Doctors Slow to Embrace Electronic Health Record Technology, Study Says
Financial and technical barriers -- and ignorance of the technology’s benefits -- are preventing all but the earliest adopters from using electronic health records (EHRs), according to a study sponsored by the Robert Wood Johnson Foundation. If doctors and patients don’t embrace this technology more fervently, the nation may miss President Bush’s 2014 target for total EHR adoption, the study’s authors said Wed.
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EHR adoption in the U.S. is about 3% a year, which would put the figure at about 50-60% in 2014, said David Blumenthal, dir. of the Institute for Health Policy, Mass. General Hospital. Down the line adoption may reach a “tipping point,” when EHR use becomes so common that even stragglers opt in. But even if that happens, a comprehensive large, national health record database “is not technically feasible,” Lumpkin said: Instead, the national system will probably pull together state and local networks. Eventually, the data could be anonymized and searchable by researchers to track health care and disease trends, he said.
Many doctors and health care providers don’t understand the many benefits offered by EHRs, authors said. Their use can “reduce errors” and strengthen doctor-patient relationships, said Myrl Weinberg, pres.-National Health Council. A technology that tells a doctor a patient’s entire medical history is particularly important for patients who can’t communicate, Weinberg said: “It helps doctors manage the patient, not the disease.” Blumenthal expressed complete confidence in EHR technology: “If it were a drug, it would be approved.”
EHRs synthesize patient information into a manageable online database, so doctors get “the right information to make the right decision at the right time,” said John Lumpkin, foundation senior vp: “The quality of health care in this country is poor and [we need] to improve the system that delivers the care.”
The fear of patient data leaks prevents many health care providers from using the technology. Confidentiality “is a concern, but it’s been allayed,” said National Health Council Pres. Myrl Weinberg: “We believe the technology is there; we are not ahead of the game.” Patients should worry far more about someone donning a lab coat and sneaking into a hospital file room than the integrity of their personal data in an EHR system, said Harvard School of Public Health Prof. Ashish Jha.
Doctors and health care administrators object to the disruption to patient care that digitizing patient records causes, the study said. “When you're implementing [EHR], getting there is not easy,” Jha said. “It’s not like a pill; it’s a complex technology,” Blumenthal said. It’s also expensive at the front-end, Jha noted.
Few EHR adoption data exist, but trends have emerged, the study said. Doctors in metropolitan areas are more likely to use the technology than rural counterparts. Doctors who serve larger numbers of Medicaid patients are 1/2 as likely as others to use EHRs: “Groups that traditionally lag behind will lag behind here,” Blumenthal said. Physicians in solo practice or with just one partner are less likely to use EHRs, and about 1/2 of U.S. doctors fall into those categories, he said. There’s “no good national estimate” of how many U.S. hospitals have adopted EHR, Jha said.
About 1 in 4 doctors use EHRs in treating patients, but fewer than 1 in 10 use “fully operational” systems, said the study, written by researchers from Mass. General Hospital and George Washington U. Hospital. To be considered “fully operational,” an EHR system must be able to collect patient health information and data, manage results, manage prescriptions and lab test orders and support physician decisions, the study said.
Those using EHR have had success, the study’s authors said. Cincinnati and Indianapolis are front runners and the Dept. of Veterans Affairs (VA) has emerged as a major leader. The VA’s VistA EHR system won Harvard U.’s “Innovation in American Govt. Award” in July. Physicians were able to instantly access health records for the 40,000 veterans displaced by Hurricane Katrina though the VA Medical Center in Gulfport, Miss. was destroyed and the New Orleans VA Medical Center evacuated.
Most doctors and hospitals haven’t caught on yet, but health IT companies are betting they will. In July, Microsoft launched Azyxxi, a software program that collects and displays patient data (WID July 27 p6). IBM and Geisinger Health System will collaborate to design and launch a Clinical Decision Intelligence System (CDIS), the companies said Tues. The CDIS will act as a platform for clinical, financial, operational and other medical data.