In the most comprehensive study to date that reliably measures the state of electronic health record (EHR) use by doctors and hospitals, researchers from Massachusetts General Hospital (MGH) and George Washington University (GWU) estimate that one in four doctors (24.9 percent) use EHRs to improve how they deliver care to patients. However, less than one in 10 are using what experts define as a "fully operational" system that collects patient information, displays test results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions.

Health Information Technology in the United States: The Information Base for Progress is a joint project of the Robert Wood Johnson Foundation and the federal government's National Coordinator for Health Information Technology. The report provides a look at how doctors and hospitals are using information systems to drive improvements in quality. It shows that EHR adoption rates remain very low due to multiple financial, technical and legal barriers. The report authors say these barriers will need to be lifted if the health sector is to meet President Bush's desired goal of ensuring that most Americans have their medical information collected, stored, and organized in an EHR by 2014.

"We are pitifully behind where we should be. We must find ways to get more physicians to embrace this technology if we are to make major strides in improving health care quality," says study co-author David Blumenthal, M.D., director, Institute for Health Policy, MGH/Partners. Blumenthal's team co-authored the report with researchers at GWU's Department of Health Policy and the Harvard School of Public Health. A companion article highlighting key findings of the report appears in today's Web edition of the journal Health Affairs.

The report was commissioned to set a benchmark for where the U.S. stands on EHR adoption. It reflects one year of examination of dozens of studies and surveys by some of the nation's leading experts on health IT and illustrates the EHR adoption environment among physicians and hospitals, what predicts whether or not a provider will adopt an EHR, where the gaps in adoption are, how much adoption depends on location, practice size, specialty, or kinds of patients treated; and how the U.S. can collect more precise and timely data on adoption to better enlighten policymakers.

"Electronic health records hold a lot of promise but we need to find ways to spur wider use," says John Lumpkin, M.D., Senior Vice President and Health Care Group Director of the RWJF. "While it is still very difficult to get a precise estimate of the national rate of EHR adoption, this report should serve as a strong basis for policies that address the important barriers to adoption and help close important gaps and disparities."

Some of the key highlights of the report:

• Hospital adoption trends are unknown. Assertions to the contrary, there are not enough high-quality, reliable surveys of hospital use of EHRs. The research team reliably estimates, however, that about 5 percent of America's 6,000 hospitals have adopted computerized physician order entry (CPOE) systems, a component of EHRs, to help reduce medical errors and ease care delivery.
• There is no evidence yet of a digital divide. There remains "considerable uncertainty" about the existence and size of gaps in use of EHRs among physicians who care for vulnerable populations. Tracking the adoption and use of EHRs among these providers, understanding unique barriers to adoption, and identifying policies to close this gap are important steps. The study did find that patient characteristics matter, however. Physicians who treat fewer Medicaid patients are more likely to report using EHRs than those with a larger share of practice revenue from the insurance program.
• A better definition of EHRs is essential. There really is no standard definition of what an EHR is and what adoption means. Consequently, a lot is left to interpretation when surveys are conducted. The report says that the U.S. could more adequately measure EHR adoption trends over time if there was a consistency in terminology and survey methods related to adoption practices.
• Adoption depends on many factors. The report points to four key things that drive adoption: financial incentives and barriers, laws and regulations, the state of the technology and organizational influences such as the size of a practice or hospital or payer mix; and how integrated a health care system is.

Copies of Health Information Technology in the United States: The Information Base for Progress are available at www.rwjf.org.

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The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. By helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in our lifetime.

The Institute for Health Policy (IHP) at Massachusetts General Hospital (MGH) and Partners Health System is dedicated to conducting world-class research on the central health care issues of our time. The mission of the IHP is to improve the health and health care of the American people through conducting health policy and health services research, translating new healthcare knowledge into practice, informing and influencing public policy, and training scholars and practitioners of health policy.

The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high quality medical care in the Washington, DC metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation's capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.