The Electronic Health Record Utilization Baseline

The Robert Wood Johnson Foundation, working with researchers from the GWU University Medical Center and the Massachusetts General Hospital, released a report today that the U.S. Department of Health and Human Services commissioned to establish a baseline for judging the Nation's progress toward achieving the President's goal of widespread electronic health record (EHR) use by 2014. The report is sobering.

While 25% of doctors use EHRs to improve patient care, but only "5 percent of hospitals used computerized physician order entry." Moreover, "less than one in 10 are using what experts define as a "fully operational" system that collects patient information, displays test results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions."

The Foudation spotlights the following findings from the report:

• Hospital adoption trends are unknown. Assertions to the contrary, there are not enough high-quality, reliable surveys of hospital use of EHRs. The research team reliably estimates, however, that about 5 percent of America's 6,000 hospitals have adopted computerized physician order entry (CPOE) systems, a component of EHRs, to help reduce medical errors and ease care delivery.
• There is no evidence yet of a digital divide. There remains "considerable uncertainty" about the existence and size of gaps in use of EHRs among physicians who care for vulnerable populations. Tracking the adoption and use of EHRs among these providers, understanding unique barriers to adoption, and identifying policies to close this gap are important steps. The study did find that patient characteristics matter, however. Physicians who treat fewer Medicaid patients are more likely to report using EHRs than those with a larger share of practice revenue from the insurance program.
• A better definition of EHRs is essential. There really is no standard definition of what an EHR is and what adoption means. Consequently, a lot is left to interpretation when surveys are conducted. The report says that the U.S. could more adequately measure EHR adoption trends over time if there was a consistency in terminology and survey methods related to adoption practices.
• Adoption depends on many factors. The report points to four key things that drive adoption: financial incentives and barriers, laws and regulations, the state of the technology and organizational influences such as the size of a practice or hospital or payer mix; and how integrated a health care system is.

There's a lot of work still to be done.