Slowpokes

With computers that can understand language and beat us in Jeopardy!, it is easy to imagine how technology could revolutionize an industry like healthcare. Moving from paper to electronic record keeping is a necessary first step in unlocking the potential of technology.

For all the public enthusiasm, however, not everyone is excited about the new digital future.  A new study finds that, despite major federal initiatives, small and rural hospitals as well as those without teaching programs have struggled (or refused) to take meaningful steps toward the implementation of Electronic Health Record systems (EHRs).

Since taking office, the Obama administration has made adoption of EHRs a major front in the battle to cut costs and improve the quality of care in the U.S. The 2009 American Recovery and Reinvestment Act contained billions of dollars in incentives to encourage hospitals to adopt EHRs. Requirements in the the administration’s signature health care initiative, the Affordable Care Act, took a different approach.  Under the law, hospitals without EHRs may face penalties or be ineligible for new forms of payment.

Using survey results from 2,646 general medical and surgical hospitals, authors DesRoches, Worzala, Joshi, Kralovec, and Jha examine the pace of EHR adoption in the U.S. While the proportion of hospitals with a basic EHR system rose from 15.1% in 2010 to 26.6% in 2011, the proportion of hospitals with a comprehensive system had reached only 8.7% (from an earlier rate of 3.6%).  Disturbingly, the EHR elements most hospitals have failed to implement are potentially the most important, such as drug-allergy checks and calculations of quality measures.

The authors note that a clear subset of hospitals – those in rural areas and those with small staff and no students – have made the least progress toward adoption of EHRs.  In 2011, only 19% of rural hospitals had a basic EHR system, while the rate among urban hospitals was 29%.  Only 21% of small hospitals had a basic EHR system, compared with 43% of large hospitals.

Current efforts to encourage meaningful EHR adoption are clearly having some impact, but progress remains uneven.  A national shortage of trained health information technology professionals could be one factor slowing the pace of change. The authors note:

The meaningful-use program has greatly increased demand for high-quality vendors of EHR systems and has strained market capacity.  Small hospitals with limited access to capital may have a hard time competing with large, urban facilities in this marketplace.

To reach the digital future, current policymakers need to think creatively about how to address the special needs of hospitals that continue to struggle.  At present, most efforts are designed to help hospitals improve their EHR systems.  DesRoches, Worzala, Joshi, Kralovec, and Jha suggest that we might need to take a step back and consider a new approach for hospitals with no existing EHR systems.