Few Hospitals Embracing Electronic Health Record Systems

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

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By Steven Reinberg
HealthDay Reporter

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."