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U.S. Hospitals Lag in Electronic Health Records Switch

The news comes amid the Obama administration and Congress’ recent push to get doctors and hospitals to switch to digital record keeping, which many advocates say will reduce medical costs and medical errors. The administration plans to make digital recordkeeping a cornerstone of its health care reform, and Congress included a $19 billion incentive program for doctors and hospitals in the recently passed stimulus bill.

But the new study, published Wednesday in the New England Journal of Medicine, shows how far most hospitals have to go.

“The data collectively show that we are at a very early stage in the adoption [of electronic health records],” said David Blumenthal, who, as the just-named national coordinator for health information technology at the Department of Health and Human Services, will oversee the distribution of the stimulus money. Blumenthal, who is currently the director of the Institute for Health Policy at Massachusetts General Hospital, was a coauthor of the new study.

The researchers surveyed more than 3,000 hospitals — about 63 percent of all acute-care hospitals in the U.S. Their first task was to develop a definition of what a “comprehensive” electronic health record system looked like.

“There was a wide range of methodologies used in the studies out there now,” said study co-author Catherine DesRoches, of Massachusetts General Hospital, in a press conference. “They’ve found estimates ranging from 5 to 59 percent of hospitals [using electronic health records]. The varying estimates make it really hard to establish a baseline.”

Using a definition arrived at by an expert panel, the researchers found that only 1.5 percent of hospitals had a comprehensive system in place — one that was used in all the hospital’s clinical units and covered 24 key areas including electronic order entry for medications and lab work and electronic patient records, among other things.

Some 7.6 percent of hospitals had at least a “basic” system — one that was in use in at least one clinical unit and covered eight of the critical functions.

The researchers also found that the hospitals generally cited the same major barriers to adopting digital records: cost, physician resistance and a lack of standards that could make different systems available now interoperable.

“By far the biggest barrier cited was cost,” said coauthor Ashish Jha, a professor of health policy at the Harvard School of Public Health, in a press conference.

Installing an electronic health record system can cost from $20 to more than $100 million, depending on the size of the hospital and the system.

Blumenthal says that the stimulus funds will begin to address that problem, and that the funding will be enough to almost completely cover the cost of adopting the systems for most physicians and even some modest-size hospitals. There will also be funding for technical support and physician training.

“The [stimulus] provisions try as directly as it’s possible to do at the federal level to address the barriers noted in our research,” he said.

The research did not include Veterans Administration hospitals, because those hospitals, which are run by the federal government, began to adopt electronic health records more than a decade ago.

Ashish Jha says that there are lessons to be learned from the VA hospitals’ experience.

“Once you get these systems in and up and running, you’re not done,” he said. “There’s a lot of upgrading, making sure it keeps up with clinical advances. This is an ongoing effort.”

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