Hospitals Not Even Close on Move to EHRs
BOSTON, March 25 -- Few U.S. hospitals have installed a comprehensive electronic health record system (EHR), but the obstacles to broader uptake may be primarily financial, a new study found.
Some of the barriers could be swept away with the $20 billion earmarked in the federal economic stimulus package for health information technology -- and, as it happens, the study's senior author is now in charge of deciding how to spend it.
In an early online release by the New England Journal of Medicine, David Blumenthal, M.D., M.P.P., of Massachusetts General Hospital, and colleagues reported that only 1.5% of 2,952 hospitals surveyed had a comprehensive EHR system, and just 17% had the less-sophisticated computerized order-entry systems for prescribing medications.
Dr. Blumenthal was named last week by President Barack Obama to serve as coordinator of health information technology in the Department of Health and Human Services.
The appointment puts him in charge of allocating the health IT stimulus money, as well as developing national technology standards for the president's ambitious long-term effort to encourage widespread adoption of electronic record-keeping in the nation's healthcare system. (See: Obama Names Harvard 'Wired Doc' to Lead EHR Push)
The researchers found that lack of standards and interoperability were also an important reason hospitals were not jumping on the EHR bandwagon.
The survey was distributed in 2008 to more than 4,000 acute-care general hospitals, with a response rate of 63%.
Directed to chief information officers or the equivalent, the survey asked about electronic systems they had in place as well as factors that discouraged or encouraged their adoption.
To be classed as "comprehensive," systems had to have 24 separate functions in four broad categories: clinical documentation, test and imaging results, computerized order entry, and decision support.
The functions ranged from physician notes and nurses' assessments to clinical reminders and drug-allergy alerts.
Moreover, the system had to be deployed in all of a facility's clinical units to be considered comprehensive.
Systems with 10 of the functions -- mostly in the documentation and test and imaging results categories -- were classified as "basic."
Only 7.6% of responding hospitals (95% CI 6.8% to 8.1%) had systems meeting the "basic" criteria in at least one clinical unit.
The survey showed that, among hospitals that did not have qualifying systems, more than 70% cited the capital expense as a barrier to adoption.
Some 30% said the return on investment was unclear, 45% pointed to maintenance costs, about 30% did not have adequate information-technology staff, and about 35% worried about physician resistance.
At the same time, 85% of respondents said additional reimbursement for electronic-records usage had been or would be an incentive to adoption.
"There is broad support and a consensus that we have to have electronic health records," said the study's lead author, Ashish Jha, M.D., M.P.H., of Harvard School of Public Health, in an interview.
"Not because they are going to be a panacea for curing our healthcare system," he said, "but really because they have to be part of a broader solution to make our healthcare system higher quality, more efficient, and lower cost."
"Our study points to the fact that we have a very long way to go in achieving the kind of electronic record adoption that we really need to transform the healthcare system," Dr. Jha said.
The researchers also pointed to the fact that existing systems, in general, have limited capability to "talk" to systems run by community physicians, insurers, and others with whom hospitals trade patient information.
"Low levels of health information exchange in the marketplace reduce the potential value of these systems and may have a dampening effect on adoption," the researchers wrote.
In a separate Perspective article also published online by the NEJM, Dr. Blumenthal -- wearing his new hat as national health technology coordinator -- acknowledged that current EHR systems are, for the most part, inadequate to such an ambitious task.
He said the current system for certifying systems as meeting basic needs is also too loose.
"Many certified electronic health record [systems] are neither user-friendly nor designed to meet [the] ambitious goal of improving quality and efficiency in the healthcare system," he wrote.
"Tightening the certification process is a critical early challenge" in his new job, he said.
Dr. Blumenthal said the legislation tying Medicare and Medicaid payments to "meaningful use" of electronic systems was an important tool to encourage adoption.
But he also noted the danger that, if the bar is set too high, physicians and hospitals would likely rebel in ways that would ultimately defeat the government's plan.
"Realizing the full potential of health information technology depends in no small measure on changing the healthcare system's overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide," he wrote.
"Only then will they be motivated to take full advantage of the power of electronic health records."
| The survey was funded by the Robert Wood Johnson Foundation and the Office of the National Coordinator for Health Information Technology.
Study authors other than Dr. Blumenthal reported relationships with UpToDate and GE Corporate Healthcare.
Dr. Blumenthal reported relationships with GE Corporate Healthcare, the Macy Foundation, the Office of the National Coordinator for Health Information Technology (predating his appointment as national coordinator), the POJP Service Corporation, and the presidential campaign of Barack Obama. |
Primary source: New England Journal of Medicine
Source reference:
Jha A, et al "Use of electronic health records in U.S. hospitals" N Eng J of Medi, 2009; DOI: 10.1056/NEJMsa0900592.
Additional source: New England Journal of Medicine
Source reference:
Blumenthal D, "Stimulating the adoption of health information technology" N Eng J Med 2009; DOI: 10.1056/NEJMp0901592.
John Gever
Senior Editor
John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University. Now based in Pittsburgh, he is the daily assignment editor for MedPage Today as well as general factotum on the reporting side. Go Pirates/Penguins/Steelers!
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