Hospital organizational strategies associated with advanced EHR adoption

In a recent Health Services Research article, Julia Adler-Milstein, PhD, and colleagues provide some of the first national-level data characterizing hospital organizational strategies surrounding electronic medical record (EHR) adoption and use, and identify which strategies are associated with adoption of advanced EHR functions. 
Following the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, EHRs were rapidly adopted by hospitals across the United States, but regulations have been criticized as being overly prescriptive and constraining hospitals and as a result, hospitals digitized records but have fallen short of realizing their full potential for patients or clinicians.  
While EHR implementation and optimization practices vary significantly across hospitals in the United States, Adler-Milstein and colleagues believe their results may partially help to explain why a range of studies have shown an inconsistent relationship between EHR adoption and outcomes and suggest that specific organizational strategies are associated with more advanced EHR adoption. These organizational practices coalesce around three main strategies related to greater engagement of senior leadership, a higher proportion of clinicians on the IT team, and greater integration across systems, particularly clinical administrative systems. For hospitals seeking to drive adoption of more advanced EHR functions, engagement from leadership and integration across systems may help enable patient engagement EHR functions, and systems integration may help in the clinical analytics functions. 
Understanding which organizational strategies are associated with adoption of advanced EHR functions is a first step to suggest hypotheses about where to conduct further investigation of how to help hospitals increase the benefit from health IT. Unlike identifying structural characteristics associated with IT adoption, organizational strategies are more actionable and can be broadly disseminated. Health system leaders interested in developing IT-enabled patient engagement may find it useful to know of the association between a more involved Board of Directors and advanced patient engagement EHR functions. Similarly, the researchers’ results show an association between investing in systems integration and the type of advanced data analytics that requires data flows and linkages from multiple clinical and administrative sources.   

Advanced EHR functions may require specific organizational approaches, which to date have not been part of federal policy efforts. While the government is not an appropriate entity to mandate organizational strategy, policymakers could play a role in identifying and disseminating best practices. Specifically, dissemination through mechanisms such as the EHR Reporting Program included in the 21st Century Cures Act. While the focus of this Program is on reporting provider experiences with health IT, complementing these with context about IT strategy could help understand differences in experiences as well as make such strategies more transparent to facilitate learning and benchmarking.  

Policymakers should consider supporting future research examining how organizational practices contribute to adoption of advanced EHR functions and ultimately outcomes, especially the difficult task of identifying causal relationships. Given the importance of the topic and the difficulty of generating strong evidence, funders should consider prioritizing these projects to generate actionable strategies for hospitals to maximize EHR performance. 

The new evidence provided by Adler-Milstein and colleagues on how organizational strategies are associated with advanced EHR functions is an important first step in understanding how hospital management can work toward realizing the potential of electronic health records. 

Hospital organizational strategies associated with advanced EHR adoption.

Holmgren AJ, Phelan J, Jha AK, Adler-Milstein J. Health Serv Res. 2021 Mar 29. doi: 10.1111/1475-6773.13655. Online ahead of print.