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Electronic Capabilities for Patient Engagement among U.S. Non-Federal Acute Care Hospitals: 2012-2014

ONC Data Brief 29 | October, 2015

Dustin Charles, MPH; Meghan Gabriel, PhD; JaWanna Henry, MPH

Research demonstrates that providing patients with access to their clinical information empowers them to increase patient engagement and improve health outcomes. Several federal programs and plans require or promote giving patients greater access to their health information. The Office of the National Coordinator for Health IT's (ONC) draft Interoperability Roadmap calls on healthcare providers to enable patients to electronically view, download, and transmit their health information to a destination of the patient's choice (1). Additionally, the draft Federal Health IT Strategic Plan encourages the advancement of patients' ability to access, amend, and make choices regarding the disclosure of their electronic health information (2). Also, the 2014 rules for the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program require participating hospitals to enable patients with online access to view, download, and transmit their health information (3). This brief describes trends in hospitals' capability to engage patients with their health information electronically from 2012 to 2014.

Six out of ten hospitals provide patients with the ability to electronically view, download, and transmit their health information

Figure 1: Percent of non-Federal acute care hospitals that provide patients with the capability to electronically view, download, and transmit their health information.

This figure displays a bar chart with ten bars that represent the ability of non-Federal acute care hospitals to electronically view, download, and transmit health information. The first two vars represents the ability to view, download, and transmit for 2013 (10%) and 2014 (64%). Bars 3, 4, and 5 represent the ability to view only for 2012 (24%), 2013 (40%), and 2014 (91%) respectively. Bars 6, 7, and 8 represent the ability to dowbload only for 2012 (14%), 2013 (28%), and 2014 (82%) respectively. Bars 9 and 10 represent the ability to transmit health information for 2013 (12%) and 2014 (66%).

NOTE: *Significantly different from previous year (p < 0.05). Data regarding "View, Download, and Transmit" were not collected in 2012.

SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement: 2012 - 2014

Critical Access and small urban hospitals lag behind other hospital types on providing patients the ability to electronically view, download, and transmit their health information.

Figure 2: Percent of non-federal acute care hospital types that provide their patients with the electronic ability to view, download, and transmit their health information, 2014.

This figure displays bar chart showing the ability of patients to view, download, and transmit provided by non-federal acute care hopsitals. 87% of critical access hospitals, 89% of small rural hospitals, 87% of small urban hospitals, 94% of medium hospitals and 96% of large hospitals provide patients with the ability to view their health information. 77% of critical access hospitals, 80% of small rural hospitals, 75% of small urban hospitals, 86% of medium hospitals and 89% of large hospitals provide patients with the ability to download their health information. 58% of critical access hospitals, 68% of small rural hospitals, 58% of small urban hospitals, 72% of medium hospitals, and 73% of large hospitals provide patients with the ability to transmit their health information. 56% of critical access hospitals, 66% of small rural hospitals, 56% of small urban hospitals, 69% of medium hospitals, and 72% of large hospitals provide patients with the ability view, download, and transmit their health information.

NOTES: Larger, bold numbers represent hospitals types with significantly higher measures than other hospital types for that capability. Hospital size is based on the number of beds: large=400 or more; medium=between 399 and 100; and small=less than 100. Rural/urban status determined by U.S. Census Bureau Type: urban=metropolitan or division; and rural=micropolitan or rural. Critical Access is a special designation for certain small hospitals by the Centers of Medicare & Medicaid Services.

SOURCE: ONC/AHA, AHA Annual Survey Information Technology Supplement: 2014

All states have hospitals that provide patients with the ability to view, download, and transmit their health information electronically.

Figure 3: State percent of non-federal acute care hospitals with the capability for their patients to view, download, and transmit their health information compared with previous year.

NOTES: Estimates for states shaded gray did not meet the standards for reliability (NR=not reliable). See the Table A for a complete list of 2013 and 2014 view, download, and transmit measures by state.

SOURCE: ONC/AHA, AHA Annual Survey Information Technology Supplement: 2013-2014

Increasingly, hospitals are adopting various types of electronic patient engagement capabilities.

Figure 4: Electronic capabilities offered by non-federal acute care hospitals to their patients (excluding view, download, and transmit patient health information), 2014.

NOTES: Questions regarding secure messaging were asked in 2014 only. *Significantly different from previous year (p < 0.05).

SOURCE: ONC/AHA, AHA Annual Survey Information Technology Supplements: 2012-2014

Eight in ten hospitals can provide patients with four or more electronic engagement capabilities.

Figure 5: Number of electronic patient engagement capabilities among hospitals, 2014.

NOTES: Patient engagement activities include: view, download, transmit, request amend, request refill, schedule appointment, pay bills, submit patient data, and send secure messages.

SOURCE: ONC/AHA, AHA Annual Survey Information Technology Supplement: 2014

Summary

The key to engaging patients in their healthcare is providing them with the electronic capability to access, modify, and request their own health information (4). Hospitals, which play a critical role in coordinating patient care with a variety of providers across numerous settings, have begun offering patients opportunities to electronically interact with their health information at rates greater than ever before. One potential factor for this increase is the 2014 requirements of the CMS EHR Incentive Program that requires hospitals to provide patients with the ability to view online, download, and transmit their health information electronically.

Using data from the AHA, this brief describes growth in patient engagement capabilities among hospitals since 2012. More than six out of ten (64%) of non-federal acute care hospitals provide patients with the ability to view, download, and transmit their health information electronically. This represents a 6 fold increase since 2013 (10%). Along with this, over half (51%) of hospitals can send and receive secure messages from patients. In addition, the ability for patients to complete administrative functions electronically, such as schedule appointments and pay bills online has increased significantly since 2012.

There are differences in patient capabilities to view, download, and transmit their health information among hospitals based on their types and location. Only half (56%) of hospitals that are Critical Access Hospitals or small urban hospitals provide their patients with these capabilities. This is significantly lower than small rural (66%), medium (69%), and large (72%) hospitals, of which about 7 out 10 have the capabilities. However, overall there has been substantial growth in these capabilities among all hospitals across the country. In 2013, six states had no hospitals with the capabilities, and no states had more than 40% of their hospitals with the capabilities. By 2014, all states had hospitals with the capabilities and only four states had less than 40% of their hospitals with the capabilities.

This brief explored nine key hospital electronic patient engagement capabilities: capability for patients to view, download, or transmit their health information; request amendments to their medical records; request prescription refills; schedule appointments; pay bills; submit patient generated data; and send secure messages electronically. While only 13% of hospitals reported all nine patient engagement activities, the majority (greater than 50%) could provide 4 to 8 of these electronic patient engagement activities. Only 4% of hospitals could not provide any of these electronic patient engagement activities.

Definitions

Non-federal acute care hospital: Includes acute care general medical and surgical, general children's and cancer hospitals owned by private/not-for-profit, investor-owned/for-profit, or state/local government and located within the 50 states and District of Columbia.

Table 1: Survey questions assessing hospitals' patient engagement activity.
See the PDF of ONC Data Brief 29 for the list of survey questions.

Data Source and Methods

Data are from the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey. Since 2008, ONC has partnered with the AHA to measure the adoption and use of health IT in U.S. hospitals.

The chief executive officer of each U.S. hospital was invited to participate in the survey regardless of AHA membership status. The person most knowledgeable about the hospital's health IT (typically the chief information officer) was requested to provide the information via a mail survey or secure online site. Non-respondents received follow-up mailings and phone calls to encourage response. The survey was fielded from November 2014 to the end of February 2015.

This analysis consisted of non-federal, acute care hospitals, including children's and cancer hospitals. The response rate for non-federal acute care hospitals was 60%. A logistic regression model was used to predict the propensity of survey response as a function of hospital characteristics, including size, ownership, teaching status, system membership, availability of a cardiac intensive care unit, urban status, and region. Hospital-level weights were derived by the inverse of the predicted propensity.

Estimates considered unreliable had a relative standard error adjusted for finite populations greater than 0.49. Responses with missing values were assigned zero values. Significant differences were tested using p < 0.05 as the threshold.

References

1. The Office of the National Coordinator for Health IT. (2015). Connecting health and care for the nation: A shared nationwide interoperability roadmap version 1.0. Accessed June 1, 2015 at: http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf .

2. The Office of the National Coordinator for Health IT. (2014). Federal Health IT Strategic Plan 2015-2020. Accessed June 1, 2015 at: http://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf.

3. Centers for Medicare & Medicaid Services. [Medicare and Medicaid] EHR Incentive Programs. Available from: https://www.cms.gov/ehrincentiveprograms..

4. Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A National Action Plan to Support Consumer Engagement via E-Health. Health Affairs. 32(2): 376-384; 2013.

About the Authors

The authors are with the Office of the National Coordinator for Health Information Technology, Office of Planning, Evaluation, and Analysis.

Suggested Citation

Charles, D., Gabriel, M., Henry, J. (October 2015) Electronic Capabilities for Patients among U.S. Non-Federal Acute Care Hospitals: 2008-2014. ONC Data Brief, no.29. Office of the National Coordinator for Health Information Technology: Washington DC.

Appendix

Table A: Percent of non-federal acute care hospitals that provide electronic capability to view, download, and transmit heath information by U.S. State, 2013 and 2014
See the PDF of ONC Data Brief 29 for the full appendix.