US: Health Information and Communications Technologies

“The adoption of these systems has been slow in the United States. In 2007, 34.8% of office-based physicians used at least one EHR [Electronic Health Record] component in their office but only 12% of physician EHRs met the criteria for having a basic system and only 4% met the criteria for having fully functional systems (Hing & Hsiao, 2010). Multi-specialty and larger physician offices (11 or more physicians) were more likely to adopt EHRs, whereas physicians in solo or single-specialty offices were the least likely. Offices run by older physicians were also less likely to adopt EHRs. A 2007 estimate put the percentage of physicians using some type of EHR in 2010 at close to 54% (Hing & Hsiao, 2010).

“In 2008 only a small percentage of hospitals (1.5%) had a comprehensive EHR system in all clinical units (Jha et al., 2009). A slightly larger percentage (7.6–10.9%) of hospitals had a basic EHR system in at least one clinical unit. An examination of the types of function adopted by hospitals reveals that in 2008 over 75% of United States hospitals had electronic laboratory and radiological reporting systems, 44% had electronic physician notes in at least one unit, and 38% had computerized provider-order entry (CPOE) in at least one unit. However, only 12% of hospitals had electronic physician notes across all units in the hospital, while only 17% had a CPOE system for medications across all units. Thirty-six per cent of hospitals had electronic nursing documentation in all units.”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2013; 15(3): 1– 431.
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
http://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/united-states-of-america-hit-2013

“Information regarding the adoption of EHRs [Electronic Health Records] in nursing homes is inconsistent but estimates put implementation at 18–47%, with 16–48% having CPOE (Kramer et al., 2010). In 2007, about 41% of home health and hospice organizations had EHRs and an additional 15% planned to have EHRs within the next year (Bercovitz, Sengupta & Jamison, 2010). Of the home health and hospice organizations with EHRs, 98% used components for recording patient demographics, 83% used clinical notes, and over half used clinical decision-support systems or computerized physician-order entry. EHRs are used extensively in free-standing dialysis facilities, particularly in large for-profit dialysis chains. All the five largest dialysis chains use EHRs (Kochevar et al., 2011). Even many small dialysis facilities use EHRs (around 61% in 2010).

“Most EHRs at the time of writing are actually EMRs [Electronic Medical Records], that is, they are not interoperable between different providers. Health-care policy aims at eventually developing this interoperability but progress is slow due to the difficulty in linking numerous proprietary systems, and issues regarding privacy and security. This next stage in HIT is discussed in the subsection on regional HITs below.”

“A few large health-care systems have achieved EHRs that are interoperable between providers within the same health-care system. The VHA [Veterans Health Administration] – the largest integrated health-care system in the United States – is an example. The VHA has developed an HIT system called the Veterans Health Information Systems and Technology Architecture (VistA) that is capable of interconnectivity between all providers within the VHA system (Byrne et al., 2010). Since 2004 the VHA has achieved close to 100% adoption of several VistA components, including inpatient and outpatient EHRs, bar code medication administration and CPOE.

“Another example is Kaiser Permanente, the largest non-profit integrated health-care system in the United States, with 8.7 million members in eight regions (Chen et al., 2009). Kaiser Permanente provides group health insurance, outpatient care such as primary and specialty care, testing, imaging and pharmaceuticals, and inpatient hospital care. Kaiser implemented a system-wide EHR – HealthConnect – in 2004. The EHR provides clinical documentation and decision support across care settings, and real-time connectivity to testing, imaging, pharmacy and other ancillary systems (Chen et al., 2009).”

“Several large integrated health-care systems offer PHRs [Personal Health Records]. The VHA has developed MyHealthVet (Kahn, Aulakh & Bosworth, 2009). The PHR supports appointment scheduling, medication requests and other services. Kaiser Permanente, the Cambridge Health Alliance and other providers offer PHRs through the Epic system.

“Even non-health-care companies are entering the PHR business. From 2008 to 2011 Google offered PHR services through an internet site called Google Health (Kahn, Aulakh & Bosworth, 2009). In 2007 Microsoft established HealthVault, a web-based PHR (Kahn, Aulakh & Bosworth, 2009). With these online and personal computer-based tools, patients can develop their PHRs through the internet and their home computers without having to access other technologies.

“The interconnectivity and portability of PHRs are positive features but these very features make it difficult to progress in PHR development. Getting data from a patient’s various providers (each of which may use a different HIT) into a standardized and centralized data warehouse is a level of technology that is underdeveloped at this time (Kahn, Aulakh & Bosworth, 2009). At the same time, privacy issues involved in data access and transfers are major concerns.”

“In 2009, the United States had 75 functioning RHIOs [Regional Health Information Organizations] covering approximately 14% of hospitals and 3% of ambulatory practices (Adler-Milstein, Bates & Jha, 2011a). None of these was fully functioning in the sense of including all providers in the full sharing of patient records and other health information. Instead, most connected hospitals with ambulatory care practices focused on sharing test results. In 2009, 17% of the 75 functioning RHIOs covered 3% of hospitals and 9% of ambulatory practices in the area.

“Underfunding, privacy and proprietary issues are major barriers to the development of RHIOs. Many RHIOs fail due to lack of funding. In 2009 over 67% of RHIOs did not meet criteria for financial viability (Adler-Milstein, Bates & Jha, 2011a). Privacy issues are the same ones that plague EHRs: how to share patient information securely. Proprietary issues involve the disadvantages of sharing information with competitors. Providers state that if they share information about patients with competitors they could lose their competitive edge with those patients (Adler-Milstein, DesRoches & Jha, 2011b).”

“Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country — essential when life-and-death decisions are being made in the ER.

“But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment. KHN and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR [Electronic Health Records] vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it.”

Source: Death By 1,000 Clicks: Where Electronic Health Records Went Wrong, Fred Schulte and Erika Fry, Fortune, March 18, 2019.
https://khn.org/news/death-by-a-thousand-clicks/

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Dec. 12, 2020 by Doug McVay, Editor.