“The adoption of these systems was slow in the United States until the 2009 enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which provided over $20 billion in grants and financial incentives to promote the adoption of EHRs [Electronic Health Records] among healthcare providers (more on HITECH below) (DesRoches et al., 2010). Prior to the Act, in 2007, only 35% of office-based physicians used at least one EHR component in their office, only 12% of physician EHRs met the criteria for having a basic system, and only 4% met the criteria for having fully functional systems (Hing & Hsiao, 2010). By 2015, a few years after the Act, 54% of office-based physicians had adopted a basic system that included information on patient history/demographics, lists of patients’ problems, medications and allergies, physician clinical notes, computerized orders for prescriptions, and the ability to view laboratory and imaging results electronically) (NEHRS, 2015).

“Likewise, in 2008 only 7.6–0.9% of hospitals had a basic EHR system in at least one clinical unit (Jha et al., 2009). In 2014, 41.4% of hospitals had basic systems while 39.1% had comprehensive systems (Adler-Milstein et al., 2017). Since 2014, small and rural hospitals have increased their adoption of basic EHR systems by 14% and critical access hospitals have increased their adoption by 18% (Henry et al., 2016). Basic EHR adoption in psychiatric hospitals doubled between 2008 and 2015, and increased five-fold for children’s hospitals (Henry et al., 2016).

“Other types of healthcare provider are also adopting EHRs. Information regarding the adoption of EHRs in nursing homes is limited but a 2012 survey reported that 18% had a fully implemented and operational EHR, while 30% had a system that was partially implemented and operational (Abramson et al., 2014). Only 11.4% of nursing homes reported no implementation plans. In 2007 about 41% of home health and hospice organizations had EHRs, and an additional 15% planned to have EHRs within the next year (Bercovitz, Sengupta & Jamison, 2010). Of the home health and hospice organizations with EHRs, 98% used components for recording patient demographics, 83% used clinical notes, and over half used clinical decision-support systems or computerized physician-order entry. EHRs are used extensively in freestanding dialysis facilities, particularly in large for-profit dialysis chains. All the five largest dialysis chains use EHRs (Kochevar et al., 2011). Even many small dialysis facilities use EHRs (around 61% in 2010).”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“A few large healthcare systems have achieved EHRs that are interoperable between providers within the same healthcare system. The VHA – the largest integrated healthcare system in the United States – is an example. The VHA developed an HIT system called the Veterans Health Information Systems and Technology Architecture (VistA) that was capable of interconnectivity between all providers within the VHA system (Byrne et al., 2010). The VHA achieved close to 100% adoption of several VistA components, including inpatient and outpatient EHRs, bar code medication administration and computerized physician order entry (CPOE). In 2013 VistA incorporated a personal health record component (see next subsection) so that patients have access to their records (VA, 2018). In 2018 the VHA began the process of transitioning from VistA to a commercial system, Cerner, also used by the Department of Defense (DOD), so that records could be interoperable between DOD and VA patients (VA, 2018). The new system began operating in October 2018.

“Another example is Kaiser Permanente, the largest private non-profit integrated healthcare system in the United States (Chen et al., 2009). Kaiser Permanente provides group health insurance, outpatient care such as primary and specialty care, testing, imaging and pharmaceuticals, and inpatient hospital care. In 2004 Kaiser began implementing a system-wide EHR, HealthConnect, rolling it out to 431 medical offices and 36 hospitals by 2010 (Wheatley, 2013). The EHR provides clinical documentation and decision support across care settings, and real-time connectivity to testing, imaging, pharmacy and other ancillary systems (Wheatley, 2013).”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“In the world’s most advanced health care markets, calls are growing to move away from fee-for-service care and toward value-based care. Such a transition includes a number of structural changes involving new payment models such as increased use of bundles, thoughtfully collecting, analyzing, and sharing patient-reported outcome measures (PROMs), and re-organizing health care delivery infrastructure into integrated practice units.

“Although payment models in the US have evolved since HITECH (for example, as seen in both private and public initiatives to encourage the use of bundles), EHRs are typically linked to revenue cycle management and traditional, fee-for-service billing. Consequently, some technology remains at odds with—or at least partially misaligned with—target payment models. Ideally, databases designed for the delivery of value-based care would go beyond “standard” medical data to include data on social determinants of health and other factors.

“The potential mismatches between the design of digital tools and the goals of the health care system are worth keeping in mind: Software systems designed around fee-for-service health care delivery will perpetuate existing waste and shortcomings, while design that builds in opportunities for broader data collection, user-friendly personal health records, and the evidence-based deployment of personalized digital tools will support the transition to value-based care. In this respect, both the US and Germany have a long way to go. Germany, in particular, has a great opportunity to thoughtfully roll out such tools over the years ahead.

“Furthermore, to take full advantage of digitized health care delivery data, systems must develop algorithms based on large and diverse population data to ensure that risk adjustment for individuals can be done on the basis of representative data from an appropriately comparable group. Algorithms need access to unprecedented amounts of anonymized data, which in turn need to be “cleaned”—not only for errors and incompleteness, but also for inherent biases.”

Source: “On The Brink Of A Digital Health Care Transformation: What Germany Can Learn From The United States, “ Health Affairs Blog, October 20, 2021.
DOI: 10.1377/hblog20211018.865750

“Forty-one FQHCs [Federally Qualified Health Centers] with 534 physical locations provided data. The FQHCs participating in the CHCF [California Health Care Foundation] initiative served 1.7 million patients in 2019 and were similar to FQHCs in California that were not included in the sample; however, the smallest FQHCs (serving ≤9999 patients in 2019) were underrepresented (Table).

“During the prepandemic period, there was a mean of 231.7 primary care visits per 1000 patients per month compared with 228.6 visits per 1000 patients per month during the COVID-19 pandemic period. Adjusted models showed a 6.5% decrease (95% CI, −104% to −2.3%; P = .03) in total visit volume for primary care, with the decline concentrated in March and April 2020. There was no significant change in total behavioral health visits (Figure).

“Prior to the COVID-19 pandemic, there was minimal telehealth use. During March 2020, FQHCs rapidly substituted in-person visits with telephone and video visits. During the pandemic period, there were 109.9 in-person, 111.0 telephone, and 7.8 video visits per 1000 patients per month for primary care with 48.1% occurring in person, 48.5% via telephone, and 3.4% via video. For behavioral health, there were 6.6 in-person, 18.2 telephone, and 4.0 video visits per 1000 patients per month with 22.8% occurring in-person, 63.3% via telephone, and 13.9% via video. Telephone visits peaked in April 2020, comprising 65.4% of primary care visits and 71.6% of behavioral health visits.”

Source: Uscher-Pines L, Sousa J, Jones M, et al. Telehealth Use Among Safety-Net Organizations in California During the COVID-19 Pandemic. JAMA. Published online February 02, 2021. doi:10.1001/jama.2021.0282.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Oct. 20, 2021 by Doug McVay, Editor.