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Few Hospitals Embracing Electronic Health Record Systems
Date:3/25/2009

Researchers say cost, doctors' reluctance to change are main barriers to adoption ,,

WEDNESDAY, March 25 (HealthDay News) -- Only a small number of hospitals in the United States have comprehensive electronic health record systems currently in place, a new study finds.

The biggest obstacle to adopting such systems are costs, which can run as high as $20 million to $100 million, plus the reluctance of doctors to change their ways, experts say.

"President Obama, members of Congress and other policymakers have been pushing the notion that we need to have electronic records in hospitals and doctor's offices to make our health-care system work better," said lead researcher Dr. Ashish K. Jha, an associate professor at the Harvard School of Public Health.

But few hospitals have adopted these systems, Jha noted. "Achieving the vision of having electronic health care records deployed widely across the health-care system, we have a very long way to go," he said.

The report is published in the March 25 online edition of the New England Journal of Medicine.

For the study, researchers questioned 3,049 U.S. hospitals about their electronic health record systems. They found that only 1.5 percent of these centers had comprehensive systems. A comprehensive system was defined as hospital-wide clinical documentation of cases, test results, prescription and test ordering, plus support for decision-making that included treatment guidelines.

Almost 8 percent of hospitals have an electronic records system that includes physician and nursing notes, but these systems do not have decision support. Some 10.9 percent have a basic system that does not include physician and nursing notes, and can only be used in one area of the hospital. When looking at computerized prescribing, the researchers found that 17 percent of the hospitals had this capacity, the researchers found.

The staggering cost of these systems has been a deterrent: The researchers noted that many hospitals don't have the resources to pay for them and there is no way to recoup the investment. "Hospitals don't get any more money for implementing these systems," Jha noted.

The researchers did not include federal hospitals in their analysis, since the Veterans Affairs hospitals have already implemented comprehensive electronic health record systems.

Jha noted that the recently passed stimulus bill includes $19 billion for promoting electronic medical records. "I think that's a great start, but given how low adoption rates are, it's just a start. It will help some hospitals get over the hump, but for many institutions, if the government really wants to help create incentives it's going to have to put a lot more resources into this area," he said.

The federal government can also base payments on improved quality of care rather than quantity of care, Jha said. Contrary to common belief, electronic health care record systems may not save money. "The jury is still out on that -- it might. There is very convincing evidence that this technology is going to make care safer, it's going to make care better," he said.

Money is only one issue slowing down the adoption of these electronic systems. Physician resistance and the lack of universal standards are also reasons cited by hospitals for not instituting these systems, Jha said.

Getting all hospitals to adopt electronic medical record systems will not happen overnight, Jha reasoned. "Even in the best-case scenario, it's going to take five to 10 years," he said.

Dr. David Blumenthal, director of the Institute for Health Policy and a physician at Massachusetts General Hospital/Partners HealthCare System, Boston, said during an afternoon teleconference Tuesday that the government is trying to soften the financial blow of adopting systems.

"The Congress and the administration showed enormous foresight and commitment to the goal of increasing adoption rates through the provisions of the stimulus bill," Blumenthal said. "The Congress wants to see results for the American people in terms of health and health care, not just in terms of technology adoption."

Blumenthal served as an advisor to the Obama campaign; in mid-April Blumenthal takes up his new job in the U.S. Department of Health and Human Services as the National Coordinator for Health Information Technology.

But two other researchers believe there's a long way to go in lowering the cost of implementing electronic medical record systems while also making them more flexible.

Current electronic record systems are monolithic, and they either fit the practice well ort hey don't, said Dr. Isaac S. Kohane, a professor of pediatrics and medicine at Harvard Medical School, co-director of the school's Center for Biomedical Informatics, and co-author of an accompanying journal article. If the system doesn't fit, "you are engaged in a costly customization process," he said.

Kohane and his co-author Dr. Kenneth Mandl, an associate professor at Harvard-MIT Division of Health Sciences and Technology, contend that using a platform of modular programs that can be made available through the federal government would allow hospitals to pick and choose the applications that best suit them, much like people now select the options they want from Google, Facebook and other Web sites.

"What we have is an opportunity to take a rational approach to what the characteristics are of a national system that would allow a standardized method of substitutable applications to access a core set of data to drive improvements in health care," Mandl said.

In addition, these applications should be less expensive than current systems, Kohane said.

More information

For more information on electronic medical records, visit the U.S. Centers for Disease Control and Prevention.



SOURCES: Ashish K. Jha, M.D., M.P.H., associate professor, Harvard School of Public Health and Harvard Medical School, Boston; Isaac S. Kohane, M.D., Ph.D., professor, pediatrics and medicine, Harvard Medical School, and co-director, HMS Center for Biomedical Informatics, Boston; Kenneth Mandl, M.D., M.P.H., associate professor, Harvard-MIT Division of Health Sciences and Technology, Boston; March 24, 2009, teleconference with: David Blumenthal, M.D., M.P.P., director, Institute for Health Policy and physician, The Massachusetts General Hospital/Partners HealthCare System, Boston; March 25, 2009, New England Journal of Medicine, online


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