More About Electronic Health Records (EHRs)

A few days ago (April 15, 2009), I posted an entry about EHRs.  I should have waited because that very afternoon what should appear in my mailbox but  the most recent issue of the New England Journal of Medicine with an article about U.S. hospitals and EMRs.  The article was written by A.K Jha and others and entitled “Use of electronic health records in U.S. hospitals.”  The authors all of whom are from either Boston or Washington, D.C., surveyed use of EHRs in all acute care  general medical and surgical hospitals in the U.S. that are members of the American Hospital Association (AHA).  The survey was conducted between March and September 2008 and included almost 5000 hospitals.  The investigators received responses from 3049 hospitals or about 63% of those sent surveys.  They found that only 1.5% of the hospitals had  comprehensive electronic-records systems (comprehensive meant that all of the hospital’s clinical units were using EHRs).  Another 7.6% of hospitals had  basic systems, meaning that at least one clinical unit was using EHRs.  Even a greater percentage of reporting hospitals had in place at least parts of  EHR systems such as use of EHRs for results of laboratory and radiological reports.  Surprisingly, the perceived barriers to adoption of comprehensive EHRs were similar in those hospitals that had implemented at least some EHRs and those that had not: initial costs; maintenance costs; uncertain return on investment; inadequate IT staff; and physician resistance.  By far the greatest perceived barrier was inadequate capital to purchase an EHR system.  The investigators concluded that among the hospitals that participated in the study, although few hospitals had even  basic EHR systems in place, many hospitals had parts of  systems in place and that governmental policymakers hoping to promote wider use of EHRs should focus on financial support, interoperability, and training of IT support staff.

What is the U.S. government doing to promote widespread use of EHRs?

The U.S. government has taken big steps to “push” the medical community into the use of EHRs.  If you are interested in the subject, I strongly recommend you check out 2 recent articles in the New England Journal of Medicine.  The first, written by Kenneth Mandl and Isaac Kohane was entitled “No small change for the health information economy.”  The second, written by David Blumenthal was entitled “Stimulating the adoption of health information technology.”  Both articles discuss the recent measures taken by the U.S. government to promote use of EHRs through the American Recovery and Reinvestment Act of 2009.  The Act uses both carrots and sticks by offering both rewards in the way of cash payments and punishments in the way of lower reimbursements for patient care services depending on whether institutions and medical practitioners get with it (i.e., implement or do not implement EHR systems).

I must say that I think the U.S. government has perhaps taken on too much now in terms of the rapidity with which the “required” changes must be implemented.  I am particularly concerned that we (i.e, health care administrators, physicians, the general public) don’t yet have a medical care system in the U.S. that could be reasonably considered anything close to a real system and that we haven’t really figured out exactly what we want our EHR system to be as part of the overll not yet existent health care system.  It will be very interesting to see if the “money on the table” helps to sort these things out or if we end up with a bigger mess than we have already.

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