Hospitals' Electronic Wasteland

Stimulus funds aim to change a system largely devoid of in-depth electronic record keeping.

Less than 2 percent of U.S. hospitals today use comprehensive electronic health records, according to a new survey of 3,000 hospitals that highlights just how far the health-care system has to go to meet President Obama’s goal of providing every American with access to electronic records by 2014.

Experts involved in the study, headed by David Blumenthal, Obama’s newly appointed national coordinator for health information technology, say that the $19 billion in funding for health-care information technology and other provisions outlined in the new stimulus bill will directly address the two major hurdles to adoption–the cost to implement and maintain the records, and the difficulty of exchanging information among various health-care providers’ differing computer systems.

“Those provisions try as directly as possible to address some of the barriers highlighted in the research,” said Blumenthal, a physician who currently serves as the director of the Institute for Health Policy at Massachusetts General Hospital (MGH) in Boston, at a press conference this week. He will assume his new post in April, leading an office within the Department of Health and Human Services–the Office of the National Coordinator of Health Information Technology–which was made permanent by the stimulus legislation.

According to the findings, published Wednesday in the Journal of the American Medical Association, about 8 percent of U.S. hospitals use basic EHR systems–which include patient demographics, medical complaints, medications, and some test results–in at least one department. Only about a quarter of those are using comprehensive EHR systems, including so-called decision support systems, which assist physicians and other health-care providers in making treatment decisions, for example, reminding them to prescribe pre-operative antibiotics.

“If the goal of [electronic record] adoption is to improve quality of care, then this kind of decision support can help clinicians provide the right care more often,” said Cait DesRoches, a public health expert at the Institute for Health Policy at MGH and one of the authors of the study, at the press conference.

Individual electronic functions are more common–about 16 percent of hospitals use electronic ordering systems for medications, while more than three-quarters of respondents reported using electronic systems for the results of laboratory and radiology tests.

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.

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