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A study published in the New England Journal of Medicine suggests that only a small number of U.S. hospitals have implemented comprehensive electronic health record (EHR) systems, the Wall Street Journal reports. Supported by the U.S. Department of Health and Human Services (HHS) and the Robert Wood Johnson Foundation, a researcher from the Harvard School of Public Health and colleagues between March and September 2008 surveyed 2,952 nonfederal U.S. hospitals about their EHR systems. For the purposes of the study, the researchers defined comprehensive EHRs as those that involve all clinical units in the hospital and include 24 separate functions in four categories, including test and imaging results, computerized order entry, clinical documentation and decision support. Meanwhile, basic EHRs were defined as those that were implemented in at least one unit. According to the data, only 1.5 percent of hospitals had adopted comprehensive EHR systems, while 7.6 percent of hospitals had a basic system capable of recording and storing notes and 10.9 percent had a basic system without the note-keeping function. Moreover, only 17 percent of responding facilities had implemented computerized provider order entry systems for medications. Despite the consensus that EHRs can lead to more efficient, safer and higher-quality care, costs remain a barrier to comprehensive implementation, with 74 percent of respondents citing a lack of capital, 44 percent noting maintenance costs and 32 percent citing unclear return on investment as major reasons for sluggish adoption. Meanwhile, 36 percent of hospitals reported that physician resistance to implementation also hindered adoption. Suggesting possible solutions to spark EHR adoption, the study authors recommend that policy-makers provide financial support for implementation, promote interoperable systems and train information technology (IT) support staff.

In an accompanying editorial, two health IT experts from Children's Hospital Boston caution that the sizable amount of spending earmarked in President Barack Obama's economic stimulus package to spur adoption of current EHR technology could be a "costly policy mistake." Suggesting that existing software platforms are antiquated and burdensome for providers who want to upgrade their systems, the authors suggest that the federal government instead encourage open platform development. Specifically, they note that EHRs should be compatible with new and diverse applications from software innovators in order to advance "a robust health information economy." (Goldstein, Wall Street Journal, 3/26/09 [subscription required]; Lohr, New York Times, 3/26/09 [registration required]; Chang, Associated Press/Washington Post, 3/25/09 [registration required]; Conn, Modern Healthcare, 3/25/09 [subscription required]; RWJF release, 3/25/09; Jha et al., New England Journal of Medicine, 3/25/09 [subscription required]; Mandl and Kohane, New England Journal of Medicine, 3/25/09 [subscription required])