HARVARD GAZETTE ARCHIVES

With fewer than one in 10 doctors making full use of electronic health records and as few as 5 percent of hospitals using one form of them, the U.S. health care industry is way behind in adopting new systems that can improve patient care and reduce medical mistakes, according to a new report co-authored by Harvard researchers.

"We are pitifully behind where we should be. We must find ways to get more physicians to embrace this technology if we are to make major strides in improving health care quality," said study co-author David Blumenthal, the Samuel O. Thier Professor of Medicine, professor of health care policy, and director of Massachusetts General Hospital's Institute for Health Policy.

Health care institutions have long adopted computerized records for financial and administrative systems, but have been slower to adopt electronic health records for the clinical side of their operations even though those systems have the potential to reduce medication mistakes, unnecessary tests, and inappropriate care; to cut costs; and to improve patient monitoring.

President George W. Bush has called on U.S. health care institutions to adopt electronic systems for a majority of patients by 2014 as a way to make health care delivery more efficient and more effective.

The report, "Health Information Technology in the United States: The Information Base for Progress," was drafted by a team of researchers from Harvard-affiliated Massachusetts General Hospital, the Harvard School of Public Health, and George Washington University. It was sponsored by the Robert Wood Johnson Foundation and the federal government's National Coordinator for Health Information Technology. It was released at a news conference in Washington, D.C., Wednesday morning (Oct. 11).

The report, which took a year to put together, compiles the results of dozens of surveys and studies on the topic. The report details several difficulties in assessing the status of the U.S. health care system in this area, including a lack of information and no standard definition of an electronic health record.

The report's major findings are that roughly one in four doctors use electronic health records in some fashion but that fewer than one in 10 use fully operational systems that collect patient information, display test results, let providers enter prescriptions, and help doctors make treatment decisions.

The report finds that about 5 percent of hospitals use computerized physician order entry, a system that is a component of electronic health record systems, but that information is too scarce to allow a detailed picture of the electronic health record use in hospitals.

There was no evidence found of a "digital divide" between providers who care for certain disadvantaged populations and others, and no correlation between electronic health record adoption by physicians practicing in a certain county and the county's ethnic makeup or per capita income. The report did find evidence, however, that physicians who treat fewer Medicaid patients are more likely to report having electronic health records than those who treat more Medicaid patients.

Adoption of electronic health record systems is affected by many factors, the report said. Among the key items are financial barriers such as the high cost of the systems and uncertainty about the return on investment, concerns about patient privacy, concerns about systems being difficult to use or becoming obsolete, and organizational barriers such as the size of a practice or hospital, and organizational leadership.

While the upside to using these systems is large, Blumenthal said doctors may find they're less productive while adjusting to them. Still, Blumenthal said he believes we should have a goal that every physician uses these systems.

alvin_powell@harvard.edu

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