Only 1.5% of nonfederal hospitals report having full EHRs

Washington -- Adoption rates of electronic health records among the nation's hospitals are severely low, indicating that the health care industry has a long way to go before achieving EHR interoperability, a new study says.

Only 1.5% of nonfederal U.S. hospitals use a comprehensive electronic health record system, and only about 8% use a basic EHR in at least one unit that includes physician or nurse notes, according to the study. The report, which based its findings on survey responses from nearly 3,000 hospitals, appeared in the March 25 online version of the New England Journal of Medicine.

The unexpectedly low levels of EHR adoption rates in hospitals suggest that policymakers face substantial obstacles to achieving health care performance goals that depend on implementing health information technology, the study's authors said.

"A lot of hospitals had some pieces of these systems, but very few have put it all together into a system that works across the hospital and has all of the functions of a comprehensive system," said Catherine DesRoches, PhD, an assistant in health policy at the Institute for Health Policy at Massachusetts General Hospital in Boston and one of the study authors.

For example, some of the hospitals surveyed had one IT system for the radiology department and another for ordering medications, but very few had an EHR that integrated all of it, DesRoches explained.

The American Hospital Assn. has conducted similar research in the past that estimated higher EHR adoption rates among hospitals, said Rod Piechowski, AHA senior associate director of policy. "We agree that the situation is one where there is a lot of room for improvement, and this is a big project," he said. "It also complements what we learned in the past -- that cost is still a huge barrier for implementing technology."

Cost was the No. 1 factor cited by hospitals -- both EHR-equipped and not -- as the reason hospitals are holding back. But physician resistance to the technology also plays a major role.

The researchers cited evidence that physicians' resistance -- partly driven by concerns about negative effects of the use of paperless records on clinical productivity -- can be detrimental to adoption. Obtaining the support of doctors, which often can be done by first getting the backing of clinical leaders, can boost momentum, the researchers said.

The study follows another report released in 2008 by the same group, which determined that only 17% of doctors are using a basic EHR system with clinician notes, while just 4% are using comprehensive EHRs.

Some types of doctors are quicker to get on board than others. Doug Henley, MD, American Academy of Family Physicians executive vice president, estimates that nearly half of the academy's 94,000 members have an EHR system in place. Despite this demonstration of early acceptance, however, he realizes that system interoperability is a long way off.

"At present, in most circumstances, they simply represent silos of information," Dr. Henley said. "They are not connected to the rest of the world, so that connectivity needs to happen. We've got the opportunity with the stimulus money to make that happen in a more aggressive and rapid fashion."

The study's authors said the recently enacted stimulus package could speed the adoption of health information technology. It provides a net of about $20 billion in Medicare and Medicaid bonuses over 10 years to physicians, hospitals and others that have adopted certified EHRs.

Physicians with approved EHRs in place and in use before 2012 will be eligible for a maximum five-year Medicare bonus of $44,000 or a Medicaid bonus of up to $64,000. Participating acute-care hospitals will receive a base payment of $2 million and additional payments based on patient discharge numbers. The maximum hospital bonus can be more than $6 million. Medicare penalties will kick in for both doctors and hospitals that do not adopt EHRs before 2015.

In implementing the stimulus provisions, the government should look beyond putting money only into existing, closed-source, proprietary technologies, said Kenneth D. Mandl, MD, MPH, an associate professor of pediatrics, and Isaac S. Kohane, MD, PhD, a professor of pediatrics, at Children's Hospital and Harvard Medical School, both in Boston. In a separate perspective piece in the March 25 NEJM, the physicians called on the government to mirror the successes achieved by large-scale information technology platforms -- such as the Apple iPhone, which has nearly 10,000 applications that consumers can download and use, and the Facebook social networking site, which allows users to add perimeter applications to their core accounts.

The federal government could encourage development of a software platform "that will support applications for communication and computation that span the domains of clinical care, public health and research," Drs. Mandl and Kohane said.

The print version of this content appeared in the April 13, 2009 issue of American Medical News.

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