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U.S. Hospitals Gain Little From Electronic Health Records Implementation.

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Shifting the healthcare system from paper-based to electronic-based in the United States may improve healthcare harvard_11quality and reduce costs, but in a new study by Harvard School of Public Health (HSPH), entitled "A Progress Report on Electronic Health Records in U.S. Hospitals", researchers suggest that goal is far off. The implementation of basic or comprehensive electronic health records (EHR) by U.S. hospitals has been elevated modestly from 8.7% in 2008 to 11.9% in 2009, but only 2% of hospitals met the federal "meaningful use" standard required to earn government financial incentives. The researchers also found that smaller, rural, and public hospitals are lagging more behind the larger, private, and urban hospitals in adopting EHRs, this leads to further widening the gap between the two groups in obtaining the benefits of health information technology. Ashish Jha, lead author and associate professor of health policy and management, said "Getting hospitals to start using EHRs is critical. Paper-based medical records lead to hundreds of thousands of errors each year in American hospitals and probably contribute to the deaths of tens of thousands of Americans. This is not acceptable. There is overwhelming evidence that EHRs can help, yet the expense and the disruption that implementing these systems can cause has forced many hospitals to move slowly."


EHR adoption and the "meaningful use".


The researchers relies on a survey conducted by the American Hospital Association, which asked 4,493 acute-care non-federal hospitals about their health information technology efforts as of March 1, 2009; 3,101 (69%) responded. A representative from each hospital answered questions about the presence or absence of 32 clinical functions of an EHR and how widely they had been implemented throughout the hospital. Responses were statistically adjusted to balance for hospitals that did not participate in the survey. They found that the rate of implementation of basic or comprehensive EHR systems in the hospitals elevated by 3.2% between 2008 and 2009. Depending on the measures examined by the authors, only approximately 2% of U.S. hospitals demonstrated EHRs that would allow them to achieve the criteria in the American Recovery and Reinvestment Act for "meaningful use," which doctors and hospitals must meet by 2012 in order to obtain financial incentives through Medicare and Medicaid reimbursements. These meaningful use guidelines include 14 core functions, such as prescribing electronically and keeping an active medication list for patients.

Taking into consideration the state of the economy at the time the survey was conducted, Jha is not surprised that adoption rates for EHR systems, which can cost up to tens of millions of dollars to buy and install, remain low. He highlighted that the government's financial incentives may go initially to larger, academic hospitals, thus contributes to further widening an already large digital divide. Jha said "The problem is that the bonuses that hospitals get for meeting meaningful use are front-loaded, meaning hospitals have to implement and use EHRs by 2012 in order to get the bulk of the incentives," he added "this is an aggressive timeline, and many hospitals may not make it. If they miss out, it may be years before many of these hospitals will be able to afford to purchase and install their own EHR systems." Other co-authors on the study include Catherine M. DesRoches, survey scientist and assistant professor of medicine at the Mongan Institute for Health Policy, Partners Healthcare; Peter D. Kralovec, senior director of the Health Forum; Maulik S. Joshi, president of the Health Research & Educational Trust and senior vice president for research with the American Hospital Association. The survey was support by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services as well as the Robert Wood Johnson Foundation.


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