Less than 2 percent of hospitals surveyed across the United States actually use comprehensive electronic health records, suggesting the country is further behind in employing information technology to improve care than previously thought. In the study of nearly 3,000 hospitals, Harvard School of Public Health researchers and others found about 8 percent use a basic electronic health record in at least one care unit that includes physician or nurse notes. But that’s still far less than countries like the United Kingdom or the Netherlands, where healthcare information technology is more widespread.

 

The study’s lead author Ashish Jha, an associate professor at the school, says Health Information Technology adoption levels are abysmally low in American hospitals. “We have a long way to go to achieve a health care system that is fully electronic,” he says.

 

The economic stimulus package that President Barack Obama signed into law in February includes nearly $20 billion to advance the implementation of electronic medical records. “We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year,” Obama said. Jha says Uncle Sam’s money is a great start, but is only a down payment. The move to wire all of America’s hospitals, doctors, insurers, pharmacies, and other players will not be cheap, costing as much as $276 billion to roll out over 10 years, according to a January 2005 study in Health Affairs. “This is a big mountain to climb,” Jha adds.

 

The Harvard study, which appeared in the New England Journal of Medicine, is based on data collected in 2008. Among the findings: larger, urban teaching institutions are somewhat more likely to have electronic health records than other hospitals. That’s in part because they may have more financial resources at their disposal. The main reasons given by hospitals for not having gone digital in their records? Inadequate capital and high maintenance costs.

 

Electronic medical records proponents say broad adoption would reduce medical errors, improve patient care, and save billions by eliminative duplicative tests and other inefficiencies. The recent survey follows another released last year in the same journal that showed only 17 percent of doctors nationally are using some form of electronic medical records and that only 4 percent use full electronic health records. “Despite the promise that [healthcare information technology] holds for better health, the accumulating evidence shows that many of those who deliver care have yet to be convinced,” says the study’s senior author David Blumenthal, director of the Institute for Health Policy. “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.”

Among the other findings in the study, computerized physician orders for medications were widely available in 16 percent of U.S. hospitals and more than three-quarters of hospitals reported adoption of electronic laboratory and radiology results reporting systems.

 

For electronic medical records to become mainstream, supporters will have to address the cost barrier. These systems can run between $20 million and $100 million, depending on the size of the hospital and the complexity of the system, according to the study. And here’s a problem: many of the savings resulting from electronic medical records may not actually benefit the hospital that invests in the system. Indeed, they could potentially even lose money in terms of lower reimbursement for insurance companies when they become more efficient.  

The other challenge will involve making the different systems talk to each other, as the electronic medical records market is very fragmented, with different standards and different vendors. The lack of interoperability “reduces the potential value of these systems and may have a dampening effect on adoption,” says the study.

The study calls on the U.S. government to take steps to address these problems, including rewarding hospitals for using healthcare IT. The study also suggests creating incentives for the support and training of more IT support staff, harmonizing interoperability standards, and creating disincentives for not using healthcare IT. The study says the Veterans Health Administration went electronic more than a decade ago and has produced “dramatic improvements” in healthcare quality.

 

The government-led Nationwide Health Information Network has been working on encouraging a patchwork of systems or “network of networks” that could be stitched together once standards have been agreed upon, rather than imposing one system. What’s more, the government has been doling out grants to spur doctors’ offices and other providers to switch from paper-based records systems to paperless ones. But doing this on a national scale won’t be easy.

“Modernizing health care systems with electronic health records is a critical piece of any health reform effort,” says John Lumpkin, senior vice president of the Health Care Group at the Robert Wood Johnson Foundation. “While the adopted rates are discouraging, this report helps us understand the key barriers we need to overcome to achieve higher rates of [healthcare information technology] adoption and better health and health care for all Americans.”