HHS Secretary Mike Leavitts health information technology advisory panel, the American Health Information Community, met for the last time Wednesday.
There was a lot of time spent during the meeting reviewing accomplishments since Leavitt founded AHIC in 2005. And there were more than a few expressions of thanks to Leavitt for his leadership and vision in promoting healthcare IT.
But two Boston-area researchers also showed up to present the results of their latest survey of the adoption and use of electronic health-record systems in U.S. hospitals. And their results plopped a giant fly in the champagne of the AHIC farewell party and tempered the self-congratulations.
Physician Ashish Jha, assistant professor of health policy and management at the Harvard School of Public Health, and Catherine DesRoches, a survey scientist at the Institute for Health Policy at Massachusetts General Hospital, Boston, presented the results of a survey of 3,037 acute-care, nonfederal hospitals conducted between February and September 2008. The survey was conducted in conjunction with the annual American Hospital Association survey of its members, and was conducted by mail with electronic and telephone follow-ups. The researchers said they had a response rate of 63%.
Here are the key numbers:
- Just 1.7% of hospitals surveyed had fully implemented across all units of their hospitals a comprehensive EHR that had all 24 key functions as selected by a panel of IT experts.
- Only 7.9% had a basic EHR with nine of the 24 functions.
- And 12% had an even more basic EHR with seven of 24 functions.
In the hospital survey, the EHR functions were divided into four categories clinical documentation, computerized physician order entry, decision support and results-viewing.
The seven electronic clinical documentation functions were: advance directives, discharge summaries, medication lists, nursing assessments, patient demographics, physician notes and problem lists.
The five CPOE functions listed were for consultations, laboratory reports, medications, nursing orders and radiology.
The six decision-support functions were: clinical guidelines and reminders, drug alerts for allergies, dosing support, laboratory interactions and other drugs.
The six results-viewing functions were: laboratory and radiology reports, radiology and diagnostic images, diagnostic test results and consulting physician reports.
I think we have a good start, Jha said, since most hospitals were at least on the IT path. Jha said the survey found relatively high, full-implementation rates for one or two EHR functions, such as patient demographics, 78%, radiology reports, 77%, and laboratory reports, 76%. But full implementation rates for individual CPOE functions were relatively low, with laboratory test ordering at 22% of hospitals surveyed and medication orders at 18%.
Still, Jha said, by their definition, most hospitals in the U.S. do not have an EHR. Most hospitals are in that early stage of one, two or three functionalities.
Jha noted in an aside that the percentage of U.S. hospitals with fully implemented EHR systems would double if the Veterans Health Administration at the Veterans Affairs Department were included, because virtually all of the VA hospitals have a comprehensive EHR under the survey standards.
A survey by the same group released in June of ambulatory EHR adoption found that only 4% of physicians in ambulatory care have a fully functional EHR available. The researchers, working under a $3.3 million HHS contract, graded on a curve in that survey report, as they did in the hospital survey. They reported that 17% of physicians were using some form of EHR with lesser functionality.
In many earlier surveys, EHR penetration rates have varied widelyand often were much higherbecause of a lack of methodological rigor and permissive definitions of what constitutes an EHR. The Boston surveyors took pains to avoid those flaws, according to DesRoches.
One of the things we were charged with was coming up with a functionality based definition of an electronic health record, DesRoches said. Clearly, our number, based on functionality, is going to be a lot lower. We saw that in our numbers on physician EHRs as well.
AHIC co-Chairman Robert Kolodner, head of the Office of the National Coordinator for Health Information Technology at HHS, which funded the EHR adoption surveys, asked if the researchers had any way of knowing how many doctors actually used the system. Before coming to HHS in 2006, Kolodner, a physician informaticist, spent more than 20 years at the VA, most of that time working in its clinical IT program and developing its VistA EHR system.
Kolodner said physician usage was a key to success.
The experience that we had in VA may or may not be generalizable, but the main change was when the front line clinicians had their hands on the keyboard, Kolodner said. Are they touching the data? Are they getting the data directly? It is only when physicians get to the point of entering the data into the system themselvesand not a ward clerk or nursethat adoption has been achieved, he said. It may not be something you can get on the survey, he said, but perhaps the information could be obtained by doing follow-up focus groups or phone surveys.
Jha said the survey questions on CPOE were specific in that they asked whether clinicians were actually doing the entering.
Leavitt said the researchers had made a great contribution, but seemed clearly irked that the presentation seemed to emphasize low numbers, saying the presentation belies the major progress that has been made.
There will be a temptation to write the headline that says 15% of hospitals have EHRs, Leavitt said. But you would be just as correct to say that 85% are on the pathway to medical records. He asked the researchers to present the information that way.
We need to figure out what the bigger number is, Leavitt said. People need to know that theyre on the northbound train. They need to know that theyre on the right track. It would be helpful to our overall communication effort to have the bigger number. What you are defining is the pathway.
AHIC Successor, a private corporation that aims to take over some of the functions of its government predecessor, meets today. Part of the meeting will be open to the public and part will be closed, according to John Tooker, executive vice president and chief executive officer of the American College of Physicians and one of three original incorporators of AHIC Successor.
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