Department of Health Services Administration, University of Alabama at Birmingham, USA.
J Healthc Manag. 2012 Nov-Dec;57(6):435-48; discussion 449-50.
Payers are known to influence the adoption of health information technology (HIT) among hospitals. However, previous studies examining the relationship between payer mix and HIT have not focused specifically on electronic health record systems (EHRs). Using data from the Nationwide Inpatient Sample and the American Hospital Association Annual Survey, we examine how Medicare, Medicaid, commercial insurance, and managed care caseloads are associated with EHR adoption in hospitals. Overall, we found a weak relationship between payer mix and EHR adoption. Medicare and, separately, Medicaid volumes were not associated with EHR adoption. Furthermore, commercial insurance volume was not associated with EHR adoption; however, a hospital located in the third quartile of managed care caseloads had a decreased likelihood of EHR adoption. We did not find empirical evidence to support the hypothesis that payer generosity and other indirect mechanisms influence EHR adoption in hospitals. The direct incentives embedded in the Health Information Technology for Economic and Clinical Health Act may have a positive influence on EHR adoption--especially for hospitals with high Medicare and/or Medicaid caseloads. However, it is still uncertain whether the available incentives will offset the barriers many hospitals face in achieving meaningful use of EHRs.
支付方被认为会影响医院对健康信息技术 (HIT) 的采用。然而，以前研究支付方组合与 HIT 之间关系的研究并未特别关注电子健康记录系统 (EHRs)。我们使用来自全国住院患者样本和美国医院协会年度调查的数据，研究医疗保险、医疗补助、商业保险和管理式医疗病例量与医院采用 EHR 之间的关系。总的来说，我们发现支付方组合与 EHR 采用之间的关系较弱。医疗保险和单独的医疗补助量与 EHR 的采用无关。此外，商业保险量与 EHR 的采用无关；然而，位于管理式医疗病例量第三四分位数的医院采用 EHR 的可能性较低。我们没有发现实证证据支持支付方慷慨和其他间接机制影响医院采用 EHR 的假设。《经济和临床健康信息技术法案》中嵌入的直接激励措施可能对 EHR 的采用产生积极影响--特别是对于 Medicare 和/或 Medicaid 病例量较高的医院。然而，目前尚不确定现有的激励措施是否足以抵消许多医院在实现 EHR 有意义使用方面面临的障碍。
