When it comes to the adoption of electronic health records, it’s good to be urban, large, and teach.

According to the latest report on EHR adoption, Health Information Technology in the United States: On the Cusp of Change, 2009, fewer than 2% of American hospitals used a comprehensive electronic health record (EHR) in 2008, 7.6% had a “basic” EHR based on the definition generated by an expert panel conducted by the Robert Wood Johnson Foundation, the Massachusetts General Hospital, and the George Washington University — the team that developed this full report on the state of EHRs in U.S. hospitals.

The most common applications instituted in hospital EHRs included laboratory results (77%), radiology reports (78%) and images (78%). About 1 in 5 U.S. hospitals used computerized order entry and clinical decision support.

The most significant barrier to EHR adoption was found to be financial — 70% of hospitals reported that inadequate capital kept them from acquiring and implementing EHRs. Other barriers cited by about 1 in 3 hospitals included physician resistance, unclear ROI, maintenance costs, and access to IT staff.

One of hte most intriguing findings in this survey was found among hospitals serving the poor, known as “disproportionate share hospitals” (abbreviated “DSH”). These are the safety-net hospitals in the U.S. that serve more people funded by Medicaid. Among DSH hospitals that used EHRs, there was not obvious difference in the quality of care delivered. The researchers conclude, based on this statistics, that the presence of an EHR mitigated that expected negative effect of a high DSH index.

Health Populi’s Hot Points: Since the overwhelming barrier to implementing EHRs is financial, based on this survey of American hospitals, the EHR funding included in the ARRA stimulus package holds tremendous promise — and inspires great expectations. This survey found that a minority of U.S. hospitals has implemented comprehensive EHRs. It is in the implementation of all aspects of EHRs where real impacts on clinical quality are made. Adopting a few modules that make up bits of EHRs doesn’t result in greatly different outcomes overall.

The subtitle of this report is, “On the Cusp of Change.” That cusp will have a pretty long tail given the low-penetration of fully implemented EHRs in American hospitals. The stimulus funding was a must-do to get EHR adoption rolling based on what RWJF et. al. have found in this important work.

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