Less than 11% of U.S. hospitals have a "basic" electronic health record system operating in at least one major clinic unit, study results showed.
A smaller percentage of hospitals have a "comprehensive" EHR system operating in all major clinical units, the survey found (N. Engl. J. Med. 2009;360:1628-38).
The findings shed light on the use of health information technology at a time when the federal government is directing billions of dollars in incentives to physicians and hospitals to begin using those systems to improve quality and cut costs.
The results are based on a 2008 survey of nearly 3,000 nonfederal acute care general hospitals in the United States.
About 1.5% of hospitals met the definition of a comprehensive EHR system, meaning that they have implemented 24 functions--such as clinical documentation, test and imaging results, computerized provider-order entry, and decision support elements--across all major clinical units in the hospital.
Basic EHR systems, on the other hand, are defined as having at least eight functions that had been implemented in at least one major clinical unit in the hospital. Those systems do not include clinical decision support and have fewer results-viewing features and computerized order entry functions than do the comprehensive systems. About 7.6% of hospitals have a basic system that includes functionalities to allow for physician notes and nursing assessments, and 10.9% of hospitals have a basic system that does not include clinician notes.
The comprehensive record definition should serve as a goal for all hospitals, while the basic system standard represents the minimum level of functionality needed to help clinicians improve quality of care for patients, said Dr. Ashish Jha of the Harvard School of Public Health, Boston, and the lead author of the study.
Despite the low rates of adoption of full EHR systems, there is some good news in the survey, Dr. Jha said. Some key functions, such as computerized provider-order entry and test and imaging results-viewing functions, are being used at higher rates than the overall adoption figures reflect. For example, computerized provider-order entry for medications has been implemented across all clinical units in 17% of hospitals. And more than 75% of hospitals reported implementing electronic laboratory and radiologic reporting systems in all clinical areas.
"That suggests that we have a good place to start," Dr. …