By: Joann Schulte DO, MPH; Editorial Board Member
Doctors and hospitals know a lot about paper pushing. Your office staff can spend hours arranging referrals for children who each need to see a sub-specialist. After the appointment, the same staff must feel like they’re on a treasure hunt as they search for the consultant’s recommendations or that delayed lab result in the medical record.
Or maybe you’re the hospitalist who needs to report a case of meningitis to the state health department. You spend fifteen minutes finding the form you need to report the case and you may spend another thirty minutes filling out the paper form if it is not online and faxing it. Those kinds of frustrations were some of the reasons that electronic health records (EHR) were developed. The EHR systems are supposed to end some of the paper pushing. Information is supposed to get where it needs to go, lab results appear, and diseases are reported. That’s the concept of meaningful use (MU) of EHRs.
At the end of last year, about 3/4 of US hospitals had adopted a basic electronic medical record that included clinician notes. MU is another matter. The federal Centers for Medicare and Medicaid offer incentive payments to encourage implementation of EHR and meaningful use(MU) of those records. The first phase of MU includes medication reconciliation and the exchange of health information between facilities.
A new report by Teufel et al. (doi: 10.1542/peds.2014-2720) published in this months' Pediatrics explores the progress of EHR adoption in children's hospitals and what barriers are reported by those institutions. Early reports suggest that implementing pediatric EHR use was difficult because programs didn't include basics, such as weight-based dosing for medications, and pediatric normal values for vital signs and diagnostic testing.
The researchers surveyed the 224 members of the Children’s' Hospital Association to assess EHR adoption challenges the hospitals faced and how many got MU payments. The study period covered September 2011 to May 2012. The survey results were linked to records from the American Hospital Association to characterize the hospitals and federal records to identify the payment of MU incentives.
Survey responses came from 133 children's hospitals (59.4%) and 35% of those hospitals (47) received some MU incentive payment. The hospitals reported their most frequently anticipated challenges included the exchange of information with other hospitals (49%) and the generation of numerator and denominator information from the EHR to report quality information (41%). Among the 47 hospitals that received MU payments, 58% reported that the greatest challenge to achieving MU was the lack of meaningful criteria to pediatric care. The hospitals getting MU incentive payments reported their most challenging issues remained exchanging information with other providers (17, 44%) and generating numerator and denominator data (18, 46%).
This report assessed only the first phase of MU; others will be implemented through 2018. It seems that pediatric hospitals have a long EHR road ahead.
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