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OBSERVATIONS - july 25, 2008

Health IT Tipping Point? Not Yet.

The health care industry has yet to reach the tipping point of electronic health record adoption necessary to realize the promise and potential of health IT.  That's the conclusion I draw from the results of a national survey of nearly 2,800 physicians published last month in the New England Journal of Medicine (N ENGL J Med 359:1 www.nejm.org, June 18, 2008).

The study by Massachusetts General Hospital’s Institute for Health Policy assessed physicians’ adoption of outpatient electronic health records between September 2007 and March 2008.  Study findings include:

  • Only 17% of physicians in ambulatory care have access to an electronic health record--four percent of respondents reported having a fully functional electronic records system, and 13% reported having a basic system. 
  • Among the 83% of respondents who did not have electronic health records, 16% reported that their practice had purchased but not yet implemented such a system at the time of the survey. 
  • An additional 26% of respondents said that their practice intended to purchase an electronic records system within the next 2 years.
  • Physicians who practice in groups of more than 50 were three times as likely to have a basic electronic-records system and more than four times as likely to have a fully functional electronic-records system as were physicians in groups of 3 or fewer.
  • Electronic records systems were more prevalent among physicians who were younger, worked in large or primary care practices, worked in hospitals or medical centers, and lived in the western region of the United States.

This is the first study of high quality in recent years to put real numbers to what many in the industry knew but couldn't prove.  Electronic health record adoption by US physician practices remains disappointingly low and slow. 

Lack of funding continues to be the number one barrier to EHR implementation.  Among physicians who did not have access to an electronic-records system, the most commonly cited barriers to adoption were capital costs (66%), not finding a system that met their needs (54%), uncertainty about their return on investment (50%), and concern that a system would become obsolete (44%).

Two critical questions come to mind in reflecting on this study: Will current public and private sector initiatives be sufficient to move us where we need to be with health IT adoption over the next several years?  And how can health IT adoption remain in the forefront as the next president is required to make difficult choices among competing national priorities?  These questions are a matter of ongoing debate.

Broad clinical IT adoption can be achieved.  We know this from the experience of countries like the United Kingdom, Australia, New Zealand, and the Netherlands where an overwhelming majority of primary care doctors (90% or more) use ambulatory electronic health records.  While no single factor explains these high health IT adoption rates, each of these nations has made widespread use of health IT a priority—supported by significant investments in infrastructure and incentives.

A new strategic plan from the Department of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) was also published last month.  The plan is intended to guide health IT promotion for the next five years, in the context of the Bush administration’s aggressive goal for most Americans to have access to an electronic medical record by 2014.  To this end, the strategic plan targets 40% of physician offices using certified EHR systems by 2012.  Strategies within the plan to promote broad adoption and ongoing use of health IT, including:

  • removing business barriers and disincentives for providers and delivery system adoption of EHRs,
  • making EHRs easy to buy and implement,
  • increasing value of EHRs through interoperability, clinical decision support, and other technical advances,
  • promoting certified health IT products as critical components and standards of clinical care,
  • developing the workforce for health IT product development and use,
  • minimizing provider liability when using health IT, and
  • removing barriers to treating patients outside of provider offices.  

The national survey of physicians and the ONC strategic plan both underscore that the barriers standing between ambulatory care providers and electronic medical records are real and will not be resolved without sound public policy and progressive public and private sector leadership. 

- Brian Raymond, MPH, Senior Policy Consultant, KP IHP

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