A final report published last week on the adoption of electronic health records systems by hospitals mirrored the preliminary findings released in November 2008: EHR adoption in nonfederal hospitals remains woefully low even after more than four years of federal encouragement of information technology use.
Still low tech
EHR adoption rates remain low: study
Only 1.5% of nonfederal U.S. hospitals use what a Boston survey team called a comprehensive electronic health record system, according to HHS-funded researchers in a survey report released by the New England Journal of Medicine.
Just 7.6% of hospitals had a basic EHR that included the capability to record physician and nursing notes, and 10.9% had a basic system without those clinical notes functions. Researchers stripped out data from Veterans Affairs hospitals because they skewed the numbers upwards. Adding the VA data to the survey, for example, lifts the percentage of hospitals with a comprehensive EHR to 2.9%.
There is no suggestion here that 90% of hospitals dont have a computer in the hospital, said article lead author Ashish Jha, an associate professor at the Harvard School of Public Health and a staff physician at the Veterans Affairs and Brigham and Womens hospitals, Boston. Jha spoke at a news conference before the report was released.
Jha said some component parts of an EHR are in widespread use75% of hospitals surveyed have electronic lab and radiology systems. For most, though, whats lacking is a constellation of functionalities that help doctors and nurses provide the best care possible, he said, adding the relatively high levels of adoption of some components suggests we have a good place to start.
Money has also been lacking for most hospitals, according to 74% of respondents who cited inadequate capital as a barrier to EHR adoption. There is no question that something wasnt working, with the government approach to IT promotion, said William Bria, chief medical information officer for the Shriners Hospitals for Children in Tampa, Fla., and president of the Association of Medical Directors of Information Systems, a professional association of physician informaticists. When youd say, Lets do this, theyd always say, Yeah, well, wheres the money? Bria said.
Without money, Bria said, Its very simple. If you just go at things like this that require very major changes in behavior in an industry that is focused around reimbursement, youre going to get what you expect: nothing.
But the world has changed, Bria said, with passage of the American Recovery and Reinvestment Act and its estimated $19.2 billion in federal funding for healthcare IT.
David Blumenthal, recently named as President Barack Obamas choice for the national coordinator for health information technology and a co-author of the report, said at the news conference that the health IT spending in the stimulus law was conceived by the Congress as a building block, as a pillar of healthcare reform. One of the key elements is to support behavior change. IT is one important and ultimately critical way to do that.
There were 2,952 hospitals in the survey, which ran from March to September 2008 and was conducted via mail in conjunction with the American Hospital Associations annual membership survey. The IT survey had a 63% response rate and was funded by HHS and the Robert Wood Johnson Foundation.
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