It will take loads of money, key policy changes, collaboration, and a major attitude adjustment among healthcare providers to boost the anemic rate of clinical IT adoption in America, a new study says.
Although these ideas are not new, the findings are backed up by estimates of low uptake from an expert panel that includes national health-IT coordinator David Brailer, M.D., senior Institute of Medicine researcher Janet Corrigan, and Gilad Kuperman, M.D., director of quality informatics at New York-Presbyterian Hospital.
"I like to think of it as a first attempt at a dashboard across the country," says Eric Poon, M.D., a physician researcher at Brigham and Women's Hospital and an instructor at Harvard Medical School.
Poon led a research team from the Harvard Interfaculty Program for Health Systems Improvement (PHSI; http://www.phsi.harvard.edu) that reported its findings in a Jan. 5 article on the BioMed Central Medical Informatics and Decision Making Web site.
PHSI studied care sites in Boston and Denver, interviewing representatives of seven provider segments as well as third-party payers. The institution presented its data in September 2003 to a panel of experts, which developed estimates for health-IT adoption nationally. (Because survey data now are more than two years old, Poon says it is important for there to be ongoing research in this area.)
Technologies with tangible financial benefits such as electronic claims processing and eligibility verification have a much higher rate of adoption than those primarily intended to improve care safety and quality, the study finds.
In the report, the expert panel estimates that just 20 percent of integrated delivery networks and 12 percent of standalone hospitals have inpatient electronic health records, and even fewer have computerized physician order entry. On the ambulatory side, EHR adoption is just 13 percent for IDNs, 9 percent for physician practices, and 7 percent for independent hospitals.
However, 90 percent of IDNs and laboratories have electronic claims systems in place, while pharmacies and payers have adoption rates of 93 percent and 94 percent, respectively, for such technology. Even physician offices are close to 80 percent in this category.
"The payment-driven systems are still far ahead of the quality-driven systems," Poon says. But he senses optimism from the group's observation that payers seem interested in diverting resources to quality-based reimbursement plans.
"Misalignment of incentives is an important barrier to HIT adoption," the report says. "Initial capital expenditures of HIT are high and payers do not directly compensate institutions or providers for its use, or for the resulting higher quality and safer care."
Poon adds that process redesign and standards adoption has to be part of the process. "A tool in isolation is not going to do anything," he cautions.