By Susan Kreimer, MS, contributor
Dec. 2, 2009 - Is health information technology turning a new leaf?
Despite some barriers, a new report says wide-scale adoption of electronic records at U.S. hospitals is "on the cusp of change."
A few functions are easier to apply than others. "Most hospitals have adopted electronic viewing of laboratory and radiology results, but the big challenge for hospitals is computerized provider order entry and clinical notes by physicians and nurses," said Ashish K. Jha, M.D., MPH, an associate professor of health policy at the Harvard School of Public Health and Harvard Medical School.
Fully implemented across all units of the hospital were electronic viewing of laboratory (77 percent) and radiology reports (78 percent) and radiology images (78 percent). Only one in five hospitals had fully implemented computerized order entry and clinical decision support, according to the report.
The lack of these functions, coupled with scarce adoption of clinical decision support, is hindering the majority of hospitals from implementation of a completely operational electronic record system. Clinical decision support alerts doctors about potential interactions between drugs or a history of allergies, which may warrant prescribing an alternative.
"In a paper-based world, physicians write their orders and there isn't immediate feedback if the medication being prescribed is harmful," said Jha, who led the research for the American Hospital Association and HIT Adoption Initiative survey that was incorporated into the report.
The annual health information technology report is a joint initiative between the Institute for Health Policy at Massachusetts General Hospital and the School of Public Health and Health Services at George Washington University. Funding comes from the Robert Wood Johnson Foundation (RWJF), the nation's largest healthcare philanthropy.
RWJF spelled out the challenges of making electronic health record (EHR) progress in its inaugural report in 2006 and in a subsequent report in 2008. Since then, health information technology has become a focal point of fostering higher quality and more efficient care in the reform debate.
The level of EHR adoption remains dismally low in practically all clinical environments. Even lower still is the adoption of records and systems that can improve and speed up measurement and public reporting.
Only 17 percent of U.S. physicians use electronic records in their practices. About 2 percent of nonfederal general acute care hospitals have a comprehensive system in place, while another 7.6 percent rely on basic EHRs, according to the 2009 RWJF report.
Teaching hospitals of 500-plus beds more commonly reported having EHRs. So did hospitals belonging to a system or those located in an urban area.
Researchers also performed a separate analysis of safety-net hospitals, which serve a high proportion of indigent patients. Because these hospitals have an even smaller EHR adoption rate for each of the functions examined, evidence of a digital divide is emerging.
Financial barriers were of particular concern to these facilities. With fewer Medicare patients, the safety-net hospitals depend on funds from state Medicaid programs. "It remains to be seen whether cash-strapped states will have the financial resources to support the incentives necessary to increase adoption among these organizations," the report indicated.
But there's reason for hope. State governments passed a total of 168 pieces of HIT-related legislation between 2005 and 2008. They can expect resources to expand EHR efforts through grants, loans and other financial assistance.
"The main take-home message here is that the federal government has put in nearly $45 billion from the stimulus bill to help doctors and hospitals adopt electronic records," Jha said. "We believe that even though adoption levels are low now, they are likely to rise quickly in the coming years."
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