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Hawai'i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai'i is limited. To address this gap, this article examines the current state of EHR in Hawai'i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai'i's people. Eight focus groups were conducted on Lana'i, Maui, Hawai'i Island, Kaua'i, Moloka'i, and O'ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative - which allows providers web-based access to patient health information from the patient's provider network- was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai'i.

With a growing shortage of physicians, particularly primary care physicians, the issue of adequate pay in Hawai'i is increasingly important. Anecdotal reports of low pay in Hawai'i have rarely been substantiated. Data from FAIR Health, a company that tracks private insurance reimbursement rates, is compared across the United States (US) for the CPT code 99213. In addition, FAIR Health and Medicare rates are compared for cities with both similar and disparate cost of living to Hawai'i. Hawai'i is in the second lowest quintile for payment in the US for private insurances, and providers are reimbursed significantly lower than in cities with similar cost of living by both Medicare and private insurances. Methods for increasing payment to physicians in Hawai'i are essential to recruiting the necessary workforce. Revising payment methodologies that increase pay for services in areas of unmet need, revising Medicare Geographic Price Cost Indices to better balance pay in areas of need, and making use of the 10% Medicare Bonus Program for physicians working in Health Professions Shortage Areas are first steps to creating a sustainable plan for physician payment in the future.

Ensuring the adequacy of the public health workforce requires an understanding of its size and composition, as well as the population's demand for services. The current article describes research undertaken as a first step toward developing an estimate of the supply of and demand for Hawai'i's public health workforce. Using an organizational-level survey, data was obtained from a subset of 34 organizations considered to be major providers of population-based public health services in Hawai'i. The results indicate that estimates of the existing public health workforce range from 3,429 to 3,846 workers. Calculations of functional demand reveal that an additional 317 to 502 employees will be required to compensate for vacancies and projected retirements over the next five years; though, the discussion points to the fact that this number may be closer to 1,005 to 1,664. While, an additional 594 to 848 employees would be needed to meet the current missions of organizations in this sample and to best meet community need. While these findings are neither exhaustive nor definitive, they raise issues concerning the state's supply of public health workers in terms of their ability to adequately meet demand for services. More research is needed to confirm these findings and track Hawai'i's public health workforce to assure a strong local public health system.

Native Hawaiians and Other Pacific Islanders (NHOPI) suffer from a number of poor health outcomes, such as high rates of overweight status, obesity, hypertension, and high rates of asthma and cancer mortality. In addition to a disproportionate burden of illness, barriers to health care access and utilization also exist. This study examines the effect of health insurance coverage on the health status of NHOPI in comparison to Asians. To analyze this relationship, the study uses the Behavioral Risk Factor Surveillance System (BRFSS) 2012 data and logistic regression. Findings show insured NHOPI were significantly more likely than insured Asian Americans to report poor or fair health after sequential cumulative adjustments of socioeconomic, lifestyle and behavioral factors, history of diagnosed diseases, and access to care (OR: 1.66, 95% CI:[1.34, 2.05]). Health insurance alone will not eliminate the present disparities experienced by NHOPI. Other barriers prohibit health care access for NHOPI that should be considered in the investigation and development of strategies to increase healthcare access and eliminate health disparities for NHOPI.

National data reports the number of adults with any diagnosable mental disorder within a given year is nearly 1 in 5. Hawai'i, along with the rest of the nation, faces a serious shortage of mental health providers. This article describes the research undertaken to create a more accurate assessment of the current mental health provider workforce in Hawai'i through developing an estimation strategy to appraise local mental health workforce needs. The results indicate the supply of psychiatrists for Hawai'i's 2010 census population was found to be 161.4 Full Time Equivalents (FTEs) psychiatrists, or 11.86 psychiatrists/100,000 population, with the greatest number of psychiatrists per capita on the island of O'ahu. Of the 161.4 FTEs, 50.4 FTEs or 31.2% were accepting new Medicaid patients. The state's results show that Hawai'i is short of meeting current patient need by more than 100 psychiatrists though the state was only short by 6 FTE psychiatrists with regard to estimates of Medicaid patients' need. While the first number is likely accurate, the second number is likely to be significantly underestimated for a number of reasons. One reason is that practitioners who reported accepting new Medicaid patients likely see comparatively few. Another reason is that it is likely that Medicaid patients make up more than the approximate 20% of the psychiatric patient population. It is reported nationally that a greater percentage of the mentally ill receive Medicaid than the population at large. Thus, there are probably many more patients on Medicaid than our estimations accounted for. It is clear more research and more changes need to be made in Hawai'i's publicly funded healthcare system to incentivize physician acceptance and make mental healthcare more accessible to this growing population.

Hawai'i's Physician Workforce Assessment project was launched in 2010. Over the past 5 years the State has experienced decreases and increases in physician workforce. This current article describes the status of the physician workforce, past trends and anticipated projections as well as recent insights into why people leave Hawai'i. Survey data, internet searches and direct dialing methodologies were utilized to clarify and elucidate practice location, full time equivalency of time providing patient care and specialty of non-military physicians caring for Hawai'i's population. A proprietary microsimulation modeling methodology from the company the US Health Resources and Services Administration employs is utilized to assess demand. The current shortage of physicians is estimated to be between 455 and 707 full time equivalents with the greatest percentage of shortages on neighbor islands. Numerically the greatest total shortage of physicians is on O'ahu and the specialty in greatest demand is primary care with a shortage of 228 Full Time Equivalents (FTEs). Physician average age in Hawai'i is 54.9 compared to a national average of 51. There was an increase in the number of physicians who report using telehealth, from 2% to 15%. Initial improvements in the size of Hawai'i's physician workforce are promising, but we note two reported suicides in the intervening year. More attention must be paid to support practicing physicians in addition to our efforts to recruit new physicians.

Background: National policy experts have estimated that the United States will be 15-20% short of physicians by the year 2020. In 2008, the Big Island of Hawai'i was found to be 15% short of physicians. The current article describes research to determine the physician supply and demand across the State of Hawai'i., Methods: The researchers utilized licensure lists, all available sources of physician practice location information, and contacted provider offices to develop a database of practicing physicians in Hawai'i. A statistical model based on national utilization of physician services by age, ethnicity, gender, insurance, and obesity rates was used to estimate demand for services. Using number of new state licenses per year, the researchers estimated the number of physicians who enter the Hawai'i workforce annually. Physician age data were used to estimate retirements., Results: Researchers found 2,860 full time equivalents of practicing, non-military, patient-care physicians in Hawai'i (excluding those still in residency or fellowship programs). The calculated demand for physician services by specialty indicates a current shortage of physicians of over 600. This shortage may grow by 50 to 100 physicians per year if steps are not taken to reverse this trend. Physician retirement is the single largest element in the loss of physicians, with population growth and aging playing a significant role in increasing demand., Discussion: Study findings indicate that Hawai'i is 20% short of physicians and the situation is likely to worsen if mitigating steps are not taken immediately.

Background: Although the State of Hawai'i overall may have an adequate number of physiatrists, there are physiatrist shortages on the neighbor islands. This study describes the demographics, practice type, and most important concerns of current practicing physiatrists within the state of Hawai'i., Methods: A phone survey was conducted of 44 actively practicing Hawai'i physiatrists. Eligible participants were members of either the American Academy of Physical Medicine and Rehabilitation (AAPMR) or the Hawai'i Society of Physical Medicine and Rehabilitation., Results: Thirty-six of 44 local physiatrists responded to the survey. Thirty-two of the thirty-six (89%) respondents were currently practicing on O'ahu, nine (25% of respondents) completed medical school at University of Hawai'i, 19 (58% of respondents) were not planning on recruiting in their practice for at least five years and the physiatrists' most common concerns included poor reimbursement, practice management problems, and high workload., Discussion: Further recruitment efforts should be tailored to attracting physiatrists to our neighbor islands. Increasing reimbursement, addressing hospital administration issues, developing a musculoskeletal fellowship program, and increasing incentives to practice on neighbor islands are proposed changes that would directly address the concerns of Hawai'i's physiatrists.

Background: Past studies in the continental US have demonstrated that students from rural areas and those who go into primary care are more likely to practice in rural areas than urban-born and specialty physicians., Methods: This study uses two separate data sets to examine whether medical students and young physicians in Hawai'i follow the same pattern. A retrospective study of graduates of the University of Hawai'i John A. Burns School of Medicine from 1993-2006 was performed examining the relationship between practice location and high school attended for those practicing in Hawai'i. In addition, a survey was conducted with the first, second and third year medical students examining their practice intentions as related to where they grew up. Both data sets were analyzed using Chi Squared tests to determine the significance of associations between individuals from rural backgrounds practicing or intending to practice in rural areas., Results: The relationship in both cases showed that students and physicians from rural areas were more likely to practice in rural areas. However, 81% of all respondents reported being willing to consider practicing in rural area, especially if lifestyle, work environment, and employment opportunities were favorable., Discussion: If the State of Hawai'i wants to expand the physician workforce in the rural areas of Hawai'i, recruiting more students from rural areas and increasing desirability of rural practice settings are excellent paths to take.