You’ve heard doctors complaining about the EHR mandate since Congress came up with the HITECH Act. More than 90% of healthcare facilities are now computerized and this includes community healthcare organizations and FQHCs. But the cost savings and workflow reductions that we were promised have failed to materialize. A new report says that EHRs have very little impact on lowering costs in these rural facilities. What is going on?
EHRs Failed Promises
The New Yorker says, “Something’s gone terribly wrong. Doctors are among the most technology-avid people in society: computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.”
Many doctors complain that computers actually add to their work volume. Yet the early predictions were that EHRs would improve healthcare quality, cut costs, lessen medical errors, and allow clinicians to do more, faster. Early studies said EHRs would save us $78 billion a year—and these were the conservative estimates. These savings have not only not materialized, they definitely didn’t arrive in rural facilities who dished out big bucks for these systems but took a financial hit that was much harder than their urban counterparts.
In the intervening years, a few studies noted that rural healthcare facilities had less understanding of how these systems worked. Other studies noted leadership in these rural healthcare organizations were 71% less likely to consider cost reductions as a benefit stemming from their EHRs.
But few studies looked closely at EHR usage and costs comparatively between urban and rural facilities. The question no one asked is whether urban clinics leverage EHRs to cut costs in ways that rural hospitals do not. In August 2022 a new study sought to compare and contrast the differences in EHR use and operational costs between rural and urban facilities. What did researchers find out?
Urban vs. Rural, EHRs, and Costs
The study noted that costs are seven times higher in urban locations. Urban healthcare facilities also have more EHR functionality than their rural counterparts. Perhaps more interesting is that urban hospitals also benefit from cost reductions tied to use of EHR software. The study noted, “EHR use helps urban healthcare organizations reduce costs, particularly ancillary and outpatient costs.”
Now for the drum roll—the same cannot be said of rural facilities. The study noted, “For rural outlets, however, the results are not so promising, as EHR use is never significantly associated with any changes in costs.” Then the study tried to correlate specific healthcare functions with lowered costs. The study broke it out by features and found urban centers did experience cost reductions with the following features:
- Computerized order entry.
- Electronic clinical documentation.
- Results viewing.
The study is groundbreaking, because, for the first time, we understand that EHRs do not have the same effect on rural and urban facilities. The study surmised that perhaps rural patients are less likely to manage their personal health information (PHI) online. Perhaps urban organizations share more information, translating into less time spent on manual patient data gathering. The truth is; we don’t yet understand why rural community health centers fail to receive the same benefit as urban facilities. Clearly, more research needs to be done.
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