Long-Term and Post-Acute Care Providers Engaged in Health Information Exchange: Final Report. 3.4.1. EHR Adoption Rates by Setting

10/29/2013

Adoption rates often are reported by levels of EHR functionality. It is important to note that definitions of an EHR differ by type of health care setting and are not comparable across many providers/settings.

EHR Adoption Among Office-Based Physicians

EHR adoption rates are reported to be increasing for two important HIE participants for care coordination -- physicians and short-term acute care hospitals. In 2012, 72% of office-based physicians had adopted an EHR system. Forty percent of physicians have adopted a "basic" EHR with certain advanced capabilities, more than double the adoption rate in 2009.85 For 12 of the 15 EHR Incentive Programs' Stage 1 MU core objectives, physicians achieved at least 50% adoption rates.86

EHR Adoption Among Acute Care Hospitals

The trend in adoption of EHR systems by non-federal acute care hospitals has been steadily increasing since 2008. From 2010 to 2012, EHR adoption of a "basic" EHR sharply increased from 19% to 44%.87 Since 2009, hospital adoption of at least basic and comprehensive EHR systems has more than doubled. The percent of hospitals with CEHRTg increased 18% between 2011 and 2012, rising from 72% to 85%. Hospital adoption rates for each of the 14 EHR Incentive Programs MU Stage 1 Core objectives ranged from 72% to 94%.88

EHR Adoption Among LTPAC Providers

The lack of availability, adoption, and use of interoperable EHRs by LTPAC providers is a major barrier to HIE.89 Based on currently available data, which in some cases is dated, adoption of computerized technology varies among LTPAC providers.7088

  • In 2010, the National Survey of Residential Care Facilities (NSRCF), which included residential care facilities, assisted living residences, board and care homes, congregate care; enriched housing programs, homes for the aged, personal care homes, and shared housing establishments, found that 17% were using an EHR system, with 3% using a basic EHR system, and that more than half (55%) of these facilities had one or more of six electronic capabilities associated with a basic EHR.9091 A more recent NSRCF was conducted in 2012. However, at the time of this report, results were not available.92 The survey does not include SNFs, HHAs, or hospice providers.

  • Approximately four in ten SNFs (43%) had adopted an electronic information system in 2004.93 There are no national or large-scale surveys of nursing home adoption of EHRs, and estimates from other sources including an expert panel varied widely.94

  • Among home health and hospice care providers, 41% had adopted any EHR, and 10% had a basic EHR system in 2007.95

  • Another study found that certain specialty hospitals that are not eligible for MU incentive payments are less likely to adopt EHR systems. The study was based on the 2009 HIT supplement to the American Hospital Association Survey, which included long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. While 12% of short-term acute care hospitals in 2009 had adopted at least a basic EHR system, only 6% of long-term acute care hospitals, 4% of rehabilitation hospitals, and 2% of psychiatric hospitals had adopted an EHR.96

Because definitions of EHRs vary by survey, the LTPAC adoption rates are not comparable with EHR adoption rates reported for EPs/EHs.

TABLE 3-2. Adoption Rate by Selected LTPAC Provider Types

LTPAC Provider Setting   EHR Adoption Rate*  
Skilled Nursing Facilities 43%**
Home and Hospice Care Facilities   41%
Residential Care Facilities 17%
Long-Term Acute Care Hospital 6%

* EHR adoption rates are measured differently across provider types and comparisons across provider type is not advised.
** Survey question was adoption of "electronic information systems".


  1. Dougherty M, Williams M, Millenson M, et al. EHR payment incentives for providers ineligible for payment incentives and other funding study. Washington, DC: Prepared for Office of Disability, Aging and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services; 2013. Available athttp://aspe.hhs.gov/daltcp/reports/2013/EHRPI.shtml. Accessed July 14, 2013.

  2. LTPAC Collaborative, State HIE Toolkit Module: Vulnerable populations and HIE. 2010.

  3. Harvell J, Harr M, Hall EP, et al. Implementing health information exchange in the long-term and post-acute care community -- Perspectives for LTPAC providers and their affiliated organizations. Webinar, December 12, 2012.

  4. ECRI Institute and s2a. Crossing the connectivity chasm: Pinpointing gaps in readiness to exchange health information. Plymouth Meeting, PA; 2012.

  5. Office of the National Coordinator for Health Information Technology. Health IT Policy Committee. Available athttp://www.healthit.gov/policy-researchers-implementers/health-it-policy-committee. Accessed June 13, 2013.

  6. Office of the National Coordinator for Health Information Technology. Principles and strategy for accelerating health information exchange (HIE). Washington, DC: Office of the National Coordinator for Health Information Technology; 2013. Healthcare Information Technology Standards Panel. HITSP enabling healthcare interoperability. Available at http://www.hitsp.org/about_hitsp.aspx. Accessed August 6, 2013.

  7. Office of the National Coordinator for Health Information Technology. Federal health information technology strategic plan, 2011-2015. Washington, DC: Office of the National Coordinator for Health Information Technology; 2011.

  8. Office of the National Coordinator of Health Information Technology. Initial set of standards, implementation specifications, and certification criteria for electronic health record technology. 2010:45 CFR Part 170.

  9. LeadingAge Center for Aging Services Technology. EHR for LTPAC: A primer on planning and vendor section. Washington, DC: LeadingAge Center for Aging Services Technology; 2013.

  10. Certification Commission for Health Information Technology. CCHIT certified products. Available at https://www.cchit.org/find-cchit. Accessed June 14, 2013.

  11. HL7 International. HL7 EHR system long-term care functional profile, release 1 -- U.S. realm. Available athttp://www.hl7.org/implement/standards/product_brief.cfm?product_id=134. Accessed August 28, 2013.

  12. Alwan M. Personal communication about LeadingAge members and participation in health information exchange of electronic medical record data. LeadingAge; 2012.

  13. Metz K, Russell W. Improving transitions of care in LTPAC: An update from the theme 2 Challenge Grant awardees. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  14. Office of the National Coordinator of Health Information Technology. Beacon Community program. Available athttp://www.healthit.gov/policy-researchers-implementers/beacon-community-program. Accessed December 20, 2012.

  15. Smith L. "Direct" your attention to Mass Health Information Exchange (HIE). Massachusetts eHealth Institute (MeHI) Newsletter; 2012.

  16. Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2012. NCHS Data Brief No. 111. Hyattsville, MD: National Center for Health Statistics; 2012.

  17. King J, Patel V, Furukawa M. Physician adoption of electronic health record technology to meet Meaningful Use objectives: 2009-2012. ONC Data Brief, No. 7. Washington, DC: Office of the National Coordinator for Health Information Technology; 2012.

  18. Jha AK, DesRoches CM, Kralovec PD, et al. A progress report on electronic health records in US hospitals. Health Aff; 2010; 29(10): 1951-1957.

  19. Charles D, King J, Patel V, et al. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2012. ONC Data Brief, No. 9. Washington, DC: Office of the National Coordinator for Health Information Technology; 2013.

  20. Coleman EA, Bennett RE, Dorr D, et al. Report on health information exchange in post-acute and long-term care. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy; 2007. Available at http://aspe.hhs.gov/daltcp/reports/2007/HIErpt.htm.

  21. Decker SL, Jamoom EW, Sisk JE. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. Health Aff; 2012; 31(5): 1108-1114.

  22. Caffrey C, Park-Lee E. Use of electronic health records in residential care communities. Hyattsville, MD: National Center for Health Statistics; 2013; No. 128.

  23. National Center for Health Statistics. National study for long-term care providers, 2011. Available athttp://www.cdc.gov/nchs/data/nsltcp/NSLTCP_FS.pdf. Accessed August 20, 2013.

  24. Hsiao CJ, Hing E. Adoption of health information technology among U.S. ambulatory and long-term care providers. National Conference on Health Statistics. Washington, DC: 2012. Available at http://www.cdc.gov/nchs/ppt/nchs2012/SS-03_HSIAO.pdf. Accessed August 20, 2013.

  25. Richard A, Kaehny M, May K, et al. Literature review and synthesis: Existing surveys on health information technology, including surveys on health information technology in nursing homes and home health. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation; 2009. Available at http://aspe.hhs.gov/daltcp/reports/2009/hitlitrev.htm#table2.

  26. Resnick HE, Alwan M. Use of health information technology in home health and hospice agencies: United States, 2007. J Am Med Inform Assoc; 2010; 17: 389-395.

  27. Wolf L, Harvell J, Jha AK. Hospitals ineligible for federal meaningful use incentives have dismally low rates of adoption of electronic health records. Health Aff; 2012; 31(3): 505-513.

g. Certified EHR is EHR technology that has been certified as meeting federal requirements for some or all of the hospital objectives of MU.

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