By John Reichard, CQ HealthBeat Editor
October 11, 2006 -- Only about 9 percent of doctors use comprehensive electronic health record systems, according to a public–private study commissioned to establish a benchmark to measure U.S. progress toward adoption of the technology.
The findings show that "we are pitifully behind where we should be," study co-author Dr. David Blumenthal told a press briefing Wednesday. Blumenthal said current rates of adoption would mean that about half of doctors would have use of electronic health record systems, or EHRs, by 2014—below President Bush's goal for dissemination, "but you might argue 'not bad' based on geologic time."
Billed by its sponsors as the most rigorous analysis yet of the extent to which the nation has adopted health information technology, the study should help spur policies that "close important gaps and disparities" in IT adoption, said Dr. John Lumpkin, a senior vice president at the Robert Wood Johnson Foundation, which funded the study along with the federal government.
Conducted by researchers at Boston's Massachusetts General Hospital and George Washington University, the study also found that no reliable data exist on the percentage of hospitals that have adopted EHRs. However, it found that about 5 percent of hospitals have installed computerized physician order entry (CPOE) systems used by doctors in hospitals to order drugs from hospital pharmacies. Boosters of the systems say they can sharply reduce medication errors, in turn saving lives and preventing costly adverse reactions.
CPOE is only one component of a hospital-based EHR system. Members of a panel convened to assess the findings expressed uncertainty at the briefing about how soon the pace of IT adoption might accelerate. Allowing hospital and insurer donations of the technology to doctors could help, but would only be a partial answer, they said. Some form of grant program will be needed, as will efforts to prod patients to press their doctors to use the technology, panelists said.
"To be very honest, [the low adoption rate] doesn't surprise us," said Dr. Karen M. Bell, director of the office of Health IT Adoption in the Office of the National Coordinator for Health Information Technology. "We know that there has been an issue with the adoption of electronic health records for some time and that the adoption gap is very prevalent as well," she added.
Bell indicated that without action on issues such as reimbursement to promote health IT adoption, the ease of technology use and its compatibility with other IT systems, "we really are not going to be able to move the adoption agenda forward in time to meet the president's hope" that adoption of electronic health records will be widespread by 2014.
The study found that overall, 23.9 percent of physicians providing care to non-hospitalized patients use electronic health records in some form. But only about one of 10 are using "fully operational" electronic health record systems that collect patient information, display test results, allow providers to enter medical orders and prescriptions, and help doctors make treatment decisions, the study said.
To better measure progress toward health IT adoption, the study provides standard definitions of what is meant by an "electronic health record system" and what constitutes "adoption." Simply ordering the technology or taking delivery of it isn't the same as adopting it, said Blumenthal, a physician at Mass General and a professor at Harvard Medical School.
The study added that "for policy makers to understand the effectiveness of efforts to improve EHR adoption, we will need ongoing tracking with high-quality surveys." Lumpkin said the researchers would report again a year from now on the extent to which adoption of the technology has increased.
Sponsors of the study expressed concern that Americans with limited access to care won't benefit from the higher quality, safer care that can result from use of the technology. Although they reported no evidence yet of a "digital divide," they did find that doctors who treat large numbers of Medicaid patients are half as likely to have electronic health records.
"Where you practice has a huge impact on whether you use an electronic health record or not," Blumenthal added. Doctors in cities are more likely to have EHRs than those in rural areas, as are doctors in larger practices and in larger health care facilities, he said.
Dr. Ashish K. Jha, an assistant professor of health policy at Harvard, said use of EHRs can help eliminate disparities in access to quality care based on race and economic factors. A "decision support" feature of the records that reminds doctors of treatment procedures and what to check for in the patient will help even out such differences, he said.
Patient awareness of the benefits of electronic health records could be a key factor in accelerating adoption of health IT, said Myrl Weinberg, president of the National Health Council. "That will be the most important element of the tipping point," she said. "As they become familiar with the advantages to them, they start talking with their friends," she said.
"If you get to a certain point, it might really take off," Blumenthal said. "But we just don't know where we are with respect to that tipping point," he added.
The council and America's Health Insurance Plans are in the final stages of planning a pilot program in northern California and Massachusetts to motivate grassroots activists to push for electronic records, Weinberg said. "Based on our experience with similar programs we expect to have great success," she said.
While House- and Senate-passed IT legislation could be helpful in establishing national leadership by creating the framework for a grant program and perhaps fostering IT donations, the fate of the measures in the upcoming lame-duck session of Congress is uncertain. If Democrats do well in the midterm elections, they may push to delay legislation until next year in hopes of strengthening privacy protections and beefing up any grant program.
