Electronic health records are still rare in US hospitals as a national survey reveals that under 2 per cent have installed comprehensive electronic health records in all departments, with many giving the high cost of capital investment and maintenance as the primary barriers to adoption. The survey authors suggest a focused policy strategy that targets money, interoperability and staff training could spur wider adoption.
The findings of the survey are published as a paper in the 25 March issue of the New England Journal of Medicine, NEJM.
Among the authors is Dr David Blumenthal, recently appointed to the post of National Coordinator for Health Information Technology (HIT), from where he will lead the Obama Administration’s 19 billion dollar plan to implement the nationwide, integrated, interoperable and privacy secured HIT infrastructure outlined in the American Recovery and Reinvestment Act (ARRA).
According to an Associate Press (AP) news report, Blumenthal, who is also head of the Institute for Health Policy at Massachusetts General Hospital, explained to the press that:
“We are at a very early stage in adoption, a very low stage compared to other countries.”
Lead author Dr Ashish Jha, who is Associate Professor of Health Policy and Management at Harvard School of Public Health (HSPH), said in an HSPH press statement that:
“This study suggests hospitals have a long way to go in achieving widespread EHR [electronic health records] adoption and use.”
“The 19 billion dollars in the stimulus bill is really just a down payment for getting us to a healthcare system that is fully electronic and can deliver the kind of care Americans deserve,” he added.
The reason for the study, as the authors outline in their background information, is that despite a consensus that health information technology should lead to safer, better health care, there is little reliable data on how many hospitals have already adopted it and to what extent.
For the study, Jha and colleagues surveyed all acute care hospitals in the American Hospital Association and asked them about their electronic health records systems, using a definition of EHR based on “expert consensus”.
From the responses they estimated how many and what kinds of hospitals had adopted health information technology, and to what extent, and also what they saw as the barriers to adoption.
The results showed that:
- Based on the responses of 63.1 per cent of surveyed hospitals, only 1.5 per cent of US hospitals have a comprehensive EHR (ie in all clinical departments).
- Another 7.6 per cent have a basic system (ie in at least one clinical unit).
- Only 17 per cent of hospitals have computerized provider-order entry for medications.
- Larger hospitals, urban hospitals, and teaching hospitals were the most likely to have EHR.
- The most frequently cited primary barriers to adoption of EHR were capital requirements and high maintenance costs.
- The major barriers cited by hospitals without EHR were: inadequate capital for purchase (73 per cent); concerns about maintenance costs (44 per cent); resistance from physicians (36 per cent); unclear return on investment (32 per cent); lack of staff with adequate IT expertise (30 per cent).
- Hospitals with EHR cited physician resistance as a major barrier, but were less likely to cite the other four as major barriers.
The authors concluded that:
The very low levels of adoption of electronic health records in US hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology.”
“A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in US hospitals,” they added.
An EHR system can cost a hospital between 20 and 200 million dollars, a significant investment to find in the current economic climate. However, Jha told the press that there is ample evidence that well implemented EHRs can reduce medical errors, improve quality and make healthcare more efficient.
“While EHRs alone won’t fix all of the ills of the healthcare system, they are clearly a component of the broader effort to reduce costs and improve the quality of American healthcare,” he added.
The study was funded by the National Coordinator for Health Information Technology in the Department of Health and Human Services and the Robert Wood Johnson Foundation.
In a separate paper titled “Stimulating the Adoption of Health Information Technology”, in the same issue of the journal, Blumenthal outlines the EHR adoption strategy enshrined in the government’s recent ARRA legislation.
The carrot and stick approach includes incentives like extra Medicare payments for doctors for the “meaningful use” of a “certified” EHR that can exchange data with other parts of the health care system, and financial penalties for both doctors and hospitals who are not using EHRs meaningfully by 2015.
Blumenthal writes:
“The nation’s economic woes have given birth to an unprecedented federal effort to modernize the information systems of a troubled health care system. It is now up to the government and the nation’s health care professionals and facilities to turn this opportunity into real improvements in the health and health care of Americans.”
“Use of Electronic Health Records in US Hospitals.”
Jha, Ashish K., DesRoches, Catherine M., Campbell, Eric G., Donelan, Karen, Rao, Sowmya R., Ferris, Timothy G., Shields, Alexandra, Rosenbaum, Sara, Blumenthal, David.
DOI: 10.1056/NEJMsa0900592
Sources: NEJM, Associated Press, HSPH .
Written by: Catharine Paddock, PhD