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Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, June 25, 2008

The New England Journal of Medicine Assesses the Real EHR Use in the USA

The following abstract is from a full article published in last week’s NEJM.

Electronic Health Records in Ambulatory Care — A National Survey of Physicians

Catherine M. DesRoches, Dr.P.H., Eric G. Campbell, Ph.D., Sowmya R. Rao, Ph.D., Karen Donelan, Sc.D., Timothy G. Ferris, M.D., M.P.H., Ashish Jha, M.D., M.P.H., Rainu Kaushal, M.D., M.P.H., Douglas E. Levy, Ph.D., Sara Rosenbaum, J.D., Alexandra E. Shields, Ph.D., and David Blumenthal, M.D., M.P.P.


Background Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption.

Methods In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices.

Results Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.

Conclusions Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.

The Full Text is available (for free) at the URL below.


The study has been warmly received by a number of commentators.

The following long article provides a lot of detail.

EHR access sparse in ambulatory-care environment

By: Joseph Conn / HITS staff writer

Story posted: June 19, 2008 - 5:59 am EDT

The summary report on a comprehensive survey, funded by government and private organizations, of physician adoption of electronic health-record systems finds that after more than four years of federal ballyhoo of health information technology, only 17% of physicians in the ambulatory-care environment have access to an EHR.

Just 4% of physicians in ambulatory care have available a “fully functional” EHR system, including patient-safety features such as drug-drug and drug-allergy alerts and full electronic prescribing.

Anticipating just such a low adoption rate, researchers graded on a curve, giving partial credit to physicians who have something less than the best EHR system in their offices. Another 13% of physicians surveyed have such “basic” EHRs with a minimum set of functions.

Given that 83% of ambulatory-care physicians don’t have an EHR, “the U.S. healthcare system faces major challenges in taking full advantage of EHRs to realize its health goals,” according to an executive summary of the published survey in the June 19 issue of the New England Journal of Medicine. A copy of the full report should be released July 2.

The survey was conducted between September 2007 and March 2008 by the Institute for Health Policy at Massachusetts General Hospital, Boston, the Harvard School of Public Health, George Washington University and RTI International, working under a contract with the Office of the National Coordinator for Health Information Technology at HHS. The initial contract was awarded in 2005 to develop a standardized methodology to measure the rate of adoption of EHRs among physicians and hospitals.
More here:


There is additional Coverage here:

'Full function' EHRs may not get full CMS incentives

By: Joseph Conn / HITS staff writer

Story posted: June 20, 2008 - 5:59 am EDT

Only 4% of U.S. physicians in ambulatory care have access to an advanced, "fully functional" electronic health-record system, but even those top-tier systems may not be fully featured enough to qualify for maximum payments under the new CMS pilot program to boost EHR adoption.

Still, most healthcare information technology experts contacted for this story reacted favorably to the release of the executive summary of what may be the most authoritative and methodologically solid study of EHR use to date.

The summary was published in the New England Journal of Medicine. The survey work was conducted under two $600,000 grants from the Robert Wood Johnson Foundation and another $3.6 million grant from the Office of the National Coordinator for Health Information Technology at HHS, the latter of which paid for both the ambulatory-care EHR survey and a separate hospital IT survey that is yet to be completed. A final report on the ambulatory survey is due July 2.

The survey of 2,758 physicians was conducted between September 2007 and March 2008 by the Institute for Health Policy at 902-bed Massachusetts General Hospital, Boston, the Harvard School of Public Health, George Washington University and RTI International.

See full article here:


The New York Times also covered the report.



Most Doctors Aren’t Using Electronic Health Records

A very important aspect of these studies is that a methodology has been developed that really assesses the quality and depth of the EHR being used. This is clear recognition of the fact that it is only when the more advanced forms of functionality are not only present, but actually used, will the hoped for benefits and improvements in care quality be achieved.

It would be invaluable if such a detailed study were carried out in Australia.

I look forward to the full paper on July 2.


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