Hospital Use Of Electronic Health Records Abysmally Low, Says New Study
Contrary to conventional wisdom, only a tiny
U.S. hospitals have full health information technology (HIT) systems in
place to improve how they deliver care, says a new study.
A survey of nearly 3,000 hospitals shows that less
2 percent use comprehensive electronic health records (EHRs), and about
8 percent use a basic EHR in at least one care unit that includes
physician or nurse notes.
The findings are the first reliable estimates of
prevalence of HIT adoption in U.S. hospitals, and come amid concerted
efforts by Congress and the Obama administration to stimulate wider use
of EHRs in the healthcare sector.
"HIT adoption levels are abysmally low in American
hospitals. We have a long way to go to achieve a healthcare system that
is fully electronic," said lead author Dr. Ashish Jha, an associate
professor at the Harvard School of Public Health. "The $19 billion in
federal help is a great start but it is only a down payment. This is a
big mountain to climb."
The study, which is based on data collected in
shows that larger, urban teaching institutions are somewhat more likely
to have EHRs than other hospitals, partly because they may have more
financial resources at their disposal. Inadequate capital and high
maintenance costs were the major barriers cited among nonadopters.
Jha conducted the study with researchers at the
Institute for Health Policy and the Biostatistics Center at
Massachusetts General Hospital, The Brigham and Women’s
the VA Boston Healthcare System, and the Department of Health Policy at
George Washington University.
The study was funded by the Robert Wood Johnson
Foundation (RWJF) and the federal government’s Office of the
National Coordinator for Health Information Technology.
The survey follows one released in 2008 by the
group of authors that showed that only 17 percent of doctors are using
EHRs, and only 4 percent use full EHRs. "Despite the promise that HIT
holds for better health, the accumulating evidence shows that many of
those who deliver care have yet to be convinced," says Dr. David
Blumenthal, director of the Institute for Health Policy and senior
author of this study. "This survey continues to make the case for why
the federal government needs to step in and exercise its fiscal and
policy muscle to spur adoption," said Blumenthal.
Other highlights from the study found:
- Computerized physician orders for medications
were widely available in 16 percent of U.S. hospitals.
- More than three-quarters of hospitals reported
adoption of electronic laboratory and radiology results reporting
Barriers To Be Removed
The largest barrier to HIT adoption among
still remains the cost. HIT systems are expensive and can cost between
$20 million and $100 million, depending on the size of the hospital and
the complexity of the system. To make matters worse, many of the
financial benefits of HIT systems may not accrue to the hospital that
makes the investment. If hospitals become more efficient, they could
potentially even lose money in terms of lower reimbursement for
This makes the business case for HIT far more
Another hurdle to overcome is interoperability
or allowing for easy exchange of patient care information between
hospitals or from hospitals to physicians’ offices. Right
the market is very fragmented with different standards and different
vendors. The lack of ease with which information can be shared "reduces
the potential value of these systems and may have a dampening effect on
adoption," said the study.
Until there is more clarity in the marketplace and
these systems become far more interoperable, many hospitals will resist
adopting EHRs, the authors warn.
What Can the Government Do?
The government can take steps to address this
Rewarding hospitals — especially those with the least access
capital — for using HIT can help stimulate the diffusion of
Other approaches that could help: Creating
for the support and training of more IT support staff, harmonizing
interoperability standards and creating disincentives for not using
The Veterans Health Administration has had EHRs in
for more than a decade and has produced dramatic improvements in
The United Kingdom and the Netherlands have also
successfully spurred HIT adoption, though, like in the United States,
most of their progress has been in ambulatory care.
"Few countries have yet to make substantial
progress in the inpatient setting," the authors said.
Although HIT adoption rates are pretty low, Jha is
worried that the economic recession could make things worse, at least
in the short term. This hasn’t been a good year for hospitals
make capital investments, he says, so it’s doubtful that much
change will occur in 2009. Nevertheless, he and his co-authors say that
since many institutions have parts of EHRs in place, policy
interventions and financial help could increase their prevalence in
hospitals over the long term.
"Modernizing healthcare systems with electronic
records is a critical piece of any health reform effort," said Dr. John
Lumpkin, senior vice president of the healthcare group at the RWJF.
"While the adopted rates are discouraging, this report helps us
understand the key barriers we need to overcome to achieve higher rates
of HIT adoption and better health and healthcare for all Americans."
The study was published in the New
England Journal of Medicine.
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