November 2020. Electronic health record log data is increasingly being used in health services and informatics research. Measures are often study-specific and not replicable across institutions or vendors, which limits the generalizability of findings. However, most major EHR vendors calculate use measures from log data and make those measures available to practice and hospital managers, often for identifying inefficiencies. We surveyed the landscape of vendor-provided EHR use measures for outpatient providers, and compared the existing measures to previously proposed measures. Use of these measures can improve standardization in research using these data for insights into clinician workload, administrative burden of EHRs, and provider burnout.
September 2020. Since its inception in 2017, the Merit-Based Incentive Payment System has reported high rates of physician attestation and resulting payment bonuses from Medicare. We analyzed detailed reporting data from the first year of MIPS to understand variation how providers achieved their final MIPS scores, finding that 46% of physicians skipped at least one of the three component quality reporting categories. Despite this, many of these physicians still received payment bonuses for 2017. The removal of incentives to participate across all three program categories could result in providers being less prepared for penalties set to go into effect in 2022.
Full study with Jordan Everson
August 2020. Adoption of electronic health records has increased physician documentation burden, raising concerns about physician burnout deriving from after-hours EHR use. We analyzed two years of longitudinal survey data of EHR users at a large health system, to compare physicians’ rates of reported off-hours use to other EHR users. 25% of physicians reported EHR use on days off, and 50% reported use in the evenings, compared to 5% and 41% of nurses, respectively. These findings suggest that the burden of after-hours EHR use falls primarily on physicians, however other EHR users also report after-hours and off-day EHR use.
June 2020. Integration of prescription drug monitoring program (PDMP) databases with electronic health records (EHRs) is an important tool in combating the opioid crisis in the US. We assessed nationwide hospital adoption of three EHR capabilities related to opioid prescribing and PDMP integration: ability to electronically prescribe controlled substances, checking of state PDMPs directly from EHRs, and integration of PDMP data into EHRs. Less than one third of hospitals reported the ability to check state PDMPs, and only 14% reported full PDMP data integration. More troublingly, hospitals in high opioid-prescribing counties were less likely to report these capabilities.
May 2020. Responding to the COVID-19 pandemic requires effective public health informatics infrastructure, which includes electronic reporting of cases and other data from hospitals to public health agencies. We analyzed 2018 hospital data to assess barriers to public health reporting, and found that 41% of hospitals indicated public health agencies’ inability to receive data as a barrier. These challenges reflect systematic under-investment in public health informatics, and federal health information technology programs largely focused on provider organizations like hospitals, rather than public health agencies.
January 2020. The regulatory environment surrounding health information exchange (HIE) is complex, and includes variations in state policies regarding patient consent for data exchange. We analyzed 2016 national hospital data and found that hospitals in states with opt-in consent policies were more likely to report regulatory barriers to health information exchange, compared to hospitals in opt-out consent states. However, this was concentrated among less technologically equipped hospitals. We found no relationship between consent policies and the actual amount of HIE in which a hospital engaged, suggesting that burdens brought on by opt-in policies may fall disproportionately on less technologically advanced hospitals. This may further exacerbate the digital divide in hospital technology adoption.