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The survey did not assess how effectively hospitals were using electronic records or whether they could share information with other offices. "Just because hospitals have these systems doesn't mean they are sharing the information with offices down the street," said Ashish Jha, a physician at Harvard Medical School and lead author on the study, at the press conference. The ability to seamlessly share patient information is one of the long-term goals of the effort to digitize health care.
The analysis covered approximately 63 percent of all acute-care general hospitals in the U.S. Researchers did not include data on federal hospitals, which would have boosted figures somewhat--the Veterans Health Administration hospitals all use comprehensive electronic records. The findings follow a similar report released by the same group in 2008, which found that only 17 percent of doctors use such systems, and only 4 percent use the fullest versions.
Hospital administrators identified cost as the major barrier to adoption--these systems can cost a hospital anywhere from $2 million to hundreds of millions of dollars. The stimulus plan attempts to overcome this barrier by allocating $17 billion in incentives to physicians and hospitals. Beginning in 2011, hospitals can earn a one-time payment of $2 million for implementing EHRs, as well as extra Medicare funds. Physicians will be eligible to collect as much as $44,000 over five years in the form of extra Medicare payments.
Researchers say the second major hurdle is interoperability. Many hospitals have implemented individual systems--in radiology departments, for example--that don't work with other systems. "Those pieces become difficult to overcome," said Blumenthal. "That's one of the reasons hospitals have been slow [to adopt electronic records]."
The stimulus legislation also attempts to deal with this issue. One of Blumenthal's duties as the national coordinator will be to convene a committee on health information standards, though he declined to specify details at the press conference. "There are many ways to do that technically, but I'm not prepared to specify a particular approach at this point," he said.
Amid a growing emphasis on electronic health records, one patient tests online health services.
Open programs to third-party developers, say two tech-savvy physicians.
I agree standards are key - as a former hospital CIO I know - how many different ways are there to write in a patient's chart "high blood pressure" - I can think of 4 in a matter of seconds. Imagine the internet with without HTTP or WWW as "standards".
The truth is that it is not just standards but a major cultural change akin to changing GM from a car/tuck company to a nanotech company. The issue is multifaceted not just standards, but dollars, outsource vs in-house, open source vs proprietary, etc. Look the the Department of Veterans' Affairs and their EMR system called VISTA about 10 years old and extremely well received and has driven massive costs out of their system across the country in over 180 hospitals and clinics. Last info I remember was that as of about 2006 they had a cost increase of less than 6% (total)over 10 years and the majority of the savings was due to the EMR system.
And this does not even touch the homeland security perspective issue for a public health event. Look to Katrina and Tulane Medical center losing millions of hours of research while the VA hospitals in the area that got flooded lost nothing due to the Vista EMR and backup systems.
Bottom line without federal intervention to force standards and use of EMR interoperable systems we will continue along this backward way of practicing medicine while costs continue to rise.
This study is fatally flawed. It used a definition of electronic record as a complete and fully integrated/connected record that only a few harvard-affiliated and other major medical centers could lay claim to. It is analogous to saying no one uses interstate highways because every home's driveway doesn't have an easy on-ramp.
thousands of smaller hospitals/office practices have a functional (for their purposes) electronic record, and they have capability to share it with other providers (at their discretion). Even within the model VA Health System not all providers are able to see all patients records across every (VISN) network.
Further, the true electronic record innovators mostly work "offline" from the fully-integrated record so their enhanced systems and prototypes likewise would not show up as "adopted" within this study.
Next time, ask for the "degree" or "percent" of information captured in the EHR if you want the true measure.
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DeltaDude
2 Comments
Hospital Electronic Wastland
I don't see how you can even start such a project without worldwide agreement on file formats. Getting world wide agreement & clearly defining data fields and what goes in them may also be a major challenge.
Just thinking about this gives me a major headache.
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