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Landmark Public-Private Effort Finds One Quarter Of
Physicians Using Electronic Health Records, But Fewer Using Systems With Key Capabilities

Limited Data Suggest That One In Twenty Hospitals
Have Electronic Prescribing, Say Health Affairs Authors

Bethesda, MD -- The best available evidence suggests that about one-quarter of physicians were using an electronic health record as of 2005, but fewer than one in ten physicians were using EHRs with functionalities such as electronic prescribing, researchers say in an article published today on the Health Affairs Web site.

According to Harvard assistant professor of public health Ashish Jha and coauthors, the data on hospitals’ use of information technology are more limited, but best estimates suggest that 5-10 percent of hospitals had electronic prescribing -- or computerized physician order entry (CPOE) -- systems in 2005. However, whether hospitals had stand-alone CPOE systems or comprehensive EHR systems with a CPOE component is unknown, the researchers say.

The Health Affairs article by Jha and coauthors offers these and other key findings from the first report of the Health Information Technology Adoption Initiative (hitadoption.org), a partnership between the federal government, the Robert Wood Johnson Foundation, and several academic research institutions. The initiative’s mission is to track the adoption of EHRs by both physicians and hospitals. The Bush administration has set forth a goal of widespread EHR use by 2014, and the research by Jha’s team is meant to create a “reliable baseline” against which progress toward that goal can be measured.

“Health information technology in general and EHRs in particular could increase quality and reduce the cost of health care,” said Jha. “However, despite the potential importance of EHRs, there is a surprising lack of consensus about just how prevalent -- or, more accurately, just how rare -- they are in the current health care system.”

Jha and his coauthors cite two reasons for this confusion. First, there is no current standard regarding the meaning of EHR adoption in terms of capabilities or functionalities, and second, there is no unified approach to the measurement of EHR adoption. Prior studies have registered different estimates, the researchers say, but “it is unclear whether the differences can be attributed to different design methodologies or to different ways of defining the function and use of technology.”

To clear up the confusion, Jha’s team undertook a systematic review of the literature with the goal of answering three questions: (1) What is the overall level of EHR adoption by physicians and hospitals; (2) do adoption rates vary by provider type -- for example, solo versus large physician practices -- or by clinical context, such as ambulatory versus hospital care; and (3) what is the EHR adoption level “among providers who disproportionately care for minorities and other underserved patients?”

Data Lacking On Adoption Of
EHRs By Safety-Net Providers

Jha and coauthors identified 36 relevant surveys conducted between 1995 and 2005 but were able to obtain the survey instrument and complete results for only 22 of these surveys. The researchers focused their analysis on surveys that they rated at least “high” or “medium” in both methodology and content. Generally, high-quality surveys were those with representative  sampling, high response rates, and precise definitions of EHR.

“Although there is no universally accepted definition of EHR, consensus is emerging that electronic documentation of providers’ notes, electronic viewing of laboratory and radiology results, and electronic prescribing … are key components of an EHR,” Jha and coauthors write. “These are some of the elements identified by the Institute of Medicine (IOM) in its recent report on the features of EHR systems.”

The findings by Jha’s team include the following:

-- According to 2005 version of the National Ambulatory Medical Care Survey -- an annual, government-funded, nationally representative survey of all ambulatory visits to physicians whose practices are not hospital-based -- 23.9 percent of physicians were using an EHR. However, only 9 percent of physicians were using an EHR with at least four of the functionalities identified as key by the IOM.

-- EHR use varies substantially by practice size. For example, a 2003 Commonwealth Fund survey found that 13 percent of physicians in solo practices used EHRs “occasionally,” as compared with 57 percent of physicians in groups of 50 or more.

-- There was a lack of data on the adoption and use of EHRs among safety-net providers. What evidence there is suggests that safety-net hospitals use less health IT than other hospitals.

Jha and coauthors offer several recommendations for future measurements of EHR adoption and use, including standardizing study methodologies and standardizing the definition of EHR using criteria advanced by the IOM and other organizations. They also urge greater attention to EHR adoption by safety-net providers and others who care for underserved populations. Given the potential of EHRs to improve quality, “ensuring access to these tools among all providers is critical to reducing disparities in health care,” Jha and coauthors state.
The article by Jha and coauthors can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w496



Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2006 Project HOPE–The People-to-People Health Foundation, Inc.