to Adopt Electronic Health Records
Office of the National Coordinator for Health IT, Office of Economic Analysis, Evaluation, and Modeling, 200 Independence Ave, SW, Washington, DC 20201. E-mail: . The American journal of managed care
(Impact Factor: 2.26).
Objectives: To assess Regional Extension Centers' (RECs') health IT outreach and provider engagement efforts among primary care providers (PCPs) based in underserved areas. Study Design: A retrospective assessment of REC program enrollment. Methods: We computed REC program enrollment rates among PCPs for the entire United States and across census regions and compared enrollment in underserved areas relative to non-underserved areas. Measures of area-level underserved status included rural and health professional shortage area (HPSA) designations. Results: Of the estimated 302,689 ambulatory PCPs practicing in the United States, 120,783 (39.9%) were enrolled in an REC. REC enrollment rates among PCPs were higher in large rural (47.3%) and small rural (56.1%) areas relative to urban (37.9%) areas. REC enrollment rates among PCPs were also higher for single-county HPSAs (51.9%) relative to non-HPSAs (40.0%), geographic HPSAs (41.7%), and population group HPSAs (38.6%). The Northeast region exhibited the highest REC enrollment rates overall and across categories of underserved status relative to all other census regions. Conclusions: The REC program serves as a unique opportunity to address the health information technology needs of PCPs working in underserved areas. Over the course of 2 years, the program has exceeded its goal of enrolling 100,000 priority primary care providers. Provider engagement is the first step in a 3-step process aimed at getting providers to adopt and become meaningful users of electronic health records. Significant work remains for the RECs to meet these objectives, and future research should evaluate the success of the REC program in meeting subsequent milestones.
Available from: Melinda Buntin
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ABSTRACT: To describe small area variation in ambulatory electronic health record (EHR) adoption and assess evidence of a "digital divide" in whether adoption is lagging in traditionally underserved communities.
Survey data on U.S. ambulatory health care sites (261,973 sites representing 716,160 providers) collected by SK&A Information Services in 2011.
We examined cross-sectional variation in two measures of local area EHR adoption: share of providers at sites using an EHR with e-prescribing functionality; and predicted probability of EHR adoption for the average site. Local areas were defined as Public Use Microdata Areas (n = 2,068). Using multivariate regression, we examined the association between adoption and three area characteristics: high concentration of minority population; high concentration of low-income population; and metropolitan status.
EHR adoption varied significantly across local areas, ranging from 8 to 88 percent with a median of 41 percent. Adoption was lower in large metropolitan areas; areas with high concentration of minority population in the Northeast and West; and areas with high concentration of low-income population in the Midwest.
Our 2011 estimates suggest there was substantial room for increased EHR adoption across the United States, including some underserved areas with relatively low EHR adoption rates. Further research should monitor policy initiatives in these areas and examine sources of heterogeneity in low- and high-adoption communities.
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ABSTRACT: Expanding the use of interoperable electronic health record (EHR) systems to improve health care delivery is a national policy priority. We used the 2010-12 National Ambulatory Medical Care Survey-Electronic Health Records Survey to examine which physicians in what types of practices are implementing the systems, and how they are using them. We found that 72 percent of physicians had adopted some type of system and that 40 percent had adopted capabilities required for a basic EHR system. The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers. As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty. However, small practices continued to lag behind larger practices. Finally, the majority of physicians who adopted the EHR capabilities required to obtain federal financial incentives used the capabilities routinely, with few differences across physician groups.
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ABSTRACT: Assess the Regional Extension Center (REC) program's progress toward its goal of supporting over 100,000 providers in small, rural, and underserved practices to achieve meaningful use (MU) of an electronic health record (EHR).
Data collected January 2010 through June 2013 via monitoring and evaluation of the 4-year REC program.
Descriptive study of 62 REC programs.
Primary data collected from RECs were merged with nine other datasets, and descriptive statistics of progress by practice setting and penetration of targeted providers were calculated.
RECs recruited almost 134,000 primary care providers (PCPs), or 44 percent of the nation's PCPs; 86 percent of these were using an EHR with advanced functionality and almost half (48 percent) have demonstrated MU. Eighty-three percent of Federally Qualified Health Centers and 78 percent of the nation's Critical Access Hospitals were participating with an REC.
RECs have made substantial progress in assisting PCPs with adoption and MU of EHRs. This infrastructure supports small practices, community health centers, and rural and public hospitals to use technology for care delivery transformation and improvement.
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