By Christina Orlovsky, contributor 

Oct. 14, 2009 - When it comes to implementation of health information technology (IT) and electronic health records (EHRs), the majority of primary care physicians in the United States remain far behind on the paper trail, according to a new report from the Information Technology and Innovation Foundation (ITIF), a “think tank” whose mission is to influence public policies.

The report, “Explaining International IT Application Leadership: Health IT,” reveals that only 28 percent of U.S. primary care physicians use EHRs, as compared to 99 percent of their peers in Finland and 100 percent of their Swedish counterparts. An additional Nordic country, Denmark, rounded out the top three at 95 percent. The United Kingdom, another region with high IT adoption, reports that 89 percent of primary care doctors have implemented EHRs in their practice.

In addition to EHRs, the ITIF report also looked at usage of other types of health IT, including electronic ordering of tests and prescriptions, advanced telehealth programs and portals that provide online access to health information.

Study author Daniel Castro, of the Washington, D.C.-based ITIF, points to the overall differences in the healthcare landscape between the United States and our international counterparts, both present day and historically, as the key reason for the differential.

“The big thing you notice is that we’ve only been talking about health IT in the United States since 2004,” Castro explains. “When you look around the world, you see that as early as 2001 or 2002, there were some countries that had 90 percent IT implementation before we had even started the strategy.”

Castro adds that the countries that have been determined to be health IT leaders all have one thing in common: a national strategy and dedication to technology—something we lack in the United States.

“Here, you see a lot of objections to EHRs, especially from privacy advocates, but you see that overseas it works perfectly,” he says.

“In the three countries we see as leaders—Denmark, Finland and Sweden—you see a lot of similarities, mainly that they have a national strategy. Countries are making IT a core part of government and since healthcare is a part of their government, health IT is an extension of that,” he continues. “Countries that are making healthcare a priority are going to do anything to improve it.” That kind of strategy often includes additional funding, as well.

An additional factor identified in the report is international patients’ understanding of the importance of EHRs in relation to their care and to the quality of their physician.

“In Denmark, for example, the patients are technologically savvy and they’ll go to a doctor and say that if that doctor wasn’t using computers or EHRs, he or she isn’t a good doctor,” Casto adds. “Plus, there’s a peer pressure and a peer leadership among physicians that you just don’t see in the United States.”

Additionally, while other countries do not differ from the United States in their value of privacy, leading adopters of health IT see it as a mode of protecting privacy. On the contrary, organizations in the United States that advocate for privacy see health IT as a threat.

“In other countries, the citizens see the benefit to privacy; if it works, people feel it’s secure,” Castro explains.

“Here, I don’t think we’re at that stage yet—I don’t think most patients understand what an EHR is,” he adds. “Plus, it’s important to recognize that the United States has much different political realities than other countries. You can’t have a government-run health record in the United States like you can in other countries.”

Finally, the report concludes that several things need to happen to help U.S. primary care physicians and the American public overcome the current barriers to health IT implementation, including interoperability, the realization among physicians of a cost benefit and mandates for adoption.

“This goes into the idea of national level leadership,” Castro says.

“These other countries have clear strategies and they set out what they want to do over the next few years,” he concludes. “The main thing we need is to have more of a mandate. Mandates give people an incentive to adopt early and push people to act.”

For more information, visit the ITIF Web site.

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