5 Findings From the January 2019 Health IT Issue of AJMC®

For the eighth year, The American Journal of Managed Care^® (AJMC^®) presents its annual issue focused on health information technology (IT). This year, articles featured insights on health information exchange (HIE) use, data breach consequences, telemedicine experiences, and much more. Here are 5 findings from the research published in the issue.

1. Hospital data breaches are associated with a 64% increase in annual advertising expenditures

An observational analysis of hospitals that experienced data breaches—including theft, loss, hacking, and unauthorized access—found that breached hospitals were associated with significantly higher advertising spending in the 2 years after the breach compared with hospitals that were not breached. The expenditures likely represented efforts to mend the hospital’s public image and prevent losing patients to competitors, according to the authors.

While settlements, penalties, and class-action lawsuits are significant financial burdens on breached hospitals, the analysis showed that advertising campaigns also contribute to the total costs. “Advertising costs subsequent to a breach are another cost to the healthcare system that could be avoided with better data security,” the authors concluded.

2. Keeping an EHR system up to date requires substantial maintenance efforts

Many hospitals considering launching an electronic health record (EHR) system focus on the initial costs and efforts to install the system, but a retrospective study took a longer view of the maintenance needed to update and upgrade the EHR over 6 years. The researchers learned that 5551 unique changes were made to their health system’s EHR in that time (an average of 2.5 per day) and these changes affected 135 EHR functions and 151 unique user roles.

They noted that the costs and impacts of maintenance warrant more attention because “the true benefits of EHR adoption may only emerge with persistent attention to enhancing the EHR-based workflows and tools that drive improvements in care.” They suggested that maximizing the benefits of an EHR system requires significant investments of expertise and teamwork beyond the initial implementation.

3. APM participation is associated with greater HIE diversity, breadth, and depth, but lower volume

According to this cross-sectional analysis of hospital data, participation in an alternative payment model (APM) was associated with sharing more data types (HIE diversity), exchanging data with more partner types (breadth), and using a push and pull approach (depth), but APM participation was also associated with sending data for fewer discharges (volume).

These findings suggest that value-based payment may be provoking investments in HIE infrastructure, the authors wrote. However, there also seems to be an incentive to limit the number of partners they share data with. Despite the signs of strong infrastructure, “significant challenges to achieving high HIE volume remain and may require more targeted policy actions,” they concluded.

4. Health system organizational structure influences odds of advanced health IT use

Hospitals across the United States vary widely in their adoption of advanced health IT capabilities, and at least some of this variation can be explained by organizational structure and EHR standardization, according to an analysis of health system characteristics.

The strongest predictor of advanced health IT adoption was the extent of EHR standardization, followed by the health system’s management and ownership of hospitals and medical groups, but the degree of centralized resource allocation was not a significant predictor. “Health system leaders looking to improve the diffusion of new technologies should consider ways to better standardize their implementation and use of EHRs to drive widespread adoption of and benefit from new features,” the authors suggested.

5. Patients and clinicians report satisfaction with telehealth visits for follow-up care

As more healthcare providers experiment with telehealth instead of in-person visits, a descriptive analysis of clinician and patient surveys found that most patients and clinicians reported no difference in the overall quality of a virtual video visit compared with an office visit. In particular, more than 8 in 10 patients would recommend a virtual visit to their family and friends, and willingness to pay a co-pay for a virtual visit increased among patients who would have to travel more than 90 minutes or spend $25 or more on travel to attend an office visit.

“These visits are not just replacements for in-office visits; they hold the possibility of new avenues for care delivery, more frequent but shorter encounters, and opportunity for earlier intervention,” wrote the researchers, who suggested further study on the optimal mix of virtual and in-person modes of care.