Most Hospitals Would Not Qualify for Health IT Incentives

Here's a shocking statistic: Only 6 percent of hospitals have enough portions of an electronic health record to qualify for government incentives under the economic stimulus legislation. That's according to Dave Garets, president and CEO of HIMSS Analytics, the research arm of the Healthcare Information and Management Systems Society, which began its annual conference today in Chicago.

Both electronic nursing documentation and computerized physician order entry (CPOE) will probably be required to show the "meaningful use" of an EHR that the government will require for Medicare and Medicaid incentives, Garets says.

"You don't start seeing significant improvements in patient safety, cost reduction, error reduction, and efficiency until you have nurses documenting online and doctors ordering online, so they have most of the data they need to make a rational decision," Garets told BNET at the HIMSS convention.

On the other hand, he said, two-thirds of hospitals could probably qualify for health IT incentives if they just took those two steps. That would show that they were capable of exchanging summary information with other providers and that they were using some degree of clinical decision support.

Teaching nurses to use electronic templates, or sequences of "pick" boxes, is a relatively easy step, Garets points out. "There's pretty good success in getting nurses to document online. They see the value in it pretty quickly. It also helps standardize nursing practice."

A much bigger barrier is getting physicians to use CPOE systems, he says. Particularly if they don't have electronic medical records in their offices, they may not be accustomed to ordering tests and medications online, and they don't want anything to slow them down. Consequently, while about 23 percent of hospitals say they have implemented CPOE systems, according to HIMSS Analytics data, a far smaller percentage are using them or using them fully. A good measure of meaningful use, Garets says, would be the percentage of orders that are placed through a CPOE system.

CPOE can be promoted by hospitalists, who are usually employed by or contracted to hospitals. However, they may have little influence on the attitudes of other staff physicians. In some hospitals, Garets says, the medical staff leaders have told physicians if they don't use CPOE, they could lose their staff privileges. But that is rare, as most hospitals cannot afford to turn away a major portion of their staff.

A couple of other factors may turn the tide, Garets suggests. For one thing, more institutions may take advantage of the relaxation of the Stark self-referral law, which allows them to donate up to 85 percent of the cost of EHR software to staff physicians. While relatively few hospitals have done that so far, Garets believes that the promise of substantial government aid for hospital health IT adoption may change their attitude. In return for hospital help in supporting and implementing EHRs that will allow the doctors to collect Medicare bonuses, the physicians might be willing to support hospital initiatives in areas like CPOE, Garets suggests. Hospitals are also increasing their employment of doctors, and some physicians might go to work for hospitals that provide EHRs, rather than having to purchase them on their own, he says.

Hospitals' profitability and ability to acquire capital have been affected by the recession, Garets concedes. But the big turnout of hospital IT professionals at this conference indicates that there is a lot of interest in reaping the billions in government incentives that will be available in a couple of years.