By Gabriel Perna: Subscribe to Gabriel's RSS feed
August 26, 2010 9:20 PM EDT
Despite government incentives and a strong political push, the transformation from paper to electronic records in U.S. hospitals has moved slowly, according to a recent study.
According to researchers at the Harvard School of Public Health (HSPH), the number of all hospitals with electronic health records only increased from 8.7 percent in 2008 to 11.9 percent in 2009. Even worse, only two percent met the federal government's "meaningful use" standard to qualify for government incentives.
Ashish Jha, lead author and associate professor of Health Policy and Management at HSPH, said money is the biggest problem for hospitals when it comes to e-records. Quite simply, they don't have enough to pay for a costly implementation.
"For small or medium size hospitals, the bill could run between $5-10 million. For large hospitals, it's about $100 million," Jha said. "From a pure cash standpoint, records are expensive."
While the federal government did put e-record incentives in place as part of the 2009 American Recovery and Reinvestment Act, Jha says they are not enough to push hospitals towards e-records at an accelerated rate. As part of the incentive, hospitals must show "meaningful use" of e-records to warrant financial assistance. This includes 14 core functions.
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"The incentives exist, but the bar is set really high for meeting them," Jha said. "And while the money is not trivial, it wouldn't be fully cost effective. Given the times and the fact most hospitals are running on tight margins as is and access to capital is not always easy, hospitals are moving slowly."
Jha says the slow implementation is also because hospitals say swapping out legacy systems and making them electronic is disruptive to everyday care. "It's like my colleague says, it'd be like swapping out a jet engine on a plane in mid-flight. A hospital just can't shut down. You still have to run the hospital while tearing out the guts," Jha said.
While the problem is bad in large, urban hospitals, it's even worse in rural medical centers. Jha said rural hospitals are less likely to have e-records and will likely fall behind their big city and university counterparts as the years go by.
However even with the challenges of implementing e-records in hospitals, Jha says it's critical for the future of the medical industry. He says paper based medical records are antiquated and can cause problems.
"We know from good evidence, study after study, medical errors are common in hospitals and the bottom line is paper based records are part of the problem. In what other part of the economy are most transactions still done on paper? Everything is done electronically," Jha said.
The study, conducted from 2009-09, asked 4,493 acute-care non-federal hospitals about their health information technology efforts and got 3,101 responses.
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