Beacon Partners surveyed 168 health care organizations on the status of their EHR adoption. (EHR Survey) These hospitals said patient care improvement was the main reason for their adoptions of EHRs. Almost all the organizations reported that they did not have a comprehensive EHR system in place, although most are working on one. The biggest problems reported in moving to an EHR are cost and other internal resources to work on the project. Many EHRs are not in compliance with various standards and certifications and hospitals are concerned about the effort required to meet evolving criteria and to meet the meaningful use definition. Most hospitals with EHRs weren’t sure if they improved patient satisfaction. The survey’s results are consistent with other research indicating modest progress at best in getting widespread implementation of EHRs.
The General Accounting Office issued a report on use of EHRs to share health information and any impact of that sharing on quality. (GAO Report) This report is largely anecdotal; not a statistical study. The report was required under the HITECH provisions of the stimulus bill, supposedly to help Congress monitor the growing use of EHRs. The GAO examined four health information exchanges and providers actively using those exchanges. The report discusses the history of health information exchange efforts, the security and privacy issues related to their use and how the case study exchanges deal with those issues. One is left with the impression that the GAO thinks more could be done in the area of explicit patient consent and ability to correct records. There seems to be a lack of appreciation that all the cost and expense that goes into the privacy requirements is itself a substantial barrier to greater use of EHRs and exchanges. The report concludes by giving some examples of how sharing data through an exchange has improved quality.
England is supposedly the poster child for use of health information technology to improve performance of the system. England has both national health insurance and public ownership of physician practices and hospitals. For years the country has been embarked on a very expensive project to convert everything to electronic medical records. As one might expect for any government project in any country, this one is over-budget and very late in meeting timelines. Several contractors have been fired or have quit along the way, including some large vendors. Now the London Times reports that budget pressures may force cancellation of the entire effort. (EHR Article) This is another warning for the United States not to underestimate the difficulty in getting working, usable EHRs across the entire system. If Great Britain’s government run system can’t get it done, it’s not going to be an easier in our balkanized one.