US hospital use of electronic health records abysmally low, says new study

March 25, 2009

(Boston MA) - Contrary to conventional wisdom, only a tiny fraction of U.S. hospitals have full health information technology (HIT) systems in place to improve how they deliver care, says a new study published in the March 26 on-line edition of the New England Journal of Medicine. A survey of nearly 3,000 hospitals shows that less than 2 percent use comprehensive electronic health records (EHRs), and about 8 percent use a basic EHR in at least one care unit that includes physician or nurse notes. The findings are the first reliable estimates of the prevalence of HIT adoption in U.S. hospitals, and come amid concerted efforts by Congress and the Obama Administration to stimulate wider use of EHRs in the health care sector.

"HIT adoption levels are abysmally low in American hospitals. We have a long way to go to achieve a health care system that is fully electronic," says lead author Ashish Jha, MD, an Associate Professor at the Harvard School of Public Health. "The $19 billion in federal help is a great start but it is only a down payment. This is a big mountain to climb," he adds.

The study, which is based on data collected in 2008, shows that larger, urban teaching institutions are somewhat more likely to have EHRs than other hospitals, partly because they may have more financial resources at their disposal. Inadequate capital and high maintenance costs were the major barriers cited among non-adopters.

Jha conducted the study with researchers at the Institute for Health Policy and the Biostatistics Center at Massachusetts General Hospital, The Brigham and Women's Hospital, the VA Boston Healthcare System, and the Department of Health Policy at George Washington University. The study was funded by The Robert Wood Johnson Foundation (RWJF) and the federal government's Office of the National Coordinator for Health Information Technology.

The survey follows one released in 2008 by the same group of authors that showed that only 17 percent of doctors are using EHRs, and only 4 percent use full EHRs. "Despite the promise that HIT holds for better health, the accumulating evidence shows that many of those who deliver care have yet to be convinced," says David Blumenthal, MD, director of the Institute for Health Policy and senior author of this study. "This survey continues to make the case for why the federal government needs to step in and exercise its fiscal and policy muscle to spur adoption," adds Blumenthal.

Other highlights of what the study found:Barriers To Be Removed

The largest barrier to HIT adoption among hospitals still remains the cost. HIT systems are expensive and can cost between $20 million and $100 million, depending on the size of the hospital and the complexity of the system. To make matters worse, many of the financial benefits of HIT systems may not accrue to the hospital that makes the investment. If hospitals become more efficient, they could potentially even lose money in terms of lower reimbursement for insurance companies. This makes the business case for HIT far more difficult.

Another hurdle to overcome is interoperability - or allowing for easy exchange of patient care information between hospitals or from hospitals to physicians' offices. Right now, the market is very fragmented with different standards and different vendors. The lack of ease with which information can be shared "reduces the potential value of these systems and may have a dampening effect on adoption," says the study. Until there is more clarity in the marketplace and until these systems become far more interoperable, many hospitals will resist adopting EHRs, the authors warn.

What Can the Government Do?

The government can take steps to address this problem. Rewarding hospitals - especially those with the least access to capital - for using HIT can help stimulate the diffusion of EHRs. Other approaches that could help: creating incentives for the support and training of more IT support staff, harmonizing interoperability standards, and creating disincentives for not using HIT.

The Veterans Health Administration has had EHRs in place for more than a decade and has produced dramatic improvements in health care quality. The United Kingdom and the Netherlands also have successfully spurred HIT adoption, though, like in the United States, most of their progress has been in ambulatory care. "Few countries have yet to make substantial progress in the inpatient setting," the authors say.

Although HIT adoption rates are pretty low, Jha is worried that the economic recession could make things worse, at least in the short term. This hasn't been a good year for hospitals to make capital investments, he says, so it's doubtful that much change will occur in 2009. Nevertheless, he and his co-authors say that since many institutions have parts of EHRs in place, policy interventions and financial help could increase their prevalence in hospitals over the long term.

"Modernizing health care systems with electronic health records is a critical piece of any health reform effort," adds John Lumpkin, MD, senior vice president of the Health Care Group at the Robert Wood Johnson Foundation. "While the adopted rates are discouraging, this report helps us understand the key barriers we need to overcome to achieve higher rates of HIT adoption and better health and health care for all Americans."
For copies of the study, "The Use of Electronic Health Records in U.S. Hospitals," to appear in the March 26, 2009, on-line edition of the New England Journal of Medicine, please contact Staci Gorden at Burness Communications, at 301-652-1558 or contact NEJM Media Relations at Reporters with media subscriptions to NEJM can access the article at Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. By helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in our lifetime.

The Institute for Health Policy (IHP) at Massachusetts General Hospital (MGH) and Partners Health System is dedicated to conducting world-class research on the central health care issues of our time. The mission of the IHP is to improve the health and health care of the American people through conducting health policy and health services research, translating new healthcare knowledge into practice, informing and influencing public policy, and training scholars and practitioners of health policy.


Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to