In a recent study published in the New England Journal of Medicine, authors reported low electronic health record (EHR) adoption rates by hospitals.
The study, commissioned by the Office of the National Coordinator for Health Information Technology - there really is a federal office for everything - reported that fewer than two percent of acute care hospitals maintain comprehensive EHR systems, while only 8-12 percent of hospitals use basic electronic record systems anywhere inside the hospital.
Surveying over 3,000 hospitals, the study corrects past assumptions that EHR adoption is substantially higher-some report as high as 59 percent (Laschober, 2005). The recalibration stems from a more concise definition of what entails a comprehensive and basic electronic health record system.
This time around, an expert panel of researchers alongside hospital administrators and the American Hospital Association (AHA) developed the definitions. The group defined a comprehensive EHR system as a system with functionalities in all clinical units (clinical documentation, imaging, computerized provider order entry, and decision support). CPOE functionality is the most cited benefit to an EHR system, enabling physicians to quickly prescribe and reduce medical error (Chaudhry, 2006). A basic electronic system was defined as one that meets functionality requirements for one or some of its clinical units.
Definitions aside, components of EHR systems seem to be in place. Forty-four percent of hospitals reported computerized physicians' notes and provider-order entry (38 percent) features. And 75 percent of hospitals reported using electronic laboratory and radiologic reporting systems.
Its all about the money...and attitudes
According to the study, the barriers to EHR adoption for hospitals are first and foremost the cost of EHRs, which include capital expenditures on purchasing the equipment, maintaining it, and training staff how to use it. But some barriers are mental, including lack of belief among hospital administrators and healthcare providers that the EHR systems will provide an adequate return on investment or can be managed by in-house staff without problems. And then of course there's the desire of physicians to continue writing illegible prescriptions.
Not surprisingly, urban academic medical systems are slightly more inclined to have comprehensive electronic systems - most likely due to their availability of resources. However, there was little difference in adoption rates among private and public hospitals, outside of the Department of Veterans Affairs, which accounted for half of all hospitals utilizing a full EHR system. Clearly the money for jumpstarting an EHR system is a universal worry.
Government Must Pony Up to Make the Play
So, what is the lesson here? Well, it seems we have a long way to go before seeing comprehensive EHR technology in hospitals. Second, hospitals need inducement by government to participate in the transition from paper to portal. Third, the government must support outcome studies that assess and critique the use of EHR technology, revealing the positive and negative.
The transition to electronic seems logical -- less paper, decision support, fewer medical errors, less redundancy, better continuity of care -- but the case for EHRs must be more thoroughly made using real data. By investing in studies such as this one, the government aids in moving the nation closer to making a better case for EHRs while also assessing the gaps where funding or policy incentives are needed. With $19 billion slated for health record technology from the Stimulus bill, studies such as this assure us that the money will go to a needed cause.
Also Interesting:
Get our Newsletter!
Click here to sign up and stay informed
